The "All Cases" Lung Cancer Diagnosis and Treatment Practice Sharing Project was staged in the divisional final, directly hitting the forefront of SCLC immunotherapy!

*For medical professionals only

Leaders in the field gathered together to share classic lung cancer diagnosis and treatment cases and discuss the way of lung cancer immunotherapy!

Lung cancer is the first malignant tumor in China's annual incidence and death, of which small cell lung cancer (SCLC) accounts for about 15% of all lung cancer, and has a high degree of malignancy, easy to recur, very poor prognosis characteristics, patients urgently need effective treatment to improve the prognosis, and in recent years immunotherapy combined with chemotherapy, has become the first-line treatment plan for extensive SCLC, has been widely used and highly recognized in clinical practice in China, so that immunotherapy has comprehensively rewritten the diagnosis and treatment pattern of SCLC
。

In order to further comprehensively promote the in-depth development of lung cancer treatment in China and improve the level of SCLC immunotherapy and standardized diagnosis and treatment through exchanges and collaboration, the "All Cases" lung cancer diagnosis and treatment practice sharing project sponsored by the China Medical and Health Development Foundation has carried out wonderful academic exchanges and discussions
throughout the country in the form of sharing real cases of lung cancer diagnosis and treatment from the clinical frontline.

After several rounds of preliminary selection and fierce competition, on November 13, 2022, the finals of the "East District" and "Central District" of the "All Cases" lung cancer diagnosis and treatment practice sharing project came on the same day.

Professor Han Baohui of Shanghai Jiao Tong University Chest Hospital, Professor Zhou Jianying of the First Affiliated Hospital of Zhejiang University School of Medicine, and Professor Gao Beili of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine co-chaired the "East Zone" final.
In order to continuously improve the long-term survival and quality of life of lung cancer patients, we will contribute
to turning lung cancer, especially advanced lung cancer, into a chronic disease.

Figure 1: Professor Han Po Hui's opening remarks

Figure 2: Professor Zhou Jianying gave the opening speech

Professor Wang Baocheng of the 960th Hospital of the People's Liberation Army and Professor Shu Yongqian of Jiangsu Provincial People's Hospital, as the chairmen of the "Central District" final, also pointed out in their opening speeches that in order to achieve the important goal of increasing the overall 5-year survival rate of cancer by 15% by 2030 in the "Healthy China 2030" strategy, it is necessary to effectively improve the diagnosis and treatment level of lung cancer.
So that each patient can get the most accurate diagnosis and receive the most standardized, individualized, safe and efficient treatment
.

Figure 3: Professor Wang Baocheng made an opening speech

Figure 4: Professor Shu Yongqian gave his opening speech

A total of 6 contestants participated in each of the divisional finals of the "All Cases" lung cancer diagnosis and treatment practice sharing project, and the contestants took the stage in turn to share their own cases, and conducted practical questions and answers on 1 case randomly selected from the pool of high-quality cases prepared by the conference, showing the participants' lung cancer immunotherapy skills, and the expert jury synthesized the two parts of case explanation and on-the-spot answering to score the contestants and judge various awards.

Highlights of the "East Zone" final

The 6 contestants who participated in the East Zone finals were: Professor Bao Zhang and Professor Yao Yinan of the First Affiliated Hospital of Zhejiang University School of Medicine, Professor Shen Shengping and Professor Zhao Lei of the Chest Hospital Affiliated to Shanghai Jiao Tong University, Professor Zhong Min of the First Affiliated Hospital of Nanchang University, Professor Zhou Qinfei of Zhejiang Cancer Hospital, the sharing of the 6 contestants all revolved around the immunotherapy of real-world SCLC, and finally Professor Bao Chang from the First Affiliated Hospital of Zhejiang University School of Medicine performed well in the self-case sharing and practical Q&A session.
He was unanimously selected by the expert jury as the overall winner
of this final.

The SCLC real-world immunotherapy cases shared by Professor Bao are as follows:

The patient, a 61-year-old male, was admitted to the hospital in November 2020 due to "chest tightness and shortness of breath with cough and sputum for 1 month", the patient had a history of smoking, smoked 30 packs/year, and had quit smoking for 1 year; Lung CT on admission showed that the left lung mass and mediastinal lymphadenopathy, tracheoscopic biopsy sample pathological diagnosis of SCLC, immunohistochemistry: Ckpan(+), P40 (-), Ki-67 (70%), TTF-1 (+), CgA (+), Syn (+), CD56 (+), CD45 (+), preliminary diagnosis was SCLC (cT4N3M0, stage IIIC).

After multidisciplinary discussion, the first-line treatment plan of the patient was determined to be durvalumab + etoposide + carboplatin (EP chemotherapy), and the efficacy was evaluated to achieve partial remission (PR) after 2 cycles of treatment, but after 4 cycles of treatment, the patient developed fatigue, and had immune-related adverse events such as autoimmune thyroiditis, myositis, and increased blood sugar, and the patient stopped the drug by himself; By June 2021, the patient still felt fatigue, so he suspended immunotherapy and reduced the dose of chemotherapy on EP regimen, and the patient felt that he could not tolerate it and did not continue treatment
.

In October 2021, the patient's cough symptoms worsened again, and the chest CT showed that the lesions were significantly enlarged, close to the pre-treatment level, and the progression (PD) of the disease was judged, that is, the progression-free survival (PFS) of first-line treatment with davalumab + EP regimen was 12 months; The second-line treatment used the durvalumab + EP regimen to re-challenge immunity, and PR was reached again, and after 4 cycles of treatment, it was switched to durvalumab monotherapy maintenance therapy, and PD recurred in July 2022, and the PFS of the second-line treatment was 9 months
.
The third-line and fourth-line treatment regimens of patients were duvalumab + albumin-bound paclitaxel and durvalumab + EP regimens, but both developed PD rapidly after 1 month of treatment, and the current fifth-line treatment uses anlotinib monotherapy
.

Summary of the treatment process

The treatment of this patient reflects that immunotherapy represented by durvalumab also has a good effect on limited-stage SCLC (LS-SCLC), and the performance of immunotherapy moved to LS-SCLC, combined with concurrent chemoradiotherapy or as consolidation therapy after concurrent chemoradiotherapy is worth looking forward to
.

Highlights of the "Central Zone" final

Among the 6 contestants of the "Central Region Final", Professor Hu Nana of the First Affiliated Hospital of University of Science and Technology of China, Professor Liu Chengxin of the Affiliated Cancer Hospital of Shandong First Medical University, Professor Qian Yingying of Nanjing First Hospital, Professor Wang Jun of the First Affiliated Hospital of Zhengzhou University, and Professor Xu Shisheng of Qingdao Municipal Hospital all shared SCLC immunotherapy cases, and Professor Yuan Dongmei of the Eastern Theater General Hospital brought a case of inoperable locally advanced non-small cell lung cancer.
However, the actual confirmed case of SCLC concurrent immunotherapy was finally discussed by the expert jury, and Professor Yuan Dongmei of the Eastern Theater General Hospital won the overall championship
of this final.

The case of lung cancer immunotherapy shared by Professor Yuan Dongmei is as follows:

The patient's female, 68 years old, "intermittent cough and sputum production for more than 2 years, diagnosed lung cancer for nearly 1 month" was admitted to the hospital for the first time in August 2020, the patient had intermittent cough in the middle of 2018, coughing up a small amount of white sputum, and the chest CT examination in the local hospital in July 2020 showed that the dorsal segment of the lower lobe of the right lung was massed, and malignant tumors were considered; Pathology of fiber bronchoscopic biopsy: poorly differentiated carcinoma
.
After PET/CT and pathological biopsy consultation in the hospital, the patients were considered to be hypodifferentiated carcinoma of right lower lung, with possible metastasis of right hilar lymph nodes, immunohistochemistry: CK5/6(+), p63 minority (+), CK8(+), CgA (-), CK7 ( +), Ki67 about 30%+, NapsinA(-), P40(-), Syn(-), TTF-1(-), CK5/6( -），PD-L1 10%+； Gene mutations: TP53(+), TMB-H
.

After admission, the patient completed the relevant examinations, and the preliminary diagnosis was: right lung non-small cell lung cancer (T3N2M0, stage IIIB, EGFR/ALK/ROS1 negative, TP53 positive, PD-L1 10%+, TMB-H), after discussion by the multidisciplinary team, albumin-bound paclitaxel + cisplatin chemotherapy was used for 2 cycles, and the efficacy evaluation reached PR, and then robot-assisted right middle and lower lobe lobectomy + lymph node dissection was performed in October 2020.
However, the postoperative pathological biopsy suggested SCLC, and the postoperative adjuvant regimen considered PD-L1 inhibitor + EP chemotherapy
.

Since December 2020, the patient has received 4 cycles of durvalumab + EP regimen, and then received 1 cycle of durvalumab monotherapy maintenance therapy, considering that the pathological biopsy of the patient's metastatic lymph nodes is also SCLC, it is recommended that the patient undergo local radiotherapy, but the review of PET/CT showed that the patient's mediastinal lymph nodes and liver metastases, so TOMO knife radiotherapy (50Gy/10fx) was performed for the above two metastases, and duvalumab maintenance therapy was continued for 2 cycles.
Anlotinib was added to the treatment of liver metastases (2W/1W intermittent therapy), and immunotherapy
was suspended in July 2021 due to the patient's right lung infection.

In September 2021, after the patient's infection was controlled, he re-examined and saw that there were new metastases in the right lobe of the liver, but other lesions in the body were well controlled, and the third-line treatment continued the regimen of divalimumab + anlotinib, and TOMO knife radiotherapy (37.
5Gy/5fx) was performed for the new lesion of the right lobe of the liver, and the patient's condition continued to be controlled, and multiple metastases of the liver were re-examined in July 2022, considering the recurrence of PD, and the fourth-line treatment plan was adjusted to durvalumab + sulfatinib, Patients are continuing to be followed
.

The diagnosis process of this case was tortuous, which brought certain challenges to the multidisciplinary treatment team, but after the pathological diagnosis of SCLC was clarified, the use of durvalumab immunotherapy, combined with radiotherapy, chemotherapy and anti-angiogenic therapy, achieved long-term disease control of the primary lesion and oligometastatic lesion, reflecting the excellent value
of immunotherapy in the treatment of SCLC.

Summary and reflection on the treatment process of this case

Summary of the meeting

The chairmen of the conference spoke highly of this final, and the participants brought detailed and comprehensive case sharing and patient analysis, which fully reflected the standardized level of SCLC immunotherapy, and the overall performance was brilliant, looking forward to resuming offline academic exchanges in the future and further improving the precision treatment level of lung cancer among young and middle-aged clinical workers!