​This factor may affect the efficacy of immunotherapy?

*Only for medical professionals to read and refer to what "Zhongshan characteristics" will this Zhongshan Lung Cancer Forum bring? From October 8th to October 10th, 2021, the 7th Zhongshan Lung Cancer Forum was successfully held in Shanghai.
During this period, the "Medical Oncology Channel" set up a special site for famous doctors Kung Fu tea, and invited the chairman of the conference-Professor Zhang Xin, Zhongshan Hospital, Fudan University Discussed and shared issues related to intestinal flora and lung cancer immunotherapy
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Solid scientific research results sharing, exploring the unknown.
"The relevant topics shared by the Zhongshan Lung Cancer Forum include the relationship between EGFR mutation abundance and efficacy, the relationship between tumor heterogeneity and lung cancer treatment, as well as bronchoscopy and genetic testing.
Discussion high accuracy
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research never stop, many studies have shown that there is a certain relationship between the intestinal flora and lung cancer immunotherapy, but many doctors still lack systematic understanding of it, our team is conducting joint research with the Department of Gastroenterology
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the The forum will focus on sharing and discussing the essence of relevant scientific research
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"Professor Zhang Xin said when referring to the original intention of the forum topic sharing
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Everything is ready, only the wind is owed.
Patient recognition is the biggest motivation.
The fundamental purpose of research is to apply to clinical practice
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In February of this year, Science released a phase I clinical study, the results showed that fecal microbiota transplantation (FMT) can improve the resistance of melanoma patients to PD-1 monoclonal antibody
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Another study also published on Science showed that FMT combined with PD-1 monoclonal antibody treatment can benefit patients with melanoma who are resistant to PD-1 monoclonal antibody
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These scientific results are amazing and provide guidance for the follow-up research on intestinal flora and immunotherapy
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"In 2015, it was first discovered that intestinal flora can affect the efficacy of immune checkpoint inhibitors against tumors; a clinical study in 2018 found that the use of antibiotics within 30 days before the start of tumor immunotherapy significantly shortens the progression-free survival (PFS) and overall survival (OS)
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A number of other important studies have confirmed that tumor patients with high microbial flora diversity receive better immune checkpoint inhibitor therapy
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Inspired by related research and reports on the relationship between immunotherapy and intestinal flora , Our team and the gastroenterology team decided to carry out the corresponding phase I study
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The
initial stage of the research was more focused on safety and preliminary efficacy
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Unlike other previous studies, the research force jointly carried out by our team and the gastroenterology team is not small The direction of immunotherapy for cell lung cancer (NSCLC)
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"Professor Zhang Xin talked about a study on intestinal flora jointly carried out by the two teams
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It is worth mentioning that the research on intestinal flora carried out by Professor Zhang Xin’s team and the team of the Department of Gastroenterology, Zhongshan Hospital, Fudan University has some special features.
The first-line treatment of lung cancer patients usually adopts combination treatment schemes, such as the combination of chemotherapy and immunotherapy
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Therefore, the design of this study takes this situation into consideration and conforms to the general trend of combination therapy
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In addition, the patients included in previous related studies are selective and may It is a group of patients who are effective for immunotherapy
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The research conducted this time uses healthy people as an exploration point
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We extract healthy intestinal flora through a comprehensive physical examination of college students
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At first, I was worried that clinical patients would not accept FMT as a treatment method.
What is gratifying is that many patients accept and approve of the treatment
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This also gives researchers and clinicians more motivation and encouragement to carry out follow-up research
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"It seems irrelevant, but the impact is far-reaching.
Intestinal flora exists in large numbers in the human body.
As related research continues to deepen, researchers have found that some diseases are closely related to intestinal flora
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Past studies have found that Alzheimer’s, pediatric hyperactivity, etc.
There is a certain connection between diseases and intestinal flora
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Professor Zhang Xin analyzed the reasons why lung cancer and many other diseases are related to intestinal flora: "The correlation is unknown, and it is bound to arouse heated discussions and strong responses.

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Lung cancer and intestinal flora seem to be difficult to associate, but in recent years, immunotherapy has developed in a blowout pattern.
A large number of patients with lung cancer use immunotherapy.
Therefore, from basic research to clinical research, a series of studies have shown that intestinal flora and lung cancer The side effects of immunotherapy and even the reversal of drug resistance are closely related
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"On the way to study the relationship between lung cancer immunotherapy and intestinal flora, the impressive study includes an animal study.
In this study, the researchers used antibiotics to empty the intestinal flora in the animal's body, and then gave Immune checkpoint inhibitors
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Unexpectedly, the experimental animals are almost completely resistant
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Researchers began to analyze previous relevant clinical studies to determine whether the use of antibiotics affects the efficacy of lung cancer immunotherapy
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"After in-depth research and exploration, 2018 A very subversive research conclusion has emerged, that is, within 30 days before immunotherapy, patients who use antibiotics may experience a decline in the effect of immunotherapy
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"Professor Zhang Xin said
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In 2018, a number of studies on the association between lung cancer immunotherapy and intestinal flora have been published
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One of the experiments inoculated animals with beneficial intestinal flora, and the results showed that animal immunotherapy has a better effect
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The method of transplanting the intestinal flora of other individuals to the recipient is also called FMT
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This experiment also proved to a large extent the value of intestinal flora in the prediction and even intervention of the therapeutic effect of immunotherapy
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A number of studies have been published in top medical journals.
A study published in the Nature series of journals suggests that patients with high adverse reactions to dual immunotherapy have found specific intestinal flora.
This means that in the future, it may be possible to manipulate Intestinal microbiota to treat the toxicity of immune combination therapy, while maintaining a strong response to the combination therapy
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 Known as Zhongshan, taking the road of Zhongshan This year is the seventh Zhongshan Lung Cancer Forum.
What new prospects will the Zhongshan Lung Cancer Forum have in the future? Professor Zhang Xin said: "Each forum is dedicated to the dissemination, sharing and collision of new research, new results and new ideas
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Once the
Zhongshan Lung Cancer Forum is named, it must integrate the characteristics of Zhongshan and share Zhongshan’s experience
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It is worth noting that, Our research on liquid biopsy has a deep foundation, especially when the amount of samples from lung cancer driver gene-positive patients is not enough, circulating tumor DNA (ctDNA) liquid biopsy can be performed
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However, the bottleneck of liquid biopsy in the field of advanced lung cancer is also obvious, namely Sensitivity is low
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In the
past, we have made corresponding improvements, such as improving the efficiency of blood testing through the improvement of the kit, in order to increase the positive rate of detection
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"For small lesions that are not easy to reach by bronchoscope, Professor Zhang Xin expressed his personal views and opinions.
Looking forward to: "In addition to obtaining biopsy tissue, you can consider using flushing fluid, followed by a series of methylation and driver gene tests, as a supplement to differential diagnosis and individualized markers
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It is hoped that this new type of liquid biopsy can also provide a new option for patients without histopathological diagnosis
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"Expert profile Professor Zhang Xin, Chief Physician, Doctor of Medicine, Deputy Director of the Department of Pulmonary Tumor and Respiratory Intervention, Zhongshan Hospital Affiliated to Fudan University, Member of the Intervention Group of the Respiratory Branch of the Chinese Medical Association Member of the Standing Committee of the Pulmonary Oncology Committee of the Chinese Medical Education Association Asia Pacific Medicine Executive Director of the Society of Biological Immunology, Deputy Chairman of the Respiratory Tumor Intervention Committee of the Shanghai Anti-Cancer Association Deputy Chairman of the Special Committee of Lung Cancer Molecular Targeting and Immunotherapy of Shanghai Anti-Cancer Association years, has engaged in the research of lung cancer gene diagnosis and gene therapy, in combination with targeted chemotherapy, lung liquid biopsy, magnetic navigation guided lung biopsy, as a sub-center PI participated in several international clinical trials
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senate "practical Internal medicine There are 6 monographs including "Science", and more than 30 papers have been published
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