Personalized targeted therapy for esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma continues to heavily burden clinicians worldwide. Researchers have discovered the genomic landscape of esophageal squamous cell carcinoma, which holds promise for an era of personalized oncology care. One of the most pressing problems facing this issue is to improve the understanding of the newly available genomic data, and identify the driver-gene mutations, pathways, and networks. The emergence of a legion of novel targeted agents has generated much hope and hype regarding more potent treatment regimens, but the accuracy of drug selection is still arguable. Other problems, such as cancer heterogeneity, drug resistance, exceptional responders, and side effects, have to be surmounted. Evolving topics in personalized oncology, such as interpretation of genomics data, issues in targeted therapy, research approaches for targeted therapy, and future perspectives, will be discussed in this editorial

Perioperative Toripalimab Plus Chemotherapy for Patients With Resectable Non-Small Cell Lung Cancer: The Neotorch Randomized Clinical Trial

IMPORTANCE: Adjuvant and neoadjuvant immunotherapy have improved clinical outcomes for patients with early-stage non-small cell lung cancer (NSCLC). However, the optimal combination of checkpoint inhibition with chemotherapy remains unknown. OBJECTIVE: To determine whether toripalimab in combination with platinum-based chemotherapy will improve event-free survival and major pathological response in patients with stage II or III resectable NSCLC compared with chemotherapy alone. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled patients with stage II or III resectable NSCLC (without EGFR or ALK alterations for nonsquamous NSCLC) from March 12, 2020, to June 19, 2023, at 50 participating hospitals in China. The data cutoff date for this interim analysis was November 30, 2022. INTERVENTIONS: Patients were randomized in a 1:1 ratio to receive 240 mg of toripalimab or placebo once every 3 weeks combined with platinum-based chemotherapy for 3 cycles before surgery and 1 cycle after surgery, followed by toripalimab only (240 mg) or placebo once every 3 weeks for up to 13 cycles. MAIN OUTCOMES AND MEASURES: The primary outcomes were event-free survival (assessed by the investigators) and the major pathological response rate (assessed by blinded, independent pathological review). The secondary outcomes included the pathological complete response rate (assessed by blinded, independent pathological review) and adverse events. RESULTS: Of the 501 patients randomized, 404 had stage III NSCLC (202 in the toripalimab + chemotherapy group and 202 in the placebo + chemotherapy group) and 97 had stage II NSCLC and were excluded from this interim analysis. The median age was 62 years (IQR, 56-65 years), 92% of patients were male, and the median follow-up was 18.3 months (IQR, 12.7-22.5 months). For the primary outcome of event-free survival, the median length was not estimable (95% CI, 24.4 months-not estimable) in the toripalimab group compared with 15.1 months (95% CI, 10.6-21.9 months) in the placebo group (hazard ratio, 0.40 [95% CI, 0.28-0.57], P \u3c .001). The major pathological response rate (another primary outcome) was 48.5% (95% CI, 41.4%-55.6%) in the toripalimab group compared with 8.4% (95% CI, 5.0%-13.1%) in the placebo group (between-group difference, 40.2% [95% CI, 32.2%-48.1%], P \u3c .001). The pathological complete response rate (secondary outcome) was 24.8% (95% CI, 19.0%-31.3%) in the toripalimab group compared with 1.0% (95% CI, 0.1%-3.5%) in the placebo group (between-group difference, 23.7% [95% CI, 17.6%-29.8%]). The incidence of immune-related adverse events occurred more frequently in the toripalimab group. No unexpected treatment-related toxic effects were identified. The incidence of grade 3 or higher adverse events, fatal adverse events, and adverse events leading to discontinuation of treatment were comparable between the groups. CONCLUSIONS AND RELEVANCE: The addition of toripalimab to perioperative chemotherapy led to a significant improvement in event-free survival for patients with resectable stage III NSCLC and this treatment strategy had a manageable safety profile. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04158440

Take A Calm View on Heat Wave of Organ Preservation in Esophageal Cancer Treatment

The esophagus plays an extremely important physiological function in human body, and esophageal cancer is a highly lethal disease among all the malignancies. Esophagectomy is still the main treatment for locally advanced esophageal cancer. Ensuring the efficacy of oncology plays a crucial role in exploring organ preservation in the treatment of esophageal cancer. We should always be aware of the inherent difficulties and potential harms of organ preservation for esophageal cancer treatment and seek a personalized and reasonable balance between ensuring cure and preserving organs, provide the best treatment design for esophageal cancer patients, to achieve maximum therapeutic effect without sacrificing the life quality of patients

The Conceptual Oligometastatic Non-small Cell Lung Cancer and Therapeutic Strategies

Non-small cell lung cancer (NSCLC) ranks among the most prevalent malignancies and is the major cause of cancer-related deaths worldwide. Nearly 20%-50% will accompany by metastatic disease and the most common extrapulmonary sites of distant metastases are the brain, bone, liver and adrenal gland. The oligometastatic state is a biologically mild tumor stage and a intermediate state in which spread may be limited to specific organs and metastases might be present in limited numbers. Oligometastases are thought to arise from micrometastases, which have been dormant for a period of time. Local control may be an crucial component of a curative therapeutic strategy in the following four clinical schemes: to prohibit metastases; to cure occult metastatic disease; to remedy oligometastases; and to deracinate any residual lesion after systemic therapy. This review aims to outline the concept of the oligometastatic NSCLC and its strategies of treatment

Thymic Tumors Preface

胸腺肿瘤是一类少见疾病，发病仅为0.17/10万，亚裔人种略高于白种人，约0.3-0.4/10万。胸腺瘤研究与投入均较少，诊断与治疗缺乏统一的指南，尤其在术前定性诊断、组织学分型、术前治疗、手术方式、术后治疗以及对术后复发的治疗等一系列问题上均处于不规范状态。很多医生也对该疾病的治疗经验有限，而且研究进展缓慢，但是对于患者和家属，这是不可接受的理由。2003年美国患者Barbara Neibauer身患胸腺肿瘤，虽经积极的治疗，但仍于两年后去世。Barbara Neibauer去世后，为促进胸腺瘤的研究，其家族出资于2005年成立了全球首个关于胸腺肿瘤的基金会即FTCR（Foundation for Thymic Cancer Research）。2010年5月5日由美国NIH （National Institutes of Health）牵头，在FTCR的基础上于纽约成立了专业胸腺肿瘤学术组织，即ITMIG （International Thymic Malignacy Interest Group）。随后，日本也成立了相应的胸腺肿瘤学术组织即JART（Japanese Association for Research on the hTymus）。2012年6月由方文涛、陈克能等教授发起，在上海成立了中国胸腺肿瘤协作组（ChART），并与JART一同加入到ITMIG。PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)0273-741