Combination cyclin-dependent kinase 4/6 inhibitors and endocrine therapy versus endocrine monotherapy for hormonal receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: A systematic review and meta-analysis.

PURPOSE:This meta-analysis aimed to assess the efficacy and safety of cyclin-dependent kinase (CDK) 4/6 inhibitors plus endocrine therapy (ET) in hormonal receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). METHODS:We searched PubMed, Embase, Cochrane, ClinicalTrials.gov., ASCO, ESMO and AACR databases from inception to October 10, 2019 for randomized controlled trials (RCTs) that compared CDK 4/6 inhibitors plus ET to single-agent ET with no treatment-line restriction. The main outcomes analyzed were progression-free survival (PFS), overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), and adverse events (AEs). RESULTS:Of 938 identified studies, 9 RCTs with 5043 women were eligible and included. Compared with ET alone, CDK 4/6 inhibitors and ET combination improved in PFS (hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.50-0.59, p< 0.00001) and OS (HR 0.77, 95% CI 0.69-0.85, p< 0.00001), regardless of ET strategies (HR 0.54, 95% CI 0.50-0.59 in PFS; HR 0.77, 95% CI 0.69-0.85 in OS), treatment line of advanced disease (HR 0.52, 95% CI 0.46-0.59 in PFS; HR 0.75, 95% CI 0.66-0.85 in OS) and menopausal status (HR 0.54, 95% CI 0.50-0.58 in PFS; HR 0.76, 95% CI 0.68-0.84 in OS). Higher risk of grade 3/4 AEs (RR 2.66, 95% CI 2.44-2.90, p < 0.00001) were observed in the combination group than in the ET group. CONCLUSIONS:Combination therapy with CDK 4/6 inhibitors and ET prolongs survival in HR+/ HER2- ABC. This combination is a better therapeutic strategy than endocrine monotherapy in HR+/HER2- ABC, regardless of treatment line, menopausal status and other individual characteristics

Clinicopathological and prognostic significance of chemokine receptor CXCR4 overexpression in patients with esophageal cancer: a meta-analysis

The prognostic significance of CXC chemokine receptor type 4 (CXCR4) for survival of patients with esophageal cancer remains controversial. To investigate its expression impact on clinicopathological features and survival outcome, a meta-analysis was performed. A comprehensive search in the PubMed, Embase, and Web of Science (up to October 8, 2013) was performed for relevant studies using multiple search strategies. Correlation between CXCR4 expression and clinicopathological features and overall survival (OS) was analyzed. A total of 1,055 patients with esophageal cancer from seven studies were included. The pooled odds ratios (ORs) which indicated CXCR4 expression was associated with tumor depth (OR = 0.35, confidence interval (CI) = 0.27-0.47, P < 0.00001), status of lymph node (OR = 0.36, CI = 0.21-0.61, P < 0.0002), TNM (tumor, node, metastasis) stage (OR = 0.38, CI = 0.25-0.56, P < 0.00001), and histological type (OR = 1.81, CI = 1.07-3.05, P = 0.03). Poor overall survival of esophageal cancer was found to be significantly related to CXCR4 overexpression (hazard ratio (HR) 1.49, 95 % CI = 1.24-1.80, P < 0.0001), whereas combined ORs exhibited that CXCR4 expression has no correlation with gender or tumor differentiation. Based on the published studies, CXCR4 overexpression in patients with esophageal cancer indicated worse survival outcome and was associated with common clinicopathological poor prognostic factors

Analysis of the relationship between the response after the First-line chemotherapy and the survival in the advanced non-small cell lung cancer

Background and objective Most patients with advanced non-small cell lung cancer (NSCLC) treated with first-line chemotherapy consisted of the third generation new drug got the disease in control (CR+PR+SD).In this study, we retrospectively reviewed our data to investigate the difference of survival between patients of disease control and progression (PD), and disease response (CR+PR) and stable (SD), to identify the prognosis factor correlated with survival. Methods In our retrospective study, 118 patients with stage IIIB (with malignancy pleural fluid) and IV NSCLC were identified who received the third generation new drug-based platinum or non-platinum regimens, the response of first-line chemotherapy were complete response (CR), partial response (PR), stable disease (SD) and progression disease (PD) according to RECIST criteria based on the records on the imaging reports papers. Results After first-line chemotherapy, 86 (72.9%) patients [CR2 (1.7%), PR47 (39.8%), SD37 (31.4%)) had disease control and 33 (27.1%) patients had progression disease. The median survival time of CR+PR+SD arm was significantly longer than PD arm (17.8 months vs 8.4 months, P=0.001), but there was no significant difference between CR+PR arm and SD arm (18.1 months vs 15.5 months, P=0.917), the PFS between two arms were no significantly different too (7.1 months vs 6.9 months, P=0.622). The Cox regression analysis shows that stage (IIIB or IV), chemotherapy lines (less than three lines or more than four lines) and disease control or not after first-line chemotherapy were independently prognosis factor of overall survival. Conclusion Our data shows that the survival of response and stable disease patients are better than that of patient with progression disease, the survival benefit of patients with stable disease and responses are no significantly difference

National survey of the medical treatment status for non-small cell lung cancer (NSCLC) in China

Introduction: Treatment choice for NSCLC in China has not previously been reported. This paper explores the clinical practice and adherence to treatment guidelines for NSCLC. Methods: A specifically designed questionnaire was used. It consisted of personal information of the responders and treatment details (patient identification data was excluded). Questionnaires were delivered to doctors in 12 major cities in China. Doctors were asked to answer the questionnaires based on real cases in their daily practice. Results: 987 cases of NSCLC were included. In first-line chemotherapy, regimens were mostly platinum-based among which gemcitabine plus platinum was predominately used (27.4%), followed by docetaxel plus platinum (16.2%) and paclitaxel plus platinum (13.5%). In second-line therapy some were treated with single agents, such as docetaxel (12.9%), gefitinib (11.1%), pemetrexed (9.3%), and erlotinib (3.5%). 44.5% were with doublet therapy. Detection rate of epidermal growth factor receptor (EGFR) mutation was only 9.6% because of the limited prevalence of testing technology. EGFR mutation rate was 46.8%. EGFR-tyrosine kinase inhibitors (TKIs) were used more frequently as salvage (14.8%) rather than upfront therapy (5.3%). Conclusions: This survey reveals the daily clinical treatment for NSCLC in China. Overall data showed modest adherence to the national guideline (NCCN guideline Chinese version) for first-line chemotherapy. We believe this survey is valuable to provide a reference for further clinical trial design and policy making. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Sanofi aventis; Science and Technology Commission of Guangzhou [2010J-E151]; Wu Jieping Medical Foundation [08-JC-003

Expert consensus on the diagnosis and treatment of RET gene fusion non‐small cell lung cancer in China

Abstract The rearranged during transfection (RET) gene is one of the receptor tyrosine kinases and cell‐surface molecules responsible for transmitting signals that regulate cell growth and differentiation. In non‐small cell lung cancer (NSCLC), RET fusion is a rare driver gene alteration associated with a poor prognosis. Fortunately, two selective RET inhibitors (sRETi), namely pralsetinib and selpercatinib, have been approved for treating RET fusion NSCLC due to their remarkable efficacy and safety profiles. These inhibitors have shown the ability to overcome resistance to multikinase inhibitors (MKIs). Furthermore, ongoing clinical trials are investigating several second‐generation sRETis that are specifically designed to target solvent front mutations, which pose a challenge for first‐generation sRETis. The effective screening of patients is the first crucial step in the clinical application of RET‐targeted therapy. Currently, four methods are widely used for detecting gene rearrangements: next‐generation sequencing (NGS), reverse transcription‐polymerase chain reaction (RT‐PCR), fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC). Each of these methods has its advantages and limitations. To streamline the clinical workflow and improve diagnostic and treatment strategies for RET fusion NSCLC, our expert group has reached a consensus. Our objective is to maximize the clinical benefit for patients and promote standardized approaches to RET fusion screening and therapy

Chinese expert consensus on the diagnosis and treatment of malignant pleural mesothelioma

Abstract Malignant pleural mesothelioma (MPM) is a malignant tumor originating from the pleura, and its incidence has been increasing in recent years. Due to the insidious onset and strong local invasiveness of MPM, most patients are diagnosed in the late stage and early screening and treatment for high‐risk populations are crucial. The treatment of MPM mainly includes surgery, chemotherapy, and radiotherapy. Immunotherapy and electric field therapy have also been applied, leading to further improvements in patient survival. The Mesothelioma Group of the Yangtze River Delta Lung Cancer Cooperation Group (East China LUng caNcer Group, ECLUNG; Youth Committee) developed a national consensus on the clinical diagnosis and treatment of MPM based on existing clinical research evidence and the opinions of national experts. This consensus aims to promote the homogenization and standardization of MPM diagnosis and treatment in China, covering epidemiology, diagnosis, treatment, and follow‐up