Anaplastic lymphoma kinase(ALK)fusion is commonly observed in lung adenocarcinoma,with an incidence rate of 5%-7%.Due to the tumor heterogeneity in advanced non-small cell lung cancer,ALK fusion can also occur in lung squamous cell carcinoma.A mul-tidisciplinary team(MDT)combines various professional opinions and evidence-based medical principles to provide personalized treatment recommendations,particularly for complex cases.This study presents the MDT diagnostic and treatment approach for a patient with lung squamous cell carcinoma with an ALK mutation.Following initial diagnosis at stage ⅢB,the patient exhibited rapid disease progression with liver and brain metastases after sequence chemoradiotherapy.After genetic testing revealed ALK fusion,the patient was treated with the ALK inhibitor,lorlatinib,which resulted in tumor regression and a persistent partial response.

Humans ; East Asian People ; Nausea/drug therapy* ; Vomiting/drug therapy* ; Antineoplastic Agents/adverse effects* ; Neoplasms/drug therapy*

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, and immunotherapy has become a relatively common treatment for NSCLC. The use of biomarkers to screen out people with high benefit from immunotherapy could help to timely grasp the therapeutic information of NSCLC patients and meet the current challenges faced by immunotherapy. Compared with traditional markers such as programmed death-ligand protein 1(PD-L1) expression fraction, circulating biomarkers have the characteristics of non-invasion, convenient collection of materials, and dynamically evaluating the prognosis of patients and observing the efficacy of immunotherapy in the process of immunotherapy, which has a broad application prospect.

With the progress of gene detection technology and the speed-up in new drug development, biological target therapy has fully covered the first-line treatment of advanced NSCLC. Immunotherapy has significantly improved the survival of advanced NSCLC patients with negative driven genes, and the median OS reaches about 2 years (15.6-30 months). EGFR is the most common driven gene. According to different EGFR mutation subtypes (L858R or 19del), different treatment mode (EGFR-TKI single drug, TKI combined with anti-vascular drugs and TKI combined with chemotherapy) is selected as the first-line treatment, which has become a consensus. Depending on the data of median PFS, the treatment efficacy against rare targets is more prominent, which has exceeded the efficacy of standard chemotherap:ALK (alectinib, PFS=34.8 months), ROS1 (ceritinib, PFS=19.3 months), RET (selpercatinib, PFS=18.4 months), BRAF (dabrafenib plus trametinib, PFS=14.6 months), NTRK (larotrectinib, PFS≥12 months) and MET (savolitinib, PFS=9.7 months). In conclusion, the first-line treatment of advanced NSCLC has entered the era of“precision-targeted treatment”based on different molecular typing, and it has become a consensus that high-throughput sequencing is required for newly diagnosed patients.

Objective To analyze the difference and influential factors of clinical prognosis between liver transplantation with autoimmune liver disease (AILD) and viral hepatitis cirrhosis. Methods Clinical data of 75 recipients undergoing liver transplantation from January 2002 to January 2017 were retrospectively analyzed. All recipients were divided into the AILD group (n=25) and viral hepatitis cirrhosis group (n=50). The intraoperative conditions of the recipients were observed including warm ischemia time, cold ischemia time, operation time, anhepatic phase and blood transfusion volume. Postoperative complications were observed including severe acute kidney injury (AKI), infection, acute rejection, biliary tract-related complications, vascular-related complications and post transplantation diabetes mellitus (PTDM). The follow-up status were monitored after discharge. The prognostic factors of liver transplant recipients were analyzed. Results The warm ischemia time, cold ischemia time, operation time and anhepatic phase did not significantly differ between two groups (all P > 0.05). In the AILD group, the incidence of postoperative acute rejection was remarkably higher, whereas the incidence of postoperative severe AKI was significantly lower than those in the viral hepatitis cirrhosis group (both P < 0.05). The postoperative 1-, 3- and 5-year survival rates in the AILD group was 92%, 87%, and 87%, which did not significantly differ from 88%, 88% and 88% in the viral hepatitis cirrhosis group (all P > 0.05). Univariate analysis showed that age, model for end-stage liver disease (MELD) score, severe AKI, infection and biliary tract-related complications were the influencing factors of clinical prognosis of the recipients (all P < 0.05). Conclusions The overall survival prognosis does not significantly differ between the AILD and viral hepatitis cirrhosis groups. Age, MELD score, severe AKI, infection and biliary tract-related complications are the risk factors affecting the clinical prognosis of liver transplantation recipients.

Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .

Objective:The implementation of a multidisciplinary team (MDT) approach for palliative treatment of patients with multi-ple primary carcinomas (MPCs) was evaluated in Tianjin Medical University Cancer Institute and Hospital. Methods:A total of 40 pa-tients with MPCs who attended the consultation by MDT in our hospital from January 1, 2014 to April 21, 2016 were analyzed retro-spectively. Clinical data of the 40 cancer patients were reviewed. The essential characteristics and results of MDT treatment decisions were summarized and expected outcomes were evaluated. Results:A total of 40 cases with MPCs were included in MDT assessment, accounting for 6.4%of the 629 patients who were handled by the MDT. A total of 39 MDT decisions were followed up successfully. Among these MDT decisions, 26 (65%) were fully implemented, 7 (17.5%) were partially implemented, and 6 (15.0%) were unimple-mented. Expected outcomes were achieved in 25 (96.2%) patients of the fully implemented concordant group, 4 (57.1%) patients of the partially concordant group, and 1 (16.7%) patient from the unimplemented group. Conclusion:MDT specializing on palliative treat-ment can provide recommendations for standardized individualized comprehensive treatment of patients with MPCs. MDT modality should be further improved and widely used for palliative treatment.

Solitary brain metastasis in non-small cell lung cancer (NSCLC) patients was previously considered as Stage IV. Gen-erally, only chemotherapy or radiotherapy rather than surgery was considered the treatment for these patients;hence, achieving the de-sired effect was difficult. In recent years, the treatment benefit for these patients significantly increased. Several patients were even pro-vided the chance of being cured through standardized and individualized treatment by a multiple disciplinary team (MDT). This article introduces two solitary brain metastasis patients with NSCLC who were treated by MDT in Tianjin Medical University Cancer Institute and Hospital. This article aims to explore a complete set of diagnostic and treatment practices for the benefit of more patients.

Objective:To observe the effect of dexmedetomidine on sleep and anxiety in cancer patients who received chemothera-py. Methods: Sixty cancer patients suffering from sleep disorders or anxiety symptoms and receiving chemotherapy between March and June 2014 were randomly divided into treatment and control groups. The patients in the treatment group were treated with intrave-nous drip of 1.0μg/kg dexmedetomidine for more than 30 min, once a day for three days. The patients in the control group were given the same dose and drip time of normal saline. Athens Insomnia Scale (AIS) was used to assess the sleep quality of patients before and the 1st, 2nd, and 3rd days after the administration of dexmedetomidine. Self-Rating Anxiety Scale (SAS) was employed to assess anxi-ety before and the 3rd day after the administration of dexmedetomidine. Results:Compared with the control group and status before ad-ministration of dexmedetomidine, the AIS scores were significantly lower in the 1st, 2nd, and 3rd days after administration (P<0.01), and the SAS scores were also significantly lower in the 3rd day after administration (P<0.01). Conclusion:Dexmedetomidine may im-prove sleep quality and alleviate anxiety symptoms in cancer patients undergoing chemotherapy.

Objective To explore the therapeutic effect of lung cancer Ⅳ recipe combined with chemotherapy on treating middle and advanced stages of non-small cell lung cancer (NSCLC) in the elderly.Methods A total of 77 NSCLC patients in middle and advanced stages aged 70 years and over who had heat-toxin syndrome in traditional Chinese medicine (TCM) were selected from Apr.2013 to Oct.2014 in our hospital.Patients were randomly divided into chemotherapy group (n=39) and chemotherapy + herbs group (n=38).Karnofsky assessment scale (KPS),effective rate,symptom and sign in traditional Chinese medicine,changes in the levels of high-sensitivity c-reactive protein (hs-CRP),carcino embryonic antigen (CEA),neuron specific enolase (NSE),tumor special growth factor (TSGF) were observed before and 1 and 56 days after treatment.Results There was no significant difference in effective rate between the two groups (P＞0.05).The KPS and symptom and sign in TCM were improved significantly in chemotherapy + herbs group as compared with chemotherapy group (36.7 ％ vs.26.5 ％,80.0 ％ vs.58.8 ％,respectively (x2 =2.721,6.731,both P＜0.05).There were no significant differences in hs-CRP,NSE,CEA,TSGF levels between two groups before and after treatment (P＞0.05),but hs-CRP level in both groups was decreased after treatment as compared to pre-treatment and the decvease was more obvious in chemotherapy + herbs group (51.47％ vs.23.77％,x2 =19.713,P＜0.05).Conclusions Lung cancer Ⅳ recipe can improve the main clinical symptoms,quality of life and tolerance to chemotherapy in NSCLC patients with heat-toxin manifestation in TCM.There is a correlation between heat-toxin syndrome and hsCRP level in NSCLC patients,which shows that hs-CRP probably is the material basis of the heattoxin syndrome in TCM.