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How does lung cancer chemotherapy reduce side effects and prolong survival？
How does lung cancer chemotherapy reduce side effects and prolong survival？Cancer patients seem to reject chemotherapy, but it is an indispensable way of tumor treatment.
Most patients with lung cancer are very resistant to chemotherapy. When they think of the mechanism of chemotherapy that kills the enemy and damages the enemy and the side effects it brings, it is inevitable to tremble and think that chemotherapy can be avoided without chemotherapy.
Moreover, the development of targeted therapy and immunotherapy in the past two years has also brought strong expectations to patients and hopes that chemotherapy can no longer be used.
Can chemotherapy really be replaced?
In fact, chemotherapy can neither be replaced, nor is it as scary as we think. In particular, some of the latest research advances have made us realize that chemotherapy is indispensable. Even the stars on the stage of lung cancer treatment-targeted therapy and immunotherapy, are inseparable from achieving the best therapeutic effect. Chemotherapy.
▌Immunotherapy combined with chemotherapy
For most patients with non-small cell lung cancer, when genetic testing results show that no suitable targeted drugs are available, the emergence of immunotherapy is like a dawn.
However, immunotherapy is not suitable for all patients. For those patients with low expression of PDL-1, immunotherapy does not seem to be so effective, and clinical trials of combined chemotherapy have proved to us that immune combined chemotherapy can perform better treatments. The effect is applicable to a wider range of lung cancer patients.
1. Drug K + chemotherapy reduces the risk of disease progression by 48%
The KEYNOTE-189 study showed that pembrolizumab (Keytruda, K drug) combined with chemotherapy reduces the risk of disease progression by 48% compared with chemotherapy alone (median progression-free survival 8.8 months vs 4.9 months), and the treatment is effective Increased by 2.5 times (47.6% vs 18.9%), regardless of the level of PD-L1 expression, the overall survival (OS) of immune combined chemotherapy is better than chemotherapy. Based on the research data of KEYNOTE-189, the indication of K drug combined with pemetrexed + platinum chemotherapy for the initial treatment of non-squamous non-small cell lung cancer (NSCLC) was officially approved in China in 2019.
Not only that, and in the treatment of squamous non-small cell lung cancer, the KEYNOTE-407 study showed that compared with chemotherapy alone, the K drug combined with chemotherapy group significantly improved overall survival regardless of the expression level of PD-L1. The combination therapy group also improved the progression-free survival and complete remission rate, and the remission was longer. The incidence and severity of adverse events in the two groups were basically similar.
2. The first-line treatment of T drug, I drug + chemotherapy is better than chemotherapy
In small cell lung cancer, in April 2020, the National Medical Products Administration (NMPA) of China announced the approval of the PD-L1 inhibitor atelizumab (Tecentriq, T drug) combined with chemotherapy for patients with extensive-stage small cell lung cancer First-line treatment. IMpower133 research data showed that the median OS of patients with T drug combined chemotherapy was 12.3 months, which was longer than 10.3 months in the control group; in addition, the median PFS of patients in the combination group was 5.2 months, which was longer than 4.3 months in the control group.
In March 2020, the US FDA approved duvalimab (Imfinzi, drug I) combined with etoposide + cisplatin/carboplatin chemotherapy for the first-line treatment of patients with extensive-stage small cell lung cancer.
3. Immunization drugs made in China continue to grow, and combined chemotherapy significantly prolongs progression-free survival
The results of the ORIENT-11 study showed that the median PFS of sintilimab + pemetrexed + platinum-based chemotherapy in the first-line treatment of non-squamous non-small cell lung cancer was 8.9 months, and the control group was (placebo + pemetrexed) For 5.0 months, the risk of progression in the combined treatment group was reduced by 52%; the objective response rate (ORR) was 51.9% vs. 29.8%. Compared with previous studies, no new safety signals appeared.
The research data of another Chinese-made immune drug CS1001 showed that PD-L1≥1% or <1% regardless of squamous cell carcinoma or non-squamous cell carcinoma, the median PFS of the CS1001+ chemotherapy group was significantly prolonged and the risk of disease progression and death was reduced by 50% .
Carrelizumab and tislelizumab have successively been approved for lung cancer indications in China, and chemotherapy drugs are also indispensable.
Carrelizumab has been approved in combination with pemetrexed and carboplatin for the first-line treatment of advanced or metastatic non-squamous non-small cell lung cancer.
Tilelizumab is approved for the first-line treatment of locally advanced or metastatic squamous non-small cell lung cancer in combination with paclitaxel and carboplatin.
▌Targeted therapy combined with chemotherapy
Many patients have heard that after some people are resistant to gefitinib and continue to use gefitinib after interspersed chemotherapy, it is still effective. Then, if you combine targeted therapy with chemotherapy at the very beginning, it will What is the effect?
Gefitinib combined with chemotherapy can improve the overall survival of EGFR-mutant non-small cell lung cancer.
In 2018, the American Clinical Oncology Association announced the results of the NEJ009 phase III clinical trial. 344 patients with advanced or recurrent EGFR-mutant non-small cell lung cancer who had not received previous treatment were randomized to receive gefitinib alone or in combination with gefitinib Carboplatin and pemetrexed treatment.
Compared with gefitinib alone, the progression-free survival (PFS) of patients with targeted therapy combined with chemotherapy was prolonged by 9.7 months, and the overall survival (OS) was prolonged by 13.4 months. In addition, the total effective rates of the combination therapy group and the single-agent therapy group were 84.0% and 67.4%, respectively.
The above studies clearly convey a message: Today, as innovative therapies emerge endlessly, chemotherapy, as the most extensive treatment for lung cancer patients, still has a place. In addition to the above-mentioned research, there are also chemotherapy + dual immunity, chemotherapy + anti-vascular + immune quadruple programs. With the development of research experiments, the role of chemotherapy has been continuously innovated.
Of course, the side effects of chemotherapy do cause a lot of trouble for patients, especially for elderly patients, who cannot withstand larger doses of chemotherapy and suffer a lot of physical damage, which will delay the timing of treatment. The use of “beat chemotherapy” may reduce the side effects of drugs.
▌Change the way of medication, chemotherapy can also be very easy
Compared with the current commonly used chemotherapy methods (larger dose, once 2-3 weeks, no drugs in the middle), rhythm chemotherapy can maintain the blood concentration at a low and stable level for a long time, and it will affect the bone marrow and gastrointestinal tract. If normal tissue cells are not damaged, it will not cause severe bone marrow suppression, nausea and vomiting and other chemotherapy-related adverse reactions. At the same time, it can inhibit the growth of cancer cells in a short or non-intermittent period, thereby slowing the occurrence of drug resistance.
The so-called rhythm chemotherapy is a new regular and long-lasting chemotherapy strategy with low doses (usually 10% -33% of the maximum tolerated dose of traditional chemotherapy), high frequency (taken every day, every other day or 3 times a week) .
Vinorelbine is a third-generation chemotherapeutic drug that can disrupt the signal transduction and migration of tumor endothelial cells to achieve anti-tumor angiogenesis. Vinorelbine combined with platinum can benefit patients regardless of whether it is used for squamous cell carcinoma or non-squamous cell carcinoma. It is a classic first-line chemotherapy regimen for non-small cell lung cancer.
The results of an international, multi-center retrospective study showed that the enrolled 270 elderly and frail patients with advanced non-small cell lung cancer who were not suitable for traditional chemotherapy received oral vinorelbine rhythm chemotherapy, and the overall effective rate reached 17.8%. The disease control rate reached 61.9%, the median disease progression time reached 5 months, and the median OS reached 9 months. Real-world studies have proved that oral vinorelbine rhythm chemotherapy is a safe, effective and long-term benefit treatment strategy for elderly patients with advanced lung cancer.
Beat chemotherapy can not only directly inhibit tumor growth, but also reduce the maturation of regulatory T cells and dendritic cells, enhance anti-tumor immune responses, and combine with immunotherapy, or increase the efficacy of immune drugs.
In recent years, rhythm chemotherapy has received more and more attention from clinicians. You see, a new treatment modality can bring better survival benefits to patients.
▌The most common adverse reaction treatment
In fact, most patients face the fear of chemotherapy, mainly because of the side effects of chemotherapy. The following is a summary of several common side effects treatment methods for you, I hope it will be helpful to you.
1. Bone marrow suppression
Coping method: If bone marrow suppression occurs, the doctor will give appropriate treatment according to the patient’s condition. As a patient, it is necessary to choose a high-protein, high-calorie, vitamin-rich diet to enhance nutrition and avoid contact with patients from relatives suffering from infectious diseases such as colds.
2. Nausea and vomiting
How to deal with it: If you feel that the medicine has a peculiar smell, you can smell some scented fruits, such as oranges, oranges, etc., or you can relieve it by taking a deep breath or chatting with others, while keeping the indoor air fresh and odorless, thereby reducing the symptoms of nausea.
If vomiting has occurred, you can flexibly adjust the meal time, and choose a meal environment that makes the patient happy, and you can eat with your family. If vomiting occurs during chemotherapy, the side lying position should be adopted to prevent the vomit from entering the trachea and causing choking. Rinse your mouth promptly and clean your mouth. If you have dentures, rinse your mouth after removing them.
If other patients in the same room experience nausea and vomiting, they should try to avoid them. After the infusion, you can also go out of the room, take a walk, breathe fresh air, and do something you like, such as listening to music. After going home, you can participate in some cultural and sports activities (playing mahjong) as a distraction. You can also press and rub Neiguan acupoint in accordance with traditional Chinese medicine to maintain the stomach.
3. Dry stools
Coping method: dry stools during chemotherapy, in addition to the medical treatment given by the doctor, non-drug interventions should also be carried out at the same time, such as diet adjustment, eating more coarse grains and crude fiber foods, such as corn flour, millet, celery, Leek etc. Eat more fruits, especially bananas, watermelons, etc., drink honey water, to achieve the effect of laxative intestines. Appropriate participation in exercise, you can also massage the abdomen, clockwise from right to left to increase bowel movements and increase the frequency of bowel movements.
Coping method: Diarrhea occurs during chemotherapy. People with more diarrhea will continue to irritate the skin and cause local skin ulceration. So wash the anus and sacrum with water and soap after each bowel movement, and dry it with a soft towel. Keep the local skin clean and dry. Zinc oxide ointment can also be applied locally. Wear soft cotton underwear.
After diarrhea occurs, the diet should pay attention to foods that are less irritating to the gastrointestinal tract. It is not advisable to eat whole grains, nuts with high oil content, alcoholic or caffeinated beverages, milk and dairy products. Eat small amounts and avoid cold foods. Severe diarrhea will cause the body to lose potassium and cause electrolyte disorders, so it is necessary to supplement potassium-rich foods such as vegetable juices in time to supplement potassium and water.
5. Hair loss
Coping method: Hair loss is a common adverse reaction of many chemotherapy drugs. In fact, hair loss caused by chemotherapy drugs does not have any adverse effects on patients. However, many friends often cannot accept the change of hair loss on their own image, which has a psychological impact, considering the problem of beauty. Even negative psychology such as low self-esteem appears, which has a certain negative impact on the treatment effect.
However, the hair loss caused by chemotherapy is reversible. After the chemotherapy is stopped, the hair can still regenerate, so do not affect your own treatment effect because of temporary hair loss. Friends who care about hair can choose to wear a scalp tourniquet or ice cap to prevent the circulation of chemotherapy drugs to the hair follicles and reduce the amount of hair loss.
In addition, it is recommended that before chemotherapy, you can cut your hair short, reduce the number of combing, and delay the time of hair loss. You can also choose a beautiful and suitable wig for yourself. Generally, the hair will re-grow 1 to 3 months after stopping the drug, and the re-grown hair will be soft and naturally curved.
(source:internet, reference only)