Lung cancer ranks first in the incidence and mortality of malignant tumors in mainland China, seriously endangering people's lives and health. In recent years, great progress has been made in the treatment of lung cancer, especially the rapid development of molecular targeted therapy and immunotherapy for lung cancer, which has changed the overall treatment model, significantly prolonged the survival time of patients, and led us into the era of precision treatment for lung cancer.
In order to further standardize clinical practice and provide more effective guidance for clinicians, colleagues in the respiratory community will work together from 2023 to 2024 to promulgate a number of international/Chinese expert consensus on the diagnosis and treatment of lung cancer, including the Chinese Expert Consensus on the Diagnosis of Early Lung Cancer (2023 Edition), the International Expert Consensus on the Diagnosis and Treatment of Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease, the Chinese Expert Consensus on the Diagnosis and Treatment of Refractory Lung Cancer 2024, and the Expert Consensus on the Diagnosis and Treatment of Lung Cancer Combined with Interstitial Lung Disease. Personalized and precise treatment plan.
On July 27, the 19th 301 Academic Conference on Respiratory Diseases held a special section on precision treatment of lung cancer. The conference specially invited experts to interpret the consensus on the diagnosis and treatment of lung cancer, so as to provide reference for clinicians in the diagnosis and treatment of lung cancer. The conference also invited a number of authoritative experts in the respiratory field to conduct in-depth exchanges on the latest progress in molecular diagnosis of lung cancer, the innovative practice of targeted and immunoprecision therapy, the challenges and coping strategies of severe lung cancer, and the wisdom of the whole process management of lung cancer, so as to seek new strategies for lung cancer treatment
Review of the content of the consensus interpretation
Prof. Zhao Wei: Interpretation of the Chinese Expert Consensus on the Diagnosis of Early Lung Cancer (2023 Edition).
The moderator, Professor Zhao Wei of the General Hospital of the People's Liberation Army, pointed out that lung cancer is the first malignant tumor in the mainland. In the face of challenges such as smoking, increasing air pollution and an aging population, the incidence and mortality rate of lung cancer continue to rise, and early screening and diagnosis are particularly important. In response to this grim situation, the Chinese Expert Consensus on Early Lung Cancer Diagnosis (2023 Edition) came into being. The consensus gives 18 recommendations in seven aspects, including early lung cancer screening population, non-invasive examination, invasive examination, artificial intelligence, big data and robotics, Internet of Things and early diagnosis of lung cancer, the role of multidisciplinary cooperation in the diagnosis of early lung cancer, and the management and follow-up strategy of lung nodules for suspected early lung cancer, so as to provide reference for clinicians in the diagnosis of early lung cancer and further promote the diagnosis of early lung cancer in mainland China.
With the continuous integration of cutting-edge technologies such as artificial intelligence, big data, and the Internet of Things, the diagnosis of early lung cancer will be more accurate and efficient. The Lung Cancer Group of the Chinese Society of Respiratory Diseases will continue to lead the research and development in this field, continuously optimize the diagnosis process, improve the level of diagnosis and treatment, and strive to move the diagnosis of lung cancer forward, strive for more treatment time and opportunities for patients, and effectively improve the prognosis of patients with early-stage lung cancer.
Professor Qin Yinyin: Interpretation of the International Expert Consensus on the Diagnosis and Treatment of Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease
Professor Qin Yinyin from the First Affiliated Hospital of Guangzhou Medical University said that there are a large number of lung cancer and chronic obstructive pulmonary disease (COPD) patients in mainland China. However, there has been a long-term lack of clear consensus on the diagnosis and treatment of lung cancer complicated with COPD. To this end, after extensive discussions, 111 experts at home and abroad formulated the International Expert Consensus on the Diagnosis and Treatment of Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease, based on the concept of "cancer and lung treatment, comorbidity and treatment" as the core and based on clinical practice.
The consensus points out that COPD and lung cancer share common risk factors, and that the two affect each other and pose a serious threat to health. Patients diagnosed with lung cancer and have high-risk factors for COPD should undergo lung function and other related examinations as soon as possible. Patients with confirmed COPD and high-risk factors for lung cancer should be followed up with low-dose CT once a year.
The consensus emphasizes that the strategy of "cancer and lung treatment" should be implemented. On the basis of anti-tumor therapy for lung cancer-COPD patients, regular treatment of COPD can benefit patients in terms of lung function, quality of life, postoperative complications, PFS and OS. A more aggressive initial regimen for COPD (ICS/LABA/LAMA as recommended) significantly reduced the risk of future exacerbations in high-risk patients with COPD, and a relative difference in the risk of all-cause mortality was observed.
In addition, the treatment methods of lung cancer in patients with lung cancer complicated with COPD include chemotherapy, targeted therapy, immunotherapy, interventional lung volume reduction surgery and radiotherapy, etc., and it is necessary to pay attention to the adjustment and impact of lung cancer treatment regimens brought about by comorbidities.
Prof. Min Li: Interpretation of the Chinese Expert Consensus on the Diagnosis and Treatment of Refractory Lung Cancer 2024
According to Professor Li Min of Xiangya Hospital of Central South University, refractory lung cancer refers to the type of lung cancer that has a low response to standard treatment or no standard treatment, and lacks a highly effective and low-toxicity treatment plan. In view of the current lack of a clear definition and treatment consensus for refractory lung cancer, experts from the Lung Cancer Group of the Respiratory Disease Branch of the Chinese Medical Association have formulated the "Chinese Expert Consensus on the Diagnosis and Treatment of Refractory Lung Cancer 2024" based on the actual diagnosis and treatment of lung cancer in mainland China and with reference to the latest research data and guidelines at home and abroad.
Professor Li Min introduced the methodology of the consensus in detail, and deeply analyzed the definition of refractory lung cancer, refractory small cell lung cancer (SCLC), refractory driver gene-positive small cell lung cancer (NSCLC), refractory driver gene-negative NSCLC and new technology solutions for precision diagnosis and treatment, etc., to provide mainland physicians with medication suggestions and references for refractory lung cancer.
Professor Xu Yang: Interpretation of the Expert Consensus on the Diagnosis and Treatment of Lung Cancer Complicated with Interstitial Lung Diseases
According to Professor Xu Yang of the PLA General Hospital, lung cancer combined with interstitial lung disease (LC-ILD), that is, patients with both interstitial lung disease (ILD) and lung cancer, has received extensive attention in recent years. In order to standardize the diagnosis and treatment process, the Lung Cancer Group of the Respiratory Disease Branch of the Chinese Medical Association has initiated the formulation of the Expert Consensus on the Diagnosis and Treatment of Lung Cancer Complicated with Interstitial Lung Diseases. At present, the consensus is still in the stage of revision and refinement and has not yet been officially released.
Professor Xu Yang summarized the core points of the consensus: (1) ILD increases the risk of lung cancer, and lung cancer needs to be monitored after ILD is diagnosed; (2) annual CT scans are recommended for patients with ILD to evaluate ILD and detect pulmonary nodules early; (3) For patients with lung cancer and ILD, ILD should be considered in the treatment; (4) For patients with localized lung cancer and lung function permitting, surgery is of great significance, but the risk of AE-ILD needs to be evaluated; (5) Chemotherapy is an optional regimen for LC-ILD, which requires individualized treatment; (6) Patients with conventional radiotherapy or radiation pneumonitis, AE-ILD, LC-IPF should be avoided; (7) Targeted and immunotherapy may induce ILD, which requires precision medicine to guide individualized treatment; (8) Antifibrotic drugs have therapeutic potential and provide new ideas for LC-ILD patients.
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