Lung cancer is a malignant tumor with the highest incidence and mortality in China. Early diagnosis and early treatment is the key to improve the survival and prognosis of patients with lung cancer. In recent years, many studies have focused on biomarkers of lung cancer. Emerging biomarkers tests have shown some potential in lung cancer screening. Combining biomarkers, imaging omics and artificial intelligence to establish a comprehensive model for lung cancer screening and prediction may be the development direction for improving lung cancer screening in the future. This paper summarizes the application of biomarkers in lung cancer screening, introduces the emerging biomarkers and new technologies, and discusses the application prospects of biomarkers in lung cancer screening, in order to providea theoretical basis for improving screening, early diagnosis and early treatment of lung cancer.
Objective To investigate the effectiveness, safety and cost-effectiveness of leflunomide for rheumatoid arthritis, and formulate an evidence-based treatment plan for a patient with rheumatoid arthritis. Methods We searched the ACP Journal Club, The Cochrane Library (Issue 2, 2007) and MEDLINE (1990 to 2007), and critically appraised the available evidence. Results The available Level A (high quality) evidence showed that the efficacy and adverse events of leflunomide were comparable to those of methotrexate. The total cost of treating patients with leflunomide was significantly higher when compared to methotrexate. The combination of leflunomide and methotrexate in patients with active rheumatoid arthritis unresponsive to methotrexate monotherapy was less costly and more effective than the strategy excluding leflunomide. Given the current evidence, together with our clinical experience and the patient’s preference, methotrexate was administered to the patient. There was an inadequate response after 6 months of treatment. And then, adding leflunomide to methotrexate attained a remarkable response 3 months later. The patient is still being followed up. Conclusion treatment with leflunomide and methotrexate in RA patients can improve the clinical outcomes. Long-term efficacy and toxicity remain to be established.
Lung microbiome is defined as the specific microbiota of lung. Lung microbiome can make the lung in a state of chronic inflammation through direct destruction, activation of inflammatory cells and release of inflammatory factors, and then progress to lung cancer. There are significant differences in lung microbiome between lung cancer patients and healthy people. Some specific microbial flora can be used as a diagnostic marker of lung cancer. Specific microbial communities are related to the efficacy of immunotherapy, and microbial composition may be used as a marker of immune-related adverse events. There are both challenges and opportunities for research on the relationship between lung microbiome and lung cancer. This review will focus on the significance and value of lung microbiome in the occurrence, diagnosis and immunotherapy of lung cancer, in order to provide a reference for basic and clinical researchers in related fields.
Objective To compare the long-term cost-utility of three first-generation EGFR-TKIs targeted drugs, gefitinib, icotinib, and erlotinib as first-line treatments for advanced non-small cell lung cancer (NSCLC). Methods Real-world data were collected from 1 511 patients with advanced NSCLC treated with first-generation EGFR-TKIs as first-line treatment at West China Hospital of Sichuan University from 2009 to 2019. A three-state Markov model was established to evaluate the clinical efficacy, safety and cost-utility of three first-generation EGFR-TKIs targeted drugs. The transition probability of each state was obtained by survival analysis, the direct and indirect costs were calculated by the bottom-up method, the health utility value was obtained through literature research, the incremental cost effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated, and sensitivity analyses and Monte Carlo simulations were performed. Results There was no significant difference in clinical efficacy among the three first-generation EGFR-TKIs in the treatment of NSCLC. The incidence of skin rash and liver injury caused by gefitinib was significantly higher than that caused by icotinib and erlotinib (P<0.05). The average economic burden of patients treated with icotinib was the lowest (CNY 192 535.3) (P<0.01). The cost-utility ratio of icotinib (CNY 132 985.9/QALYs) was much lower than that of gefitinib (CNY 205 005.3/QALYs) and erlotinib (CNY 172 893.1/QALYs). Conclusion Compared with the three first-generation EGFR-TKIs drugs, icotinib is the most cost-effective.