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Targeted therapy combined with cellular immunotherapy after lung cancer surgery further reduces the risk of recurrence

时间:2026-04-22 人气:

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Overview of the disease


 
In August 2020, Mr. Zheng was found to have a lung lesion during a physical examination, which was suspected to be a malignant tumor. He was immediately admitted to the hospital for right upper lung lobectomy and mediastinal lymph node dissection. Postoperative pathology revealed invasive adenocarcinoma in the right upper lung lobe, with visible airspace dissemination and intravascular cancer thrombus, and cancer metastasis in the R2/R4 lymph nodes (2/2, 2/3). Genetic testing indicated an EGFR 21 mutation.
After surgery, considering his condition, Mr. Zheng did not undergo chemotherapy. Due to the EGFR mutation detected by genetic testing, he was treated with Tagrisso at a dose of 80mg per day for six months.
Department

Pu
Small
Knowledge

Knowledge

EGFR mutation  

With the successive identification of oncogenic driver genes in lung cancer, the classification of lung cancer has been further refined from a simple histopathological classification to a molecular classification based on driver genes. EGFR is commonly found in lung adenocarcinoma.

The EGFR gene is a type of gene that expresses epidermal growth factor receptors, promoting normal cell division and proliferation under physiological conditions. However, in some cases, mutations in proto-oncogenes can lead to the development of tumors, with a higher incidence in non-smoking female lung adenocarcinoma. When it was discovered that EGFR mutations often occur in lung adenocarcinoma tumors, people began to consider how to inhibit tumor growth by targeting these mutations. Later, EGFR monoclonal antibodies, commonly known as "targeted drugs," were developed. Typically, EGFR mutations make lung adenocarcinoma more sensitive to specific targeted drugs.

Mr. Zheng remained uneasy after undergoing timely surgical treatment and targeted therapy. The pathology report mentioned multiple lymph node metastases, indicating that the tumor had begun to spread through the lymphatic vessels. This situation poses a higher risk of recurrence in the future.
After reviewing Mr. Zheng's medical records, Professor Zhang Minghui made the following analysis and judgment:

1. The patient's postoperative pathological stage is stage IIIA, which is in the middle-to-late stage. Postoperative targeted therapy was administered without chemotherapy.

2. The presence of lymph node metastases is the main reason for the late postoperative stage, and airspace dissemination and intravascular cancer thrombus are also high-risk factors for future recurrence.

3. NKT therapy utilizes powerful immune cells to eliminate tumor cells that may remain undetected in the body, with essentially no side effects, making it very patient-friendly. NKT cell therapy can be combined with various other treatment options, and long-term stability can be achieved when combined with NKT cell therapy after taking targeted drugs.

Mr. Zheng decided to undergo NKT cell immunotherapy in April 2021, with an initial plan of one course per two months. Over the course of more than a year, nine courses of treatment were administered, and no signs of recurrence or metastasis were observed during follow-up assessments.


 

Imaging

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 Swelling  < H235>


 
Tumor markers: CEA and CA19-9 were within the normal range during follow-up from November 2020 to August 2022; SCCA was slightly higher than the normal range in February 2021, but both were within the normal range in August 2021 and August 2022.


 

 Conclusion and Comments

During 9 treatment courses over 16 months, Mr. Zheng's condition remained stable in multiple follow-up evaluations, and his overall mental and physical well-being had systematically improved.
In a study involving 682 patients randomly assigned to two groups (339 in the osimertinib group and 343 in the placebo group), among patients with EGFR mutations-positive non-small cell lung cancer (NSCLC) at stages IB to IIIA, those treated with osimertinib exhibited significantly longer disease-free survival compared to those receiving placebo[1]. However, most patients treated with osimertinib ultimately experienced relapse within a year, with intercellular metastasis of wild-type EGFR exosomes being one potential mechanism leading to osimertinib resistance in NSCLC[2].
Despite undergoing surgical treatment and taking targeted drugs orally for a period of time, Mr. Zheng still faced a significant risk of recurrence due to factors such as late-stage disease and vascular cancer thrombus. NKT cell immunotherapy played an indispensable role in reducing the risk of recurrence and metastasis by not only eliminating residual tumor cells but also strengthening the immune system, thereby providing long-term stability for patients.
Popular science knowledge is for reference only, and individual patients should seek clinical treatment accordingly.   
Reference:< H354>

【1】Wu YL, Tsuboi M, He J, John T, Grohe C, Majem M, Goldman JW, Laktionov K, Kim SW, Kato T, Vu HV, Lu S, Lee KY, Akewanlop C, Yu CJ, de Marinis F, Bonanno L, Domine M, Shepherd FA, Zeng L, Hodge R, Atasoy A, Rukazenkov Y, Herbst RS; ADAURA Investigators. Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer. N Engl J Med. 2020 Oct 29; 383 (18): 1711-1723. doi: 10.1056/NEJMoa2027071. Epub 2020 September 19. PMID: 32955177.

[2] Wu S, Luo M, To KKW, Zhang J, Su C, Zhang H, An S, Wang F, Chen D, Fu L. Intercellular transfer of exosomal wild type EGFR triggers osimertinib resistance in non-small cell lung cancer. Mol Cancer. 2021 Jan 18; 20(1):17. doi: 10.1186/s12943-021-01307-9. PMID: 33461557; PMCID: PMC7812728.

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