Lung cancer case study and clinical trial

Patient Lu was diagnosed with lung adenocarcinoma and lymph node metastasis on August 26, 2005. A left lower lobectomy was performed on September 22, 2005. Carboplatin combined with taxotere was used 4 times after surgery. On August 3, 2007, due to pleural effusion, the diagnosis was confirmed to be recurring, and she was treated with Tarceva (the number of cycles is unknown). On January 8, 2008, the cancer progress was found on the reexamination, and then Tarceva treatment was stopped and Libita treatment was started for 16 cycles. At the same time, vertebral hip metastasis was found and 4 cycles of Zetai were performed.

In July 2010, Mr. Lu reexamined a large area of ​​brain metastasis and found dozens of small lesions in the brain. He also tested positive for the EML4-ALK fusion gene at the University of Chicago School of Medicine. The whole brain radiation therapy was then used to control the lesions, and the second phase of crizotinib drug trial was started at St. Louis University Hospital. During the treatment, the condition was stably controlled, but a re-examination in May 2012 found that the cancer had progressed slightly, and the tumor was suspected to be resistant to crizotinib. He stopped crizotinib on July 18, 2012.

On August 6, 2012, Mr. Lu participated in the AP26113 drug clinical trial at Denver Hospital. In October, the PET examination showed that the tumor disappeared and the tumor in the brain decreased and became large.

Re-examination in July 2014, whole-body PET showed: Brain lesions were basically stable, and chest had obvious progress. On May 12, 2014, the suspected anti-AP26113 lymph (3 cells, biggest 1.1 cm) cultured cell lines were performed at Massachusetts General Hospital and continued to take AP26113.

In August 2014, the doctor called and found that Mr. Lu’s new tumor tissue sequencing detected rare or unseen mutations. This mutation was only reported in ALK-positive children’s neuroblastoma and inflammatory myofibroblastoma. Previous research reports and medical evidence have shown that crizotinib cannot cope with the resistant neuroblastoma caused by this mutation. New genetic test results indicate that Mr. Lu may need to find new drugs for treatment.

On December 8, 2014, after a doctor’s analysis and decision, Mr. Lu was approved to increase the dosage of AP26113 and changed it to 240 mg per day, so the drug replacement plan was temporarily delayed. After observing the efficacy, he decided whether to change the drug and participate in other clinical trials. The patient learned through the hospital that NIVOLUMAB monoclonal antibody immunotherapy phase 3/4 drug test is recruiting lung cancer patients on a large scale, and Mr. Lu is fully confident of the future anti-cancer.