<Oncology Frontier>:So， brain metastases is a common and a serious clinical disease in patients with advanced lung cancer， which is also one of the common outcomes in lung cancer treatment failure. Could you give a simple introduction of the prognosis and treatment of patients with brain metastases?

　　《肿瘤瞭望》：肺癌脑转移是临床常见而严重的病情，也是肺癌治疗失败的常见后果之一。你可以简单介绍下发生脑转移患者的预后和治疗吗？

　　Professor Pirker：You’ve raised a very important question. Brain metastases are very frequent in patients with advanced lung cancer， and about up to 30% of the patients will develop at least brain metastases during the course of their disease. So， it’s very frequent. And lung cancer is among the cancers that – with the highest frequency. And brain metastases， of course， are a serious disease. They can be single， but they can also be multiple and treatment， of course， depends on many factors. First factor depends whether the patient is symptomatic or asymptomatic. If you are symptomatic， you have to have， to act immediately. If you have asymptomatic， single brain metastases， you might also consider systemic treatment but if you’re very symptomatic you need a rapid， immediate treatment that we usually is radiotherapy. So it depends on the symptoms in the brain or no symptoms. Then it depends also whether they have symptoms from the cancer outside the brain. If you have only disease outside the brain - let’s say only disease in the brain without disease outside the brain， you have to focus on the brain. If we have also disease outside the brain， you might consider systemic treatment， either alone or in combination with radiotherapy to the brain. Then it， of course， depends whether your track that you’re trying to treat can bypass the blood-brain barrier， and then， of course， we have several treatment options. So we have surgery， neurosurgery， we have radiotherapy， we have stereotactic radiotherapy， we have whole brain radiotherapy， and then， of course， we have also systemic treatment. Could be systemic， like the new tyrosine kinase inhibitors， which have shown that they penetrate also into the brain.

　　Professor Pirker：脑转移在进展期的肺癌患者中非常常见，30%的肺癌病人在疾病的某一阶段会出现脑转移。脑转移非常严重，可以表现单个转移灶，也可能同时出现几个病灶。治疗取决于以下几个因素：1、患者有无症状，如果已经出现症状，应该立刻进行相应治疗，即使无症状也要考虑全身治疗，如果症状明显，应该紧急进行干预；2、症状是否来自颅内病灶，如果症状来自颅内病灶，治疗当然针对颅内，如果症状来自颅外则可以单独采用系统治疗，或与脑放疗结合。3、治疗是否能穿过血脑屏障，这方面我们可以选择的方式有：外科、 神经外科、放射治疗、立体放射手术疗法、全脑放疗及包括TKI等的系统治疗等手段。

　　<Oncology Frontier>:Moving along， how should we treat advanced squamous carcinoma of the lung?

　　《肿瘤瞭望》：关于晚期肺鳞癌的治疗，您有什么看法？

　　Professor Pirker：Advanced squamous carcinoma of the lung depends on the area where you are living but in our area， in central and in middle – in Europe – approximately 30% of the patients with advanced non-small cell lung cancer will have a squamous cell subtype. And there is treatment， of course. We usually give first-line chemotherapy with platinum-based doublet， very often it’s given， for example， cisplatin plus gemcitabine， but you could also give cisplatin， docetaxel or cisplatin/vinorelbine， so there are several options. Then we usually give four to five - four to six cycles and after the patient’s progressed， we give second line treatment. So far we have second line treatment mainly with docetaxel， but now we hope to have also new treatment options with immune checkpoint inhibitors， which have shown activityparticularly also in pre-treated patients with advanced non-small cell lung cancer of the subtype of squamous cell carcinoma. So we have new options and several others are coming soon.

　　Professor Pirker：地区不同，晚期鳞癌的发病率也不同，欧洲中部约占30%。一线治疗多采用铂类为基础的双药化疗方案包括：顺铂+吉西他滨、顺铂+多西他赛或顺铂+长春瑞滨，一般给予患者4~5个周期。如果患者病情进展，则给予二线治疗，一般为多西他赛。现在有了新的治疗选择，即免疫节点抑制剂，其对于以前未治疗的非小细胞鳞癌患者中疗效显著，其他几种免疫节点抑制剂也将陆续出现。

　　<Oncology Frontier>: In terms of cancer patients with multiple organ failure， how would we treat advanced lung cancer in those patients?

　　《肿瘤瞭望》：发生多器官衰竭的晚期肺癌的患者情况十分凶险，临床应该如何处理？

　　Professor Pirker：Organ failure can occur but usually the patient that I see – they don’t have – it’s not a very frequent event. You have impaired organ function， you have impaired kidney function， you can have impaired bone marrow function due to treatment of bone marrow in light of the cancer. But occasionally you have patients who have high levels of， or have so much impaired kidney function that you can’t treat them with normal chemotherapy or you have to adapt the drugs based on the kidney function. So it’s a specific group that deserves specific expertise and you have to decide on a single basis – case by case – whether to start chemotherapy， whether you have availability of drugs that are not affected by this organs that have failure. If when you’re referring to multiple organ failure， I would suggest that this is mainly a patient with best supportive care.

　　Professor Pirker：发生多器官衰竭在临床还是比较少见，临床上肺癌患者可能出现肾功能衰竭、肝功能衰竭或骨髓抑制，偶尔会出现器官衰竭非常严重的患者，这些患者无法耐受普通化疗，临床治疗应该非常慎重，需要的医疗团队相互配合，根据患者的具体情况选择放疗开始的时间及方案。一旦患者出现多器官衰竭，那么最好的选择是姑息治疗。

　　<Oncology Frontier>:So do you think that targeted therapy is proper for patients with advanced metastatic disease?

　　《肿瘤瞭望》：靶向治疗是晚期肺癌患者治疗的重要内容，对此，您有什么看法？

　　Professor Pirker：That is true. There are groups of patients who require targeted treatments. We have several， we have for example， angiogenesis inhibitor pervasive bevacizumabin combination with first line chemotherapy for many years available. Then we had these new developments in the last ten years on the characterization of EGFR mutation positive disease and then also of ALK-positive advancements and more and more markers are coming such as ROS-1， also red effusions， so we have already oncogene-driven cancer with a specific marker adoration and they require specific targeted therapies. In the case of EGFR receptor， mutation positive disease we have at least three tracks in Europe: it’s Afatinib， it’s Gefitinib， it’s Erlotinib and to my knowledge in China you also have Icotinib available. So there are tracks available. For ALK disease we have also Crizotinib， and in both cases， both EGFR mutation positive disease and ALK positive disease we have already second-generation tyrosine kinase inhibitors， which enter the clinics.

　　Professor Pirker：的确如此，晚期肺癌的患者多采用靶向治疗，比如，贝伐珠单抗联合双药化疗方案作为一线治疗方案在临床已经应用了很多年，而近十年来，关于EGFR突变阳性以及ALK阳性的晚期疾病的治疗由来重大突破，越来越多新的靶点被发现，如ROS-1等，而且我们同样发现了一些特异性突变基因驱动的肿瘤亚型，这些肿瘤都需要寻找特异性的靶向治疗。对于EGFR受体突变阳性突变的患者，欧洲可选择的小分子靶向药物有三种：阿法替尼、吉非替尼、厄洛替尼，而据我所知，目前中国可选择的此类药物还有埃克替尼；而对于ALK基因重排的患者，我们可以选用克唑替尼；如果既有EGFR基因突变又出现ALK基因重排，那我们可以选用目前已经进入临床的二代酪氨酸激酶抑制剂。

　　<Oncology Frontier>:Okay. So moving on for the next conference. As the president of the next conference， can you tell us a little bit about maybe some preparations that are being made for that or some goals that you have or hopes that you have for the development?

　　《肿瘤瞭望》：我们都知道，世界肺癌大会是肺癌领域两年一届的盛事，您作为下一届大会的主席，对于大会将来的发展方向，您有什么样的期许？

　　Professor Pirker：Yeah， we have here a nice big conference， a world conference in Denver. And from now on， we have regular world conference on an annual basis. And the first annual， the first conference that is already one year after the last world conference will be the conference in Vienna， the world conference on lung cancer which will be held in Vienna from December 4th to December 7th.  The motto of the conference will be together， “Globally Together against Lung Cancer” and there will be three major topics which will be active prevention， accurate diagnosis， and advanced care. And I do expect that we get a global attendance， in particular I’m looking forward also to colleagues from China because China has a – because of the huge population size， you have a lot of lung cancers there and many doctors are very active in the field of lung cancer， and I hope that they will also attend the world conference on lung cancer and reach out to all the Chinese doctors besides them， of course， other doctors from Asia， but also from Europe， from America， from Africa， will be there so I try to have a global attendance， a global – global speakers， and I hope that we have an impact on this huge burden of lung cancer globally and also in China. So I’m looking forward to cooperation， to organizing this conference， to cooperation， also to get to know colleagues from China and maybe for future cooperation and exchange of experience， in particular， for example， if we think of the EGFR positive mutation disease， it’s China and the other Asian countries that have a high incidence rate of these types of cancer， in contrast to our European countries where the rate usually is much lower. So I’m looking really forward to this conference and welcome all the doctors from abroad.

　　Professor Pirker：我们刚刚在美国丹佛举办了这场盛会，从今年开始，我们的大会将一年举办一次，下届世界肺癌大会（WCLC）将于2016年12月4号~12月7号在奥地利的维也纳举行，会议的主题是“全球合作，共抗肺癌”，大会的三个主要话题是：肺癌的有效预防、精确诊断和晚期治疗。我希望能号召全世界的肺癌专家们积极参与，尤其是中国的肺癌专家，因为中国是肺癌大国，而且中国肺癌领域有很多经验丰富、学识渊博的临床医生和学者，我希望彼此增进了解、加强合作、交流经验，取长补短。例如，EGFR突变阳性患者在中国等亚洲国家的发生率很高，而在欧洲等地的发生率则很低，因此我真诚地希望他们能参与进来，加强合作和交流。除中国以外，我们也诚挚地欢迎来自亚洲、欧洲、美国和非洲的同事，我们希望组织真正意义上的全球大会，共同攻克人类的巨大威胁——肺癌。