编者按：2023年11月16日~19日，由中国抗癌协会主办、天津医科大学肿瘤医院等单位承办的2023中国整合肿瘤学大会（CCHIO）于天津举办。在国际专场，维也纳医科大学（Medical University of Vienna）Robert Pirker教授担任环节主持并发布了“非小细胞肺癌（NSCLC）辅助治疗进展”讲座。会议现场，“肿瘤瞭望”特别采访了Robert Pirker教授，详谈肺癌诊断、辅助治疗的发展与现状，以及参与CCHIO的感受。

 

Editor’s Note:The 2023 Chinese Congress on Holistic Integrative Oncology(CCHIO)，organized by the China Anti-Cancer Association and hosted by Tianjin Medical University Cancer Hospital，was held in Tianjin from November 16th to 19th，2023.In the international session 2，Dr.Robert Pirker of the Medical University of Vienna served as the moderator and delivered a lecture on"Adjuvant Therapy of Resected Non-Small-Cell Lung Cancer(NSCLC)"."Oncology Frontier"specially interviewed Dr.Robert Pirker，to brief and evaluate the recent diagnosis and adjuvant treatment of lung cancer，as well as his feelings about participating in CCHIO.

 

 

Oncology Frontier:can you share your feelings about participating in this CCHIO Congress?

 

Robert Pirker教授：2023中国整合肿瘤学大会（CCHIO）的举办与参与意义重大。肿瘤的治疗涉及不同学科，因此教育十分重要。对于中国这种肿瘤患者基数较大、相关领域进展与收获颇丰的国家而言，CCHIO无疑是极为关键的会议。本次大会展示了最新的肿瘤相关临床试验进展和肺癌领域全新的管理理念。大会还促进了国际交流。众所周知，不同国家的肿瘤发病率及其生物学特点存在差异，比如中欧等西方国家的肺癌多与吸烟有关，而中国女性人群的相关突变则较之大大降低。因此，对肺癌医生而言，为了给患者带来更多获益，了解不同领域的差异，开展相关研究，保持继续教育，维持合作互通是至关重要的。

 

Dr.Robert Pirker:I believe that this 2023 CCHIO holds great significance.Education，particularly interdisciplinary education regarding cancer，is of great significance.For a country like China，with a large population of cancer patients and significant advancements and achievements in related fields，CCHIO is undoubtedly a crucial conference.The conference provides the latest information on cancer clinical trials，keeping you update on recent developments in the management and treatment of lung cancer.The Congress also contributes to international exchanges given the variations in cancer incidence rates and biological features across different countries.For example，lung cancer in Central Europe is largely associated with smoking，whereas the prevalence of related mutations in the Chinese female population is significantly lower.Lung cancer doctors need to be aware of these differences.Therefore，research，knowledge，cooperation，networking，and education are essential for patients’benefits.

 

 

Oncology Frontier:Could you introduce the current status of lung cancer diagnosis and treatment in your country?

 

Robert Pirker教授：肺癌的诊断非常重要。首先是病理诊断和分子诊断，通过对各种突变开展分子分析，辅助诊断和后续治疗。其次，要明确肿瘤分期，肿瘤分期对治疗和预后均有影响。肺癌的治疗与分期密切相关。再者，CT、核磁共振、PET-CT、侵入性检查等技术和手段也能提供更多诊断信息。肺癌的诊断和分期为给患者提供正确的治疗参考信息十分必要。

 

Dr.Robert Pirker:Lung cancer diagnosis is paramount.First and foremost，pathological and molecular diagnoses are necessary.The molecular analysis of various mutations facilitates diagnosis and subsequent treatment.Additionally，tumor staging should be clear，as it is closely associated with both prognosis and treatment of cancer，such as lung cancer.Furthermore，techniques and methods such as CT，MRI，PET-CT，and invasive examination can also provide more diagnostic information.Therefore，the diagnosis and staging of lung cancer are crucial for formulating correct treatment plans for the patient.

 

 

Oncology Frontier:How do you view the research progress in the treatment of advanced lung cancer，especially in the field of rare mutated lung cancer?

 

Robert Pirker教授：我们在80年代后期就开始实施姑息性化疗了。如今姑息性化疗发展完善，在没有基因突变的患者中，只能随着疾病进展而更换化疗方案。在有基因突变的情况下，针对EGFR、TKI、ALK、BRAF等靶向药物发挥着重要作用。对于肺癌罕见突变如何精准选择靶向药物，目前有很多新进展。本次CCHIO会议中，来自德国的Jürgen Wolf教授作为该领域的知名专家，在肺癌罕见突变领域开展了许多Ⅰ~Ⅲ期新药临床研究，临床经验丰富，于会中分享了重要观点。肺癌罕见突变领域一日千里，治疗手段飞速发展，我们要总结经验、深入学习培训，才能跟上时代发展的脚步。我想，这也是此次CCHIO举办的意义所在。

 

Dr.Robert Pirker:We have been using palliative chemotherapy for treatment since the late 1980s.Now，palliative chemotherapy has been well established.We moved from one chemotherapy regimen to another if the disease progresses in patients without molecular driver mutations.For patients with driver mutation，we have several targeted agents such as EGFR，TKI，ALK，BRAF inhibitors.

 

There are many new developments in how to accurately select targeted drugs for rare mutations in lung cancer.At this CCHIO meeting，Professor Jürgen Wolf from Germany，a well-known expert in this field，has conducted many phase I to III clinical studies of new drugs in the field of rare mutations in lung cancer.He has rich clinical experience and shared important views about rare mutation in this congress.Both the field of rare mutations in lung cancer and the corresponding treatment methods are developing rapidly.We need to summarize our experience and deepen our learning and training to keep up with the pace of development.I think this is also the significance of holding this CCHIO.

 

 

Oncology Frontier:How do you view the research progress in preoperative treatment of lung cancer，including preoperative neoadjuvant and postoperative adjuvant therapy?

 

Robert Pirker教授：早在我入行时，肺癌辅助治疗已是主要的研究课题之一，彼时辅助化疗尚不成熟。后来，一系列研究的阳性结果表明，如含铂方案等辅助化疗可以提高患者的治愈率，从而为非小细胞肺癌患者术后辅助化疗树立了重要的里程碑。当辅助化疗的效果确立后，人们开始尝试是否能将化疗时机提前，比如在术前用作新辅助治疗。在早期治疗阶段，患者血流状态好，药物可更好的到达肿瘤，从而对肿瘤的可切除性产生影响。因此术前新辅助治疗同样非常重要。

 

如今，伴随着诊疗技术的发展，化疗联合免疫治疗已成为非小细胞肺癌的新选择。在驱动基因突变阴性时，对于Ⅰ期、Ⅱ期非小细胞肺癌患者可采取化疗联合免疫治疗辅助治疗；对于Ⅲ期考虑切除的患者，化疗联合免疫新辅助治疗是可选的方案。已有研究显示，早期化疗联合免疫新辅助治疗可提升手术机会，但其疗效是否优于辅助治疗有待验证。在驱动基因突变阳时，基于临床研究中的生存获益，埃万妥单抗(amivantamab)已成为EGFR突变阳性非小细胞肺癌患者术后的标准治疗方案；厄洛替尼、阿莱替尼等靶向治疗也可以提高早期非小细胞肺癌的治愈率。

 

尽管我们在肺癌的诊断和治疗方面取得了重要进展，但仍须强调的是，全世界约有70%的肺癌可以通过禁烟来避免，因此对烟草的管控非常重要。此外，新的筛查、诊断方式是防治肺癌的措施之一，可通过低剂量CT进行早期筛查，未来或将进一步与人工智能相结合。尤其对于重度吸烟者，早期筛查更应逐步实施。因此，未来我们需采取多种策略防治肺癌，包括烟草控制、早筛早诊、准确分期、精准病理分型和分子分型和个体化治疗等方面。

 

Dr.Robert Pirker:Early in my career，the use of adjuvant therapy for lung cancer had already emerged as a major research topic.It had not yet been established at that time.Later，a series of positive studies showed that adjuvant chemotherapy，such as platinum-based regimens，can improve the cure rate of patients，thus establishing an important milestone for adjuvant chemotherapy in patients with non-small cell lung cancer.Then，people began attempting to use adjuvant chemotherapy earlier as neoadjuvant treatment or preoperative treatment.In the early NSCLC stage，patients have good blood flow，allowing drugs to reach the tumor more effectively and might contributing positively to the resectability of the tumor.Therefore，preoperative neoadjuvant therapy is also an important area.

 

Nowadays，chemotherapy combined with immunotherapy has become a new option for non-small cell lung cancer.In patients with no driver gene mutations，chemotherapy combined with immunotherapy can be used as adjuvant therapy for stage I and II non-small cell lung cancer patients，with the aim of aggressive treatment to enhance resectability.For stageⅢpatients where resectability might not be well achieved，chemotherapy combined with immunotherapy as neoadjuvant therapy may improve the resectability rates.Studies have shown that chemotherapy combined with immunotherapy can enhance surgical opportunities，but whether its efficacy is superior to adjuvant therapy remains to be verified.

 

In patients with positive driver gene mutations，based on survival benefits in clinical studies，Amivantamab has been established as the standard treatment in patients with completely resected and EGFR mutation positive non-small cell lung cancer patients.Targeted therapies such as erlotinib and alectinib can also improve the disease-free survival in early stage non-small cell lung cancer.

 

Although important progress has been made in the diagnosis and treatment of lung cancer，it is important to note that on a global level，approximately 70%of lung cancers could be avoided by smoking cessation.So tobacco control is very important.In addition，screening with new diagnostic modalities，including early detection with the option of low-dose spiral CT and perhaps in the future in combination with artificial intelligence，is another important dimension.For heavy smokers，early screening should be implemented step by step.Therefore，we need to adopt multiple strategies to prevent and treat lung cancer in the future，including tobacco control，early detection and diagnosis，accurate tumor staging，precise pathological and molecular typing，and personalized treatment.