Molecular prediction of advanced lung cancer and gastrointestinal tumors in the era of precision medicine and optimization of internal medicine treatment models

Problem and objective to be solved: 1. Determine the testing platform for molecular pathology and gene testing, and find an economical and convenient method and platform that meets quality control standards. 2. By analyzing the results of molecular pathology and genetic testing, identify biochemical markers related to therapeutic efficacy. 3. Explore an optimized internal medicine treatment model that focuses on chemotherapy, targeting, and immunotherapy. Reasonably design clinical trials, obtain guiding experimental data (Chinese data), and serve clinical practice. 4. Further promote the professionalization and internationalization of various work in our center (department) through cooperation. Apply for assistance in inviting experts to jointly organize academic conferences and conduct training for oncology professionals in multicenter clinical trials and basic experimental research. The European Institute of Oncology (IEO) in Milan, Italy, and the Royal Marsden Cancer Center in the UK have advanced tumor transformation research centers, which have advanced concepts in both basic tumor research and clinical treatment, and are at the forefront of the international community. It is our ideal partner. Precision treatment "has been a hot topic in the past two years, with lung cancer and gastrointestinal tumors being common malignant tumors in our province." Precision treatment "has been a hot topic in the past two years, while lung cancer and gastrointestinal tumors are common malignant tumors in our province. The treatment of solid tumors has entered an era of precise molecular targeting from non-selective or solely relying on pathological types of chemotherapy a few years ago. Non small cell lung cancer is the first model to practice "precision treatment". Patients with advanced non-small cell lung cancer need to undergo molecular genetic testing, including whether EGFR, ALK, and ROS-1 undergo mutations or fusion, based on a clear pathological diagnosis. Molecular targeted therapy should be considered first, followed by further genetic testing to clarify the mechanism of drug resistance and determine subsequent treatment. The biggest problem faced by immunotherapy is that the molecular markers related to efficacy and beneficiaries are currently uncertain. For example, PD-1 inhibitors do not emphasize PD-L1 testing in second-line treatment of advanced non-small cell lung cancer. However, some studies have shown that PD-L1 testing is needed to select patients for greater benefits. As a traditional treatment of chemotherapy, there are currently no clear molecular indicators in clinical practice to guide the selection of chemotherapy drugs. The selection of chemotherapy drugs is mainly based on pathological types such as adenocarcinoma or squamous cell carcinoma. So, in the era of precision therapy, although we have started the practice of precision therapy, there are still more work and challenges to go before comprehensive and in-depth precision. For example, the planning and selection of internal medicine treatment modes with targeted, immune, and chemotherapy as the main treatment methods, single drug or combination (chemotherapy, targeted, and immune)? What is the timing of treatment, first or second line? What are the beneficiaries? Is there any suitable biomarker? Efficacy evaluation? How to prevent and manage security? How to explore and optimize internal medicine treatment models under the guidance of precise diagnosis is a new issue, hotspot, and focus of clinical research. The application of new medical technologies and drugs in clinical practice has also continuously improved the median survival of patients with gastrointestinal tumors. However, there are indeed significant differences between different patients and tumor characteristics, among which molecular changes play an important role. Basic research has shown that there are multiple molecular events in different processes of tumor progression. For example, colorectal cancer has identified multiple molecular changes and is known to have multiple molecular signaling pathways involved in tumor progression. The detection of genes and molecular pathology has important value in predicting therapeutic effects and disease prognosis. Similar to non-small cell lung cancer, molecular detection also has a guiding role in targeted treatment, and there are issues with optimizing internal treatment strategies. The Department of Oncology and the Institute of Oncology of our hospital have established a database of data specimens. Based on the above situation, we began to lead relevant research. Now we plan to expand the research, use clinical specimens and clinical information, use immunohistochemistry, molecular biology, proteomics, experimental zoology, and biochip technology to continue basic and clinical trials. The Royal Marsden Cancer Center in the UK focuses on innovative research in tumors and has won the Queen's Innovation Technology Award for its drug research and development achievements. With an advanced tumor transformation research center, it helps us learn from advanced drug research and development concepts to carry out innovative research. Rolf M. Zinkernagel (professor of experimental immunology at the University of Zurich, Switzerland) won the Nobel Prize for discovering the characteristics of cell-mediated immune defense. He has profound achievements in immunology, and in-depth academic exchanges will bring new ideas to tumor immunotherapy. Introducing foreign intelligence, strengthening international cooperation, and improving our own clinical research level, gradually aligning with international high-level clinical research, are currently urgent tasks that we need to complete. We hope that both parties can engage in extensive and in-depth cooperation in the fields of conducting translational medicine research and clinical trials, exchanging new oncology technologies, jointly organizing academic conferences, and applying for funding to support the training of oncology professionals.