Background: This real‐world study assessed the efficacy and toxicity of anlotinib as salvage treatment in Chinese patients with advanced non‐small cell lung cancer (NSCLC).Methods: The medical records of 81 patients with advanced NSCLC who had failed at least two lines of chemotherapy were retrospectively collected. All patients were administered anlotinib treatment until disease progression or intolerance as a result of adverse events. Survival curves were created using the Kaplan–Meier method. The log‐rank test was used for univariate analysis of progression‐free survival (PFS) between groups. Cox regression was used to estimate the statistically significant factors based on univariate analysis.Results: The median PFS was five months (95% confidence interval [CI] 3.5–6.5). The objective response rate (ORR) was 7% and the disease control rate (DCR) was 84%. The following subgroups of patients had longer PFS (P < 0.05): squamous cell carcinoma, no brain or liver metastases, Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–1, and no previous VEGF‐tyrosine kinase inhibitor treatment. The results of Cox regression indicated that an ECOG PS of 0–1 (hazard ratio 0.152, 95% CI 0.057–0.403; P = 0.00) and patients without brain metastases (hazard ratio 0.421, 95% CI 0.195–0.911; P = 0.028) had longer PFS following anlotinib treatment.Conclusion: Anlotinib, which is well tolerated, plays a significant role in the salvage treatment of advanced NSCLC. Patients with advanced NSCLC with an ECOG PS of 0–1 and no brain metastases achieved longer PFS following anlotinib salvage treatment.

Background: Thymoma and thymic carcinoma are rare thymic epithelial tumors. We investigated the efficacy of first‐line gemcitabine and cisplatin (GP) chemotherapy versus gemcitabine and cisplatin chemotherapy combined with the anti‐angiogenic drug endostar (GP + E) in advanced thymoma and thymic carcinoma.Methods: The records of 45 patients with invasive metastatic thymomas or thymic carcinomas treated with GP as first‐line therapy between August 2008 and July 2017 at the Department of Respiratory Medicine, Peking University Cancer Hospital and Institute were retrospectively reviewed.Results: Eighteen patients (75%) in the GP + E group achieved a partial response and six (25%) had stable disease. In GP only group, nine (42.8%) patients achieved a partial response, 11 (52.4%) had stable disease, and one (4.8%) had progressive disease. The GP + E group had a significantly higher overall response rate (75% vs. 42.9%; P = 0.028), and median progression‐free survival (PFS) and overall survival (OS) of 19 and 76 months, respectively. In the GP only group, median PFS and OS were 16 and 29 months, respectively. PFS and OS were not significantly different between the groups.Conclusions: GP has moderate efficacy and could represent a suitable first‐line therapy for thymic carcinoma and thymoma. Chemotherapy combined with endostar could improve the overall response rate, but did not prolong PFS or OS.

Recent clinical trials have suggested that solid cancers with mismatch repair (MMR) deficiency are highly responsive to immunotherapy, regardless of cancer types. Previous MMR-related studies on breast cancer have predominantly focused on germline variants. However, the somatic MMR alterations have not been comprehensively characterized in breast cancer. In this study, we integrated genomic, transcriptomic, and clinical data from over 3000 breast cancer cases across six public cohorts. Our findings revealed that 1.2% of breast cancers harbored oncogenic somatic MMR alterations, with triple-negative breast cancer (TNBC) demonstrating the highest mutation rate at 3.1%. Additionally, somatic MMR alterations were significantly associated with microsatellite instability-high (MSI-H) and MMR-related mutational signatures, indicating that somatic MMR alterations led to impaired function of the MMR system. Biallelic inactivation of MMR genes resulted in a more pronounced loss of MMR function compared to monoallelic inactivation. Importantly, these MMR alterations significantly increased the tumor mutational burden (TMB) and neoantigen load in breast cancer, regardless of MSI-H status. These findings indicate that the frequency of MMR alterations is highest in TNBC and that MMR alterations in breast cancer can lead to MMR functional deficiencies, suggesting that some patients harboring such alterations may benefit from immunotherapy.

Background: Currently there is no standard therapy recommended for second‐line treatment for thymic carcinoma. Our study compared multidrug chemotherapy, single‐agent chemotherapy, and PD‐1 inhibitors in patients diagnosed with advanced thymic carcinoma who had previous platinum‐based chemotherapy at the clinic.Methods: The study included patients with thymic carcinoma who failed first‐line platinum‐based chemotherapy. Kaplan–Meier methods were applied in the study for estimating the progression‐free survival (PFS) and overall survival (OS) curves. Pearson chi‐square or Fisher's exact chi‐square test was adopted to make comparisons of the objective response rate (ORR) between treatment groups. Cox regression was used for the multivariate analyses in PFS and OS.Results: Among the 92 patients enrolled, multidrug chemotherapy was used in 51 (55.4%) patients for second‐line therapy. Thirty‐six patients (35.9%) received single‐agent chemotherapy, and eight patients (8.7%) underwent PD‐1 inhibitors. The multidrug chemotherapy group showed better efficacy than the other two groups, with an ORR of 35.3% (p = 0.006). The median PFS of multidrug chemotherapy, single‐agent chemotherapy and PD‐1 inhibitors were 5.0 months, 3.0 months, and 4.0 months, respectively (p = 0.008). Patients in the multidrug chemotherapy group also showed an advantage in OS in comparison with the other two treatment groups (p = 0.045), with a median OS of 30.4 months. Multivariate analysis showed that second‐line treatment was independent factor for both PFS (p = 0.035) and OS (p = 0.037). Grade 3–4 AEs were mostly detected in patients receiving multidrug chemotherapy and were primarily hematologic. Treatment‐related mortality was not found in any of the groups.Conclusions: Multidrug chemotherapy had a trend toward a more positive response rate and outcomes in longer survival time than single‐agent chemotherapy and PD‐1 inhibitors. Multidrug chemotherapy is a choice worth considering for second‐line therapy in patients with thymic carcinoma if tolerable.

Existing research suggested that the intratumoral microbiome participates in the progression and metastasis of lung cancer. However, its role in distinguishing benign from early-stage malignant pulmonary tumors remains poorly characterized. In a single-center retrospective cohort of surgically resected nodules (2021–2023), specimens underwent five-region (V2, V3, V5, V6, and V8) 16S rRNA sequencing. After 2:1 propensity-score matching and sequencing QC, 98 FFPE specimens were analyzed (66 malignant; 32 benign). Diversity and community structure were compared using Chao1/Shannon indices, Bray - Curtis PCoA, and PERMANOVA (999 permutations). An eight-genus logistic-regression classifier was internally validated by 1,000-iteration bootstrap and five-fold stratified cross-validation. Malignant lesions exhibited greater microbial richness and evenness than benign lesions (Chao1, p = 0.007; Shannon, p = 0.029) and a distinct overall community structure (PERMANOVA R² = 0.020, p = 0.021). Lipopolysaccharide immunostaining indicated a higher bacterial signal in malignant tissue (median H-score 3.3 vs 1.5; p < 0.001). We developed an eight-genus diagnostic model, with five genera (Myroides, Knoellia, Pelomonas, Peptostreptococcus, Porphyrobacter) enriched in the malignant group. The model demonstrated stable discrimination on internal validation, achieving a bootstrap median AUC of 0.769 (95% CI 0.574–0.903) with sensitivity 0.864 and a five-fold cross-validation AUC of 0.783 (95% CI 0.661–0.905); when trained on the full dataset, the AUC was 0.829 (95% CI 0.744–0.913). Among malignant cases, higher model-derived risk scores showed a non-significant trend toward lymph node metastasis (p = 0.075), and DFS did not differ across risk strata (5/66 events; p = 0.474). PICRUSt2-based functional prediction suggested enrichment of pathways related to focal adhesion, calcium signaling, O-glycan biosynthesis, and immune-associated processes in the malignant group. The intratumoral microbiome is distinctly altered in early-stage malignant pulmonary tumor. A microbiota-based diagnostic model demonstrates good accuracy for discriminating malignant from benign pulmonary lesions, highlighting its potential as a novel diagnostic biomarker. Prospective multicenter validation and assessment in minimally invasive specimens are warranted. The online version contains supplementary material available at 10.1186/s12967-026-08078-1.