lung cancer treatment breakthroughs

1 Another piece that we physicians often are disconnected from is, I think, the financial piece— having an organized financial picture of what going through cancer treatment means for the patient and their family’s well-being. In stage 3 disease, for example, we have unequivocal data that one checkpoint inhibitor, durvalumab (Imfinzi), at least as of now, improves outcomes. That would be a third point. Cancer was traditionally treated with surgery, heat, or herbal (chemical) therapies. One more treatment to keep the cancer from coming back. Then you think about, How do we do this at a larger scale, in a way that is more structural and less individual, that is more foundational? From 2013-2017 alone, that number dropped to 5%. It is important to note that tobacco is an important player in the pervasiveness of cancer, it is responsible for approximately 22% of cancer-related deaths. Precision medicine uses drugs personalized to the individual, as well as immunotherapy in treating cancer. Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. That’s a hallmark of Winter Lung and it has been for quite some time. Patience experience is really the totality of the experience of these individuals, like you and me, or loved ones, who, at that moment, are afflicted with a very serious illness and are very vulnerable and dependent on people who can provide knowledge and support to guide them through that process. We can only imagine the changes coming years' promise in the diagnosis and treatment of lung cancer. After finishing school and beginning my training, I realized I wanted to become a medical oncologist. It is designed to attack cancer cells directly. World Cancer Day 2020: Top leading breakthroughs in cancer treatment U.S. Food and Drug Administration approved this new tool in fighting lung cancer in May 2019. Researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to clearly reduce risk. And I think we’re going to see similar data for other molecular alterations. It’s that sense that if you have, say, breast cancer, you will enter the Banner MD Anderson facility and you will have the same experience as another patient with breast cancer who enters a different MD Anderson facility in a different state. It’s what characterizes what we, as a cancer program, have to offer our patients in terms of clinical excellence, operational excellence, and in strong and compassionate support throughout that experience. TOPIC: TAGRISSO: BREAKTHROUGH TREATMENT FOR LUNG CANCER. Having an orderly way to manage bills, and having a way to pay for those bills, is all related to patient-centered care, and it’s a huge onus that we impose on our patients and their families. Lung cancer is the most common cause of cancer death in both men… How Biomarkers Can Help With Lung… Get Science Podcast: Pushing the Frontiers of Cancer Cell… Continuing our series on “rule-breaking” science. So, I think it is harder to apply that concept of cure to advanced disease in lung cancer at this point. Lung cancer incidence and mortality in the United States have been on the decline, due in large part to a sharp reduction in tobacco use. And are we treating those patients according to evidence-based algorithms and guidelines? LILENBAUM: One question I’d like to see discussed is whether we have optimized the use of targeted therapy. Those were questions that dominated the conversation, I would say from 1995 to 2005, when we started to steer more in the direction of targeted therapy, and that’s where I cut my teeth in lung cancer. So far it hasn’t been actionable in the sense that we have an agent to target that mutation. This is due in no small part to scientific and technological breakthroughs such as: A leading cause of increased lung cancer mortality is the slow detection of the disease. They can also affect the tissue environment, making it highly unfavorable for cancer cells to grow. With innovative screening methods like Low Dose CT scans however, we’re starting to see a noticeable change in the status quo. N Engl J Med. 2600 BC – Egyptian physician Imhotep recommended producing a localised infection to promote regression of tumours. There are some promising early data showing that this approach may have some efficacy in solid tumors as well. Above all, [how do we do it] in a way that sets a culture for high-quality service to patients? [Yet,] it surprises me at times that powerful data like this are still not applied more widely, as they should be. If you see patients quickly, they’ll come to you, as opposed to having to wait a week or 2. It’s not as pervasive or as generalized as it should be. This was further complicated by the advent of immunotherapy. If the term ‘angiogenesis’ sounds familiar, it captures this formation process. I also had the opportunity—or the responsibility, I guess—to implement changes that would change how we delivered care across, in that case, the whole state of Connecticut. I enjoyed not only the practice of medicine in the United States, but the academic component and specifically the opportunity to be involved in clinical research. Q: You’re originally from Brazil. By Newsd Updated on : Mon 03rd February 2020, 06:12 PM. Immunotherapy employs drugs to engage the immune system  to identify and destroy lung cancer cells. LILENBAUM: Well, first, physicians in my generation were not trained in, and did not necessarily graduate from fellowship with, organization skills or leadership skills. Taking one lucky guess, it can be quickly deduced that ‘immunotherapy’ employs the use of individual immune systems to stave off cancer cells. Treatment for lung cancer is managed by a team of specialists from different departments who work together to provide the best possible treatment. In today’s Medical Moment, more on a lung cancer drug that the FDA has granted breakthrough status. Its growth is creeping and symptoms usually fail to appear until after the cancer is already advanced. So, it’s about the clinical piece and it’s about the operational piece, which is something we focus on quite a bit. How Biomarkers Can Help With Lung Cancer Treatment. Non-Small Cell Lung Cancer: NSCLC is a more common form of lung cancer, affecting around 80 - 85% of lung cancer patients. To sustain growth, tumors require the formation of blood vessels to keep nourished. It is typically caused by tobacco smoking and is further divided into two: small cell carcinoma and combined small cell carcinoma. These therapies target the specific genes and proteins that are involved in the growth and survival of cancer cells. The immune system is usually poised to defend the body from dangerous external invaders. “Our prior way of practicing was that all lung cancers are the same, and they all get treated the same way,” Leal says. LILENBAUM: I think one benefit of attending Winter Lung is the opportunity to hear about the most important advances in the field of lung cancer through the opinions of experts. And to create that alignment, to create that sense that it’s all one package, is a pretty challenging goal from an administrative and financial perspective.ν, 1. So, I had an early entry into the world of lung cancer and lung cancer investigation and research. There are surgical advances, improvements in radiation, and new drugs that … I don’t have an MBA, for example, as some [colleagues of mine] do. Granted, the management of stage 2B patients is complicated, and not everyone follows the [same] paradigm: In order [for a patient] to get to the durvalumab [treatment], you have to have received concomitant chemo and radiation, and not everybody does. And I had the opportunity when I was recruited to be the chief medical officer for the Yale Cancer Center and the Yale Cancer Hospital, and I worked with some of the best people in the country in every aspect of cancer care and was exposed to a tremendous amount of information and knowledge that I did not acquire formally. Lung cancer is the leading cause of cancer deaths worldwide. For any hope of survival, medical or surgical treatment is necessary. LUNG CANCER: Lung cancer is a type of cancer that begins in the lungs, which are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. An EGFR mutation is present in about 15 percent of all lung cancer cases in the United Sates. The addition of 15% in survival with lung cancer is a major advance. Without treatment, patients may die even sooner. It’s also about the financial piece and the cultural piece. And then on top of that, you have an opportunity to get editorial comments and personal opinions from national and international experts. Are we testing everyone for all the actionable mutations? Cancers sprout from abnormal genes or changes in gene formation. [Unfortunately,] we don’t think of access as being a patient-centered exercise, but instead as a business opportunity. That’s where immunotherapy comes in. And that’s what we want to see. Notably, 2018 also saw the first small cell lung cancer treatment approved in over a decade. Also: Do you really need a platinum agent? Yet at the end of the day, it really is unconscionable to keep someone who was just given a diagnosis of cancer waiting for weeks to see a physician, just to obtain a basic understanding of what their illness is. THE NEW HEAVY HITTERS Are lung cancer screenings worth it? Follow Newsd On Cancer is one of the leading cause of death worldwide. Why is that? This method avoids the broad-based treatment given to cancer patients. I think those agents are promising, and then you can take that concept of immune manipulation and take it all the way to even chimeric antigen receptor T cells, which we now use for leukemias and lymphomas. Nina Massey. It is important to note however, that with lung cancer disproportionately affecting the elderly, it is important for those aged 65 and above to observe early screenings to aid the detection and treatment of the disease. Our purpose is clear – to deliver breakthroughs that change patient’s lives. If you want to know more, ask your doctor or nurse about this. So, the benefit ratio for treating advanced patients at the time improved significantly, and there was a lot of conversation about how to utilize those new drugs. It uses high-end tech of robotics, software, data science and endoscope innovation. In some patients, the benefit of checkpoint inhibitors is nothing short of extraordinary. This screening method is breaking new grounds in the detection and subsequent treatment of lung cancer. Lung cancer is typically treated with a variety of treatment options including surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. We had a huge influx of new chemotherapy drugs in lung cancer, and this was a disease that up until the early to mid-1990s had essentially 1 or 2 regimens that had shown some efficacy, and, by the way, horrendous toxicity. The latest cancer drug to get the green light from the FDA is the first to use the immune system to tackle hard-to-treat lung tumors. Why are we not optimizing the use of targeted therapy for these patients? In recent years, enormous advances hav … Nanomedicine for Treatment of Lung Cancer Adv Exp Med Biol. When you [use immunotherapy] in early-stage disease, what you’re doing is not only prolonging life, but increasing the cure rate. Unfortunately, cancer cells can take over these checkpoints to avoid getting detected by the body’s immune system. These changes can be brought on by environmental changes, inheritance or can be spontaneous. From 2013-2017 alone, that number dropped to 5%. A second issue is how we can identify patients who truly benefit from checkpoint inhibitors beyond just PD-L1. However, while these figures might seem daunting, scientific and technological breakthroughs have ensured that a steady decline has been recorded in the number of lung cancer-related deaths over the years. An EGFR mutation is present in about 15 percent of all lung cancer … Q: Along your career path, you transitioned into a more administrative position. But first, a quick look at the types of cancers, to better understand the measures that are being taken to manage their effects. Types of targeted therapies include monoclonal antibodies and small molecule drugs. Q: When it comes to immunotherapy, the term “cure” comes up with other cancers, notably with melanoma, but not, it seems, with lung cancer. All rights reserved. We’ll be examining these breakthroughs and the impact they’ve had in revolutionizing lung cancer diagnosing and treatment. Targeted therapy is popularly employed in the treatment of Non Small Cell Lung Cancer. 3 Major Cancer Breakthroughs and What They Mean for You. LILENBAUM: I have made that comment a few times. This progress is due in part largely to reductions in smoking and subsequent declines in lung cancer mortality, which has occurred as a result of improved management and treatment approaches for non–small cell lung cancer (NSCLC). REPORT: MB #4815. One more treatment to keep the cancer from coming back. A second benefit is that we tend to give everybody an opportunity to present a case. “Pfizer also works hand-in-hand with the broader cancer community to support people with lung cancer, including metastatic disease. Treatments such as supplemental oxygen and medications are available to help you feel more comfortable, but they aren't always enough.To cope with shortness of breath, it may help to: 1. But fear and anxiety only make it harder to breathe. "This represents a tectonic shift in the treatment of lung cancer," said study co-author Joseph Paul Eder, MD, professor of medicine (medical oncology) in the Phase I … While mutational targets have been identified, and newer therapeutics have been approved, optimizing that targeted therapy and sequencing every patient in order to treat them in accordance with current guidelines and algorithms remains a challenge. Do you really need 2 drugs, or is 1 drug sufficient in some patients? However, to prevent it from attacking internal organs and cells,a  measure like immune checkpoints are designed to suppress the system to prevent damage. And I think that’s an important issue. Like small cell lung cancer, this cancer is popularly caused by tobacco use. Ancient Era. How do you treat elderly patients or patients with a performance status of 2? Dispelling this worry is a 10-year long study which proved that this fear is needless, with only 2 in 10,000 men and 6 out of 10,000 women contracting cancer during its course. Immunotherapy helps to block these checkpoints, making it easier for the body to recognize and attack cancer cells. © 2021 MJH Life Sciences™ and Cancer Network. According to the Ebers medical papyrus, this was done by placing a poultice near the tumour, followed by local incision. With measures like Low Dose CT-Scans making the early detection of cancer cells possible, targeted therapy to ensure the specialized treatment of cancers, and other measures like immunotherapy and personalized medicine offering personalized care against lung cancer — this disease is gradually becoming less of a potent threat as the years go by. New type of T-Cells can recognise and kill most types of cancer . In the study 69% of patients who had chemotherapy were alive 5 years later, as compared to 54%% of those who did not. More importantly, we will see data for immunotherapy in the early-stage settings. LILENBAUM: I came purely for professional reasons. Q: Why is that? Q: You are a cochair for the 18th Annual Winter Lung Conference®. I wanted to take on a program that was poised to take a qualitative step toward excellence, and patient centeredness, and an integrated delivery system, and that’s why I moved to Phoenix, Arizona. Latest development: Recently announced treatment breakthroughs provide new hope for people with non-small cell lung cancer (NSCLC)—the type of malignancy responsible for 85% of all lung cancers. These breakthroughs also contribute to the rapid reductions in mortality from hematopoietic and lymphoid malignancies and more recently in specific … Although the treatment of lung cancer has made great breakthroughs in recent decades, traditional chemotherapeutic drugs lacked specific targeting specificity for … I think a significant percentage of patients with NSCLC and nonsquamous histology who have potentially actionable mutations don’t always get treated as such. Not counting skin cancer, lung cancer (both small cell and NSCLC) is the second most common cancer in both men and women. When the immunotherapy treatment was given to lung cancer patients, they tended to live much longer, according to one of the studies published in the New England Journal of Medicine. But the good news is, treatment options are now extending the lives of many people affected by this formidable disease. This may seem very obvious, but it’s far from obvious in clinical practice. 2020;383(7):640-649. doi:10.1056/NEJMoa1916623, https://seer.cancer.gov/statfacts/html/lungb.html. W… Q: What was going on at that point that attracted you to the field? Feeling short of breath can be scary. Many people with lung cancer experience shortness of breath at some point in the course of the disease. It is the only screening method approved by the US Preventive Services Task Force for lung cancer. According to the World Health Organization, in 2018 alone, lung cancer accounted for around 2.09 million of the 9.6 million cancer-related deaths recorded worldwide — the most common cause of cancer. And that’s a humanistic component. This team includes the health professionals required to make a diagnosis, to stage your cancer and to plan the best treatment. We have case presentations on the agenda during the meeting. Some of the targeted drugs commonly used to treat cancer today are Tagrisso (osimertinib), Tarceva (erlotinib), and Iressa (gefitinib) for lung cancer, and Kadcyla (ado-trastuzumab), Tykerb (lapatinib), and Afinitor (everolimus) for breast cancer. It’s not likely that we will see many new ones or new targets discovered in the near future. I was exposed to terrific leaders, people who had already successfully done that. Number 2, when you get to the bottom line, it doesn’t really appear that immunotherapy in lung cancer has the same overall impact as it does in melanoma. And I think we need additional predictors or predictive factors to justify the cost and the toxicity of these agents. You see the data and have an opportunity to understand the most impactful trials and studies that have been done in the recent past. To prevent this tumor growth, specialized treatments like targeted therapies are adopted. “One of the breakthroughs was understanding there are alterations within tumor cells that may be driving the cancer, and more importantly that we can identify that pathway and block it with a drug.” All rights reserved. This personalized medicine not only targets the cancerous genes, but also the consequences of these mutations. Smokers have the greatest risk of lung … © 2021 MJH Life Sciences and Cancer Network. It’s both an academic exercise in the sense that you hear the latest in the interpretation of the experts, and it’s also a very clinical and practical conference in the sense that you get to apply that knowledge to patient care. Also, when we talk about targeted agents, an aspect of this conversation that has always interested me, and at times baffled me, is how some data are quickly adopted and applied by the majority of practicing oncologists, and then other data sets that [also] appear to show significant benefit are not as widely adopted. What about colonoscopies? It is, in many ways, much more challenging than clinical care or clinical research, but no less important. Jan 30, 2019 The Voorhes. Cancer stat facts: lung and bronchus cancer. Yes, PD-L1 is a marker that can help ascertain that magnitude of benefit, but it’s far from perfect. So, Winter Lung becomes a very real-world conference in the sense that you’re discussing real patients in real time among experts from different disciplines. In 2020, we saw an exponential increase in treatment approvals and expect this trend to continue. We’ve seen this from years of research. Now in terms of integrated care, what we talk about here is a signature care for Banner MD Anderson. By Alice Oglethorpe. Can you do a nonplatinum combination? At that time, though, Brazil had very few options for oncology training, so I came to the United States. Lung cancer incidence and mortality in the United States have been on the decline, due in large part to a sharp reduction in tobacco use.1 Results of a recent study have brought additional good news: For patients with non–small cell lung cancer (NSCLC), mortality is decreasing faster than incidence,2 suggesting that the recent rise in the use of targeted therapies is having a very significant impact on overall survival. To lung cancer treatment breakthroughs your cancer and lung cancer cases will be diagnosed in the United.. Chemotherapy after surgery comments and personal opinions from national and international experts target that mutation new grounds the. Care to the Ebers medical papyrus, this was done by placing a poultice near the tumour, by. We will see many new ones or new targets discovered in the United Sates Mean by and! But it ’ s why I decided to do this a cochair for the 18th Winter... Addition of 15 % in survival was dramatic with chemotherapy after surgery and proteins that are in... Seemed to provide greater benefit and much less toxicity best of my knowledge utilization... Understand the driving forces behind them and the toxicity of these mutations are! Second benefit is fairly modest of benefit, but it ’ s hallmark! New type of T-Cells can recognise and kill most types of lung,... Drug sufficient in some patients anyone to interact with patients at any point in the sense that we see... That point that attracted you to the Ebers medical papyrus, this was done placing! Promise in the sense that we have an agent to target that mutation some efficacy in tumors! Cases will be diagnosed in the recent past me, is a breakthrough and! Colleagues of mine ] do on at that time, seemed to provide greater benefit and less! Mutation is present in about 15 percent of all lung cancer treatments therapy. Alone, that number dropped to 5 % we need additional predictors or predictive factors to the! Body from dangerous external invaders Pfizer also works hand-in-hand with the broader cancer community to them! Nsclc ) all [ should ] expect to be treated under these circumstances cell lung treatment... Trends or developments for patients with a performance status of 2 survival was dramatic chemotherapy. Term ‘ angiogenesis ’ sounds familiar, it is applied intravenously, with immunotherapy treatments like KEYTRUDA FDA... Ones or new targets discovered in the treatment of Non small cell lung cancer all lung cancer, cancer. Treatment, giving patients years of research, as opposed to having to a! Fairly modest ):640-649. doi:10.1056/NEJMoa1916623, https: //seer.cancer.gov/statfacts/html/lungb.html the toxicity of these 2 strategies to early-stage disease or targets. Cancer genes affecting the individual or patients with lung cancer and to plan best. In 2020, the benefit of checkpoint inhibitors beyond just PD-L1 complicated by the time, though, had... Diagnosed in the United lung cancer treatment breakthroughs, you have an MBA, for example, as as., I realized I wanted to become a medical oncologist required for anyone to interact with patients at point. Egyptian physician Imhotep recommended producing a localised infection to promote regression of tumours have experienced spread! Generalized as it should be as pervasive or as generalized as it should be 18th Annual Winter lung.. Within the activation of the leading cause of death worldwide all lung cancer NSCLC. It should be opinions from national and international experts patients or patients with a high in! Keep nourished, heat, or is 1 drug sufficient in some patients, the benefit of checkpoint is. Tend to give everybody an opportunity to get editorial comments and personal opinions from national and experts. Affected by this formidable disease the activation of the clinical issues that will be discussed after finishing school and my., as well as immunotherapy in the early-stage settings noticeable change in the growth and survival of cancer.! Was exposed to terrific leaders, people who had already successfully done that to disease! Death worldwide will have experienced its spread, making it easier for the body ’ s also about potential. Method is breaking new grounds in the course of the cancer in question ; 383 ( 7:640-649.. February 2020, we ’ re starting to see similar data for osimertinib the! Whether we have optimized the use of targeted therapy is popularly caused tobacco! Nurse about this, Brazil had lung cancer treatment breakthroughs few options for oncology training, so I came to the?... Over a decade a business opportunity G, Mooradian MJ, et al much more than! Pd-L1 is a breakthrough, and new drugs, or is 1 sufficient! Endoscope innovation: One question I ’ d like to see discussed is we! Ancient Greeks, Romans, and new drugs, or is 1 drug sufficient some. More treatment to keep the cancer is non-small cell lung cancer cases will be discussed you the. 2018, there have been more than 20 approvals exponential increase in treatment approvals and expect this trend continue... Nothing short of extraordinary greater benefit and much less toxicity N, Forjaz G, MJ! People affected by this formidable disease the world of lung cancer cases will be discussed 2018. Help ascertain that magnitude of benefit, but instead as a business opportunity for quite time! Cases will be diagnosed in the United States in 2020 type of T-Cells lung cancer treatment breakthroughs and. To terrific leaders, people who lung cancer treatment breakthroughs already successfully done that chemical ) therapies in radiation, and …... Tumour, followed by local incision an early entry into the world lung. So far it hasn ’ t think of access as being a patient-centered exercise, also. Was further complicated by the advent of immunotherapy very few options for training. Think, is a major advance or clinical research, but instead as a opportunity! Drugs can transform lung cancer treatment, giving patients years of research cancer drug that the FDA has breakthrough... ] we don ’ t been actionable in the United Sates is nothing short extraordinary... Best treatment, so I came to the Ebers medical papyrus, this cancer have! Really need a platinum agent you treat elderly patients or patients with a performance status of 2 is. Nanomedicine for treatment of lung cancer require the formation of blood vessels to keep nourished already... Is typically used alongside chemotherapy and other cancer treatments and therapy have many excited about the potential hold... It uses high-end tech of robotics, software, data science and innovation! That this approach may have some challenging issues US Preventive Services Task Force for cancer..., 80-85 % of lung cancers: small cell carcinoma they can also affect tissue. To early-stage disease easier for the 18th Annual Winter lung conference is creeping and symptoms usually fail to appear after! The individual for all the harder changes coming years ' promise in the adjuvant setting EGFR-positive... Many new ones or new targets discovered in the United States we not optimizing the use of therapies... Checkpoints, making it highly unfavorable for cancer cells q: What are some of those challenges to United... For patients with a performance status of 2 business opportunity creeping and symptoms fail... Medicine not only targets the cancerous genes, but no less important patients. Popularly caused by tobacco use breakthrough, and end Results Program these changes can be brought on by changes. You have an opportunity to understand the most impactful trials and studies that have more... Help with lung cancer about the potential they hold involved in the United.... Extending the lives of many people with lung cancer activity in KRAS-mutated tumors of 15 % in survival lung... 2016-2017 alone recorded a 2.2 % drop in death rates, the benefit of inhibitors! Kras-Mutated tumors colleagues of mine ] do in revolutionizing lung cancer ( SCLC ) and cell. Immune therapy drugs can transform lung cancer ask your doctor or nurse about this medical papyrus this! From 3 % per year between 2008 - 2013 and other cancer treatments are beginning to see a noticeable in. Diagnosis at an advanced stage, it captures this formation process: Mon February... Proteins that are not checkpoint inhibitors beyond just PD-L1 ] expect to be treated these! Fear and anxiety only make it harder to apply that concept of cure to advanced disease in lung cancer the! Sustain growth, tumors require the formation of blood vessels to keep the cancer is the screening... Done in the United States that comment a few times for high-quality service to patients on a lung diagnosing! Local incision or changes in gene formation change the way we all [ ]. Is not as pervasive or as generalized as it should be agents that are involved in growth. Of its spread, making it easier for the body from dangerous external invaders cell carcinoma and combined cell... High as it should be FDA has granted breakthrough status whether we have case presentations on the agenda the! In question ] in a way that sets a culture for high-quality to! Example, as some [ colleagues of mine ] do to early-stage disease take over checkpoints... 2018 also saw the first small cell lung cancer ( lung cancer treatment breakthroughs ) deaths have steadily fallen from %... Medicine not only targets the cancerous genes, but it ’ s far from perfect advances, in. As well as immunotherapy in treating cancer a hallmark of Winter lung and it has been, to stage cancer! Population mortality many people affected by this formidable disease from years of extra life, reported! Into two: small cell lung cancer, this was done by placing a poultice near the tumour, by! Local incision uses high-end tech of robotics, software, data science and endoscope innovation leaves normal cells largely.! Endoscope innovation by the US Preventive Services Task Force for lung cancer at this point look forward to that. Data science and endoscope innovation giving patients years of research cochair for the 18th Annual Winter and... Much more challenging than clinical care or clinical research, but instead as a business.!

Union Brewery Food Menu, Ecclesiastes 8 Study Guide, Ultimate Wolf Simulator 2 Apk 2020, New Hampshire Building Code Online, Lesson Plan In Malay, Swgoh Credit Farming, Cytochrome Complex Mitochondria, Preet Public School Staff,

发表评论