局所的に進行したおよび転移した非小細胞肺癌の全身療法: レビュー

Kathryn C Arbour¹, Gregory J Riely¹

¹Thoracic Oncology Service, Division of Solid Tumor, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York.

JAMA

|August 28, 2019

まとめ

バイオマーカーによる治療は,転移性非小細胞肺がん (NSCLC) の生存率を大幅に改善しました. 分子検査はパーソナライズされた治療の標的を特定し,進行したNSCLC患者の治療結果を改善します.

科学分野:

腫瘍学
分子生物学
遺伝学

背景:

非小細胞肺がん (NSCLC) は,米国における癌による死亡の主な原因であり,転移性疾患の生存率は歴史的に低い.
NSCLCの生物学的理解における最近の進歩は,標的治療法の開発を促しました.
転移性NSCLCの有効な全身療法を選択するには,バイオマーカーの識別が不可欠です.

研究の目的:

転移性非小細胞肺がんにおける生存結果に対するバイオマーカー指向治療の影響を検討する.
NSCLCの治療決定を導くために分子検査の重要性を強調する.
特定の分子変異とPD-L1発現に基づいた現在の治療戦略を要約する.

主な方法:

EGFR,ALK,ROS1,およびBRAF V600E変異を含む特定のバイオマーカーの存在に基づいています.
これらの変化とPD- L1 (プログラム死亡リガンド1) 発現に対する分子検査は,すべての転移性NSCLC患者に対して推奨されます.
標的療法と免疫チェックポイント阻害剤の比較

主要な成果:

特定された分子変異に対する標的治療は,化学療法と比較して進行性のない生存率を改善します.
ティロシンキナーゼ阻害剤 (EGFR変異に対するゲフィチニブ,エルロチニブ,アファチニブ,ALK再構成に対するクリゾチニブなど) は優れた有効性を示しています.
免疫チェックポイント阻害剤は,単独または化学療法と併用して,特定の標的生物マーカーがない患者にとって優れています.
5年間の全生存率は著しく改善し,高いPD- L1発現では25%,ALK陽性NSCLCでは40%を超えました.

結論:

バイオマーカーによる治療は,転移性非小細胞肺がん患者の全生存率を大幅に改善しました.
分子プロファイリングに基づくパーソナライズされた治療戦略は,NSCLCの結果を最適化するために不可欠です.
NSCLCの分子サブタイプに関する研究が継続されれば治療のさらなる進歩が期待できます

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