局部晚期和转移性非小细胞肺癌的全身疗法:一篇评论
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
概括
以生物标志物为导向的疗法显著改善了转移性非小细胞肺癌 (NSCLC) 的生存率. 分子测试可以确定个性化治疗的目标,从而改善晚期NSCLC患者的治疗结果.
科学领域:
- 癌症学
- 分子生物学
- 遗传学
背景情况:
- 非小细胞肺癌 (NSCLC) 是美国癌症死亡的主要原因,转移性疾病的存活率历来很低.
- 最近了解NSCLC生物学方面的进步促使开发针对性的疗法.
- 在转移性NSCLC中选择有效的全身治疗时,生物标志物的鉴定至关重要.
研究的目的:
- 对转移性非小细胞肺癌的生存结果对生物标志物导向治疗的影响进行审查.
- 突出分子测试对于指导NSCLC治疗决策的重要性.
- 根据特定的分子变化和PD-L1表达来总结当前的治疗策略.
主要方法:
- 系统治疗的选择是基于特定生物标志物的存在,包括EGFR,ALK,ROS1和BRAF V600E突变.
- 建议对所有转移性NSCLC患者进行分子检测,以检测这些变化和PD- L1 (编程死亡配体1) 的表达.
- 针对性治疗和免疫检查点抑制剂与传统化疗的比较.
主要成果:
- 与化疗相比,针对发现的分子变化的向治疗改善了无进展的存活率.
- 氨酸激酶抑制剂 (例如,格菲提尼布,埃尔洛提尼布,阿法提尼布用于EGFR突变;克里佐提尼布用于ALK重组) 显示出更高的疗效.
- 免疫检查点抑制剂,单独或与化疗一起,对于缺乏特定可向生物标志物的患者来说是优越的.
- 五年整体存活率显著提高,高PD- L1表达超过25%,ALK阳性NSCLC超过40%.
结论:
- 在转移性非小细胞肺癌患者中,以生物标志物为导向的疗法显著改善了整体存活率.
- 基于分子分析的个性化治疗策略对于优化NSCLC的结果至关重要.
- 对NSCLC分子亚型的持续研究可能会带来进一步的治疗进步.
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