晚期非小細胞肺癌之化學治療與標靶治療

Chemotherapy and Targeted Therapy in Patients with Advanced Non-small Cell Lung Cancer

柯獻欽(Shian-Chin Ko) ； 鄭高珍(Kuo-Chen Cheng)

《內科學誌》 29卷3期 (2018/06) Pp. 143-152

https://doi.org/10.6314/JIMT.201806_29(3).04

摘要

肺癌是常見且死亡率很高的癌症，根據衛生福利部死因統計：2016年台灣有9,372人死於肺癌，佔所有死亡人數的5.4%，無論是男性或女性，肺癌都佔癌症死亡原因的第一位，肺癌的五年存活率僅19.7%，每年健保花費117億新台幣。肺癌在初診斷時，約六成即屬於無法手術切除的晚期肺癌，治療此類晚期肺癌病人的目標在於延長存活期、增進生活品質與減少治療的副作用。近幾年來肺癌的治療突飛猛進，標靶治療與免疫治療的出現，搭配傳統的化學治療，令人眼花撩亂、莫衷一是。許多研發問世的新藥可供病人治療選擇，但是醫療人員要跟得上國際的治療新知，向病人／家屬介紹與建議，且要兼顧國情與保險給付，成為照顧肺癌病人的新挑戰。本文本著精準醫療的概念，依據晚期肺癌病人的組織型態、癌細胞分子特性、與病人年齡體能狀態，參照最新的研究論文，介紹晚期非小細胞肺癌的化學治療與標靶治療，讓讀者能一窺肺癌治療的新進展。

關鍵字

非小細胞肺癌(Non-small cell lung cancer) ； 化學治療(Chemotherapy) ； 標靶治療(Targeted therapy) ； 精準醫療(Precision medicine)

並列摘要

Lung cancer is the most common cancer globally and is the leading cause of cancer death in both men and women in Taiwan. About 60% of lung cancer patients belong to advanced non-small cell lung cancer (NSCLC) at the time of diagnosis. The therapeutic goals of patients with advanced NSCLC are prolonging survival, improving quality of life, and reducing side effects of treatment. Over the past decade, the treatment of lung cancer has progressed rapidly, including cytotoxic chemotherapy, targeted therapy and immunotherapy. Due to principles of precision medicine, the treatment of patients with advanced NSCLC must be individualized according to tumor stage, histologic morphology, molecular characteristics of the tumor cells, age and performance status. In order to give the best treatment to the patients, we must cautiously select the appropriate drugs and closely monitor the response and side effects.