- 期刊
Usage of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKI) in Tumor EGFR Wild-Type or Unknown Non-Small Cell Lung Cancer
使用上皮細胞生長因子接受體胳胺酸酶抑制劑於生長因子接受體為野生型或是不明的非小細胞肺癌
摘要
近來十年針對已轉移的非小細胞肺癌的標靶治療的研究正是處於蓬勃發展的階段。在I-PASS研究發現「第四期非小細胞肺癌病患如腫瘤EGFR有活化性突變時，使用EGFR-TKI比使用化療可以延緩疾病惡化而且生活品質較好」以後，使用EGFR-TKI於EGFR有活化性突變的第四期非小細胞肺癌已成為第一線標準治療。化療則留給EGFR為野生型或是不明的非小細胞肺癌的第一線治療。不管病患第一線接受標靶治療或是化療，最終還是會復發而接受二線治療。有效的二線治療包括docetaxel，pemetrexate，與erlotinib。許多第三期的臨床試驗結果顯示使用gefitinib或是erlotinib於二線或三線的治療效果並不比docetaxel或pemetrexate差。本篇回顧文章就是針對這些研究做分析，尤其是評估這些藥品使用於EGFR野生型或不明的非小細胞肺癌病患的效益。
並列摘要
Targeted therapy for metastatic non-small cell lung cancer (NSCLC) has been actively studied in the last decade. The use of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is considered the standard first-line treatment for metastatic NSCLC patients with tumor EGFR activating mutations, especially after the I-PASS and many similar studies showed longer progression-free survival and better quality of life when these patients received EGFR-TKIs, than when they received platinum-based chemotherapies. Chemotherapy was the remaining option for those patients whose tumor EGFR was wild-type or unknown. Almost all patients who received first-line treatment, either EGFR-TKI or chemotherapy, eventually relapsed and needed second-line salvage therapy. Documented effective second-line therapy for NSCLC patients who had been treated with platinum-based chemotherapy included docetaxel, pemetrexate, and erlotinib. Several phase III randomized trials showed that usage of gefitinib or erlotinib in a second-line or third-line setting was not inferior to docetaxel or pemetrexate treatment. The present review attempts to summarize previous studies of second-line treatment with EGFR-TKI or chemotherapy for NSCLC patients, paying special attention to compare the efficacies between different agents in those patients whose tumor EGFR was wild-type or unknown.