非小細胞肺癌的標靶治療

Targeted Therapy in Non-small Cell Lung Cancer

施穎銘(Ying-Ming Shih) ； 陳育民(Yuh-Min Chen)

《內科學誌》 19卷1期 (2008/02) Pp. 8-13

https://doi.org/10.6314/JIMT.2008.19(1).02

摘要

晚期非小細胞肺癌的治療以化學治療爲主，放射治療爲輔，但治療伴隨的副作用常影響病人生活品質。新發展的標靶治療(targeted therapy)針對致癌機轉(oncogenesis)的特定分子路徑加以截斷，減少對正常細胞的傷害。上皮生長因子受體酪胺酸激酶抑制劑(epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI)是第一個核准上市治療肺癌的標靶治療藥物，適用在晚期非小細胞肺癌病人接受化療無效後的後線治療。常見的副作用有皮疹及腹瀉，間質性肺炎的發生不多，但嚴重者可能致命。亞洲人、從未吸菸者、女性、肺腺癌、EGFR有突變者治療反應特別好。使用上皮生長因子受體單株抗體(epidermal growth factor receptor monoclonal antibody, EGFR-moAb)也有許多小型的研究支持它的療效，但目前欠缺大型的臨床實驗結果驗證。血管內皮細胞生長因子單株抗體(vascular endothelia 1 growth factor monoclonal antibody, VEGF-moAb)，已有大型臨床研究顯示和化療合併使用在晚歎未治療過的非小細胞肺癌病人，反應率及存活率較單獨使用化療爲佳，但病人有肺大量出血的危險性，尤其是在肺鱗狀細胞癌，因此使用上要特別小心。

關鍵字

非小細胞肺癌 ； 標靶治療 ； 上皮生長因子受體 ； 酪胺酸激酶抑制劑 ； 血管內皮細胞生長因子 ； 單株抗體

並列摘要

Chemotherapy or radiotherapy is the mainstay of management for advanced non-small cell lung cancer. However, the treatment induces toxicity often affecting the patient's quality of life. The new developing targeted therapies are designed to interfere with specific molecules involved in oncogenesis. Epidermal growth factor receptor tyrosine kinase inhibitor is the first drug of targeted therapy approved for patients with advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy. The common side effects include skin rash and diarrhea. Interstitial pneumonitis has been reported and might lead to mortality. The response rates are higher in Asian populations, women, adenocarcinoma, never smokers and EGFR mutations. Epidermal growth factor receptor monoclonal antibody has been shown survival benefit in advanced NSCLC during phase Ⅱ trials but lacks of large randomized phase Ⅲ studies. Vascular endothelial growth factor monoclonal antibody combined with carboplatin and paclitaxel in the treatment of naive advanced NSCLC has significant survival benefit and response rate but increases the risk of pulmonary hemorrhage, especially in squamous cell carcinoma of lung.

並列關鍵字

Non-small cell lung cancer ； Targeted therapy ； Epidermal growth factor receptor ； Tyrosine kinase inhibitor ； Vascular endothelial growth factor ； Monoclonal antibody