This article expert:
Wang Jie, Director of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences
The latest national cancer report released by the National Cancer Center in 2022 shows that the number of new lung cancer cases in my country is about 830,000 each year. Malignant tumors with “double first” morbidity and lethality ①. Fortunately, with the emergence and continuous improvement of targeted therapy, non-small cell lung cancer may no longer be a terminal disease.
Precision targeted therapy makes lung cancer “chronic”
“Lung cancer in China” Treatment has kept pace with global treatment progress, and the biggest progress is precision targeted therapy.” Professor Wang Jie, director of the Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, pointed out, “Targeted drugs are defined carcinogenic sites for specific gene mutations. The most common drug in non-small cell lung cancer (NSCLC) is the EGFR gene mutation, which has a high incidence in Asian and Chinese populations, and accounts for 30%-35% of the entire non-small cell lung cancer. Especially in non-smoking female adenocarcinoma, its incidence can reach 50% to 60%. In recent years, targeted drugs for EGFR mutations have developed from the first, second and third generations.”
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At present, the efficacy and safety of targeted therapy drugs targeting EGFR, ALK and ROS1 have been confirmed in patients with advanced non-small cell lung cancer. In my country, about half of non-small cell lung cancer patients have EGFR gene mutation②. Compared with traditional treatment, first- and second-generation EGFR-targeted drugs have significantly prolonged the survival time of patients with advanced mutations in the past 20 years. At present, authoritative guidelines at home and abroad have recommended the third-generation original EGFR-targeted drugs as the preferred first-line treatment for patients with advanced non-small cell lung cancer carrying EGFR-sensitive mutations. At present, a number of first-, second- and third-generation EGFR-targeted drugs have been included in medical insurance.
“Lung cancer is divided into non-small cell lung cancer and small cell lung cancer. About 85% of lung cancers are non-small cell lung cancer. Non-small cell lung cancer is further divided into adenocarcinoma and squamous cell carcinoma. , adenosquamous carcinoma, different types and different stages of lung cancer have different treatment plans.” Professor Wang Jie said that “prescribe the right medicine” according to individual circumstances, choosing standardized and precise treatment can help lung cancer patients achieve longer survival and higher quality of life.
Lung cancer targeted therapy
To avoid these 4 misunderstandings
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Myth 1: Medication must be in the order of the first, second, and third generations
Many patients believe that the use of targeted drugs should be in the order of the first, second, and third generations, and they are afraid of drug resistance and no subsequent drugs are available.
In fact, the main clinical treatment strategies at present are not necessarily in order, depending on the individual situation of the patient. Taking EGFR-targeted therapy as an example, there are several ways: one is to use the first-generation targeted drug first, and after drug resistance, if patients with T790M mutation use the third-generation; the second strategy is to use the second-generation targeted drug first, After the emergence of drug resistance, if the patient has the T790M mutation, three generations are used; the third strategy is to use three generations directly.
In addition, the problem of drug resistance to targeted therapy has been continuously improved in the past 5 years. About 2/3 of patients receiving first- and second-generation EGFR-targeted drugs developed resistance due to T790M mutation③, but they Second-line treatment with third-generation EGFR-targeted drugs further reduces the risk of disease progression or death. At the same time, clinical studies and a large number of real-world studies have shown that the use of third-generation EGFR-targeted drugs in first-line treatment significantly prolongs the resistance time compared with first- and second-generation targeted drugs, and can bring significant overall survival to patients ( OS) and other tangible survival benefits④⑤.
Myth 2: One genetic test is enough
< p>The most important thing for a targeted drug to be effective is to have a precise target, which requires genetic testing to pinpoint the target, but genetic testing is not done once. Especially for patients with positive EGFR mutation, during the whole treatment process, drug resistance mutations need to be monitored multiple times. For example, after a generation of drugs is used, which mutations appear in the next step, the results of genetic testing will help doctors to judge whether they can follow up. Use third-generation targeted drugs.
Myth 3: If there is no discomfort after targeted therapy, do not review it
Doctors will recommend re-examination for patients taking targeted drugs, especially those with advanced lung cancer with mutations, usually every 2-3 months. However, some patients feel that I am not feeling well, so they do not go for re-examination, and it is very likely that drug resistance will quietly occur during this period. Targeted drug resistance is not based on the patient’s feeling, but on the basis of CT examination to judge whether the tumor has increased or shrunk.
Myth 4: Refuse to use targeted drugs for fear of side effects
Targeted drugs may have side effects in the early use of some patients. However, don’t worry about side effects, you must be patient with your doctor to slowly overcome the side effects, and you cannot stop taking the medicine without authorization because of side effects.
Adjuvant therapy after targeted therapy
Increase patient survival
After surgical resection of early-stage lung cancer, adjuvant chemotherapy is generally performed, although the 5-year survival rate of patients can be improved by 5%⑥
span>, but the patient’s long-term survival benefit is limited,And there are problems such as high recurrence rate, poor compliance and brain metastasis.
Now, with the adjunctive use of targeted therapy after lung cancer surgery, this situation is improving. Compared with adjuvant chemotherapy, patients with EGFR mutation-positive early-stage lung cancer can achieve significant disease-free survival benefits with postoperative adjuvant targeted therapy, while reducing the rate of distant recurrence, especially CNS progression (ie, brain recurrence) or risk of death ⑦.
References:
①The National Cancer Center released the “2022 National Cancer Institute” Cancer Report”
②Liu SY, et al. J Thorac Oncol. 2016 Sep;11(9):1503-10.
③Zhao Tianyu, Yin Zhenyu. A case report of interstitial lung disease after osimertinib targeted therapy for non-small cell lung cancer[J]. Practical Geriatric Medicine 2021, Vol. 35, No. 2, pp. 211-214, ISTIC CA, 2021.
④Data cut-off: 12 June 2017
⑤Soria et al. N Engl J Med 2018; 378:113-25
⑥Burdett S, Pignon JP, et al. Cochrane Database Syst Rev. 2015 Mar 2:(3):CD011430.
⑦Mok TS, et al. N Engl J Med. 2017 Feb 16;376(7):629 640.
p>Source: Health Times
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