Having lung cancer and metastases from bone to brain means that the lung cancer is advanced and the chance of cure is very small, but the quality of life can be improved and the survival time can be prolonged through treatment. For patients with sensitive gene mutations, targeted drug therapy is the first choice according to the corresponding mutation target. However, if there is no genetic mutation and oral small molecule targeted drugs are ineffective, what should the patient do? How to choose a treatment plan later? For patients with advanced lung cancer without genetic mutations, the following treatment options can be selected.
1. Local radiotherapy For localized bone metastases and brain metastases with symptoms of cerebral edema, local radiotherapy can be performed to improve symptoms and control the disease. Especially in patients with brain metastases, other therapeutic drugs are difficult to penetrate the blood-brain barrier, and radiotherapy can be the first choice. According to the situation of brain metastases, precise radiotherapy or whole-brain radiotherapy can be performed.
2. Systemic intravenous chemotherapy still plays a very important role in patients with advanced lung cancer. For squamous cell carcinoma of the lung, gemcitabine, paclitaxel, docetaxel, vinorelbine combined with platinum chemotherapy are usually selected. , The first choice for lung adenocarcinoma is pemetrexed combined with platinum chemotherapy after 4-6 cycles of pemetrexed single-agent maintenance therapy. Patients who are not suitable for platinum use non-platinum double-drug regimens, including gemcitabine combined with docetaxel, gemcitabine combined with vinorelbine. For patients with slightly poor constitution, the above single-agent chemotherapy can be selected.
3. Immunotherapy Immunotherapy has become a new standard of care for non-small cell lung cancer without driver gene mutation. PD-1/PD-L1 inhibitors restore the body’s anti-tumor immune response by blocking the immunosuppressive signal between tumors and T lymphocytes. At present, China has officially approved pembrolizumab in combination with chemotherapy drugs (pemetrexed + platinum) for the treatment of non-squamous cell carcinoma patients in non-small cell lung cancer. Pembrolizumab combined with carboplatin and paclitaxel (or nab-paclitaxel) for first-line treatment of metastatic squamous cell carcinoma of the lung.
4. Antiangiogenic drugs
Anti-angiogenic drugs include 1. Intravenous drug Endostatin, namely recombinant human endostatin; 2. Intravenous bevacizumab; 3. Oral anti-angiogenic drugs The targeted drug anlotinib. Endovir and bevacizumab are usually used in combination with chemotherapy drugs. According to CSCO guidelines, bevacizumab combined with platinum-containing double-drug chemotherapy can be used as first-line treatment for lung cancer without gene mutation. Endostat combined with vinorelbine and cisplatin can also be used as first-line therapy. Oral anlotinib is used as a third-line drug for non-mutated lung cancer, but it should be used with caution in patients with central squamous cell carcinoma and bleeding tendency.
5. Targeted drugs Patients with squamous cell carcinoma of the lung have always been distressed that no targeted drugs are available. In February 2017, the State Food and Drug Administration approved afatinib as a second-line treatment for advanced squamous cell carcinoma. Afatinib is an irreversible inhibitor of epidermal growth factor receptor (EGFR) and human epidermal receptor 2 (HER2) tyrosine kinases. In a head-to-head study with erlotinib, patients with squamous cell carcinoma of the lung showed better results.
6. Symptomatic and supportive treatment of advanced lung cancer has occurred with brain metastases and bone metastases, and the overall prognosis is relatively poor. If the patient is old and has poor physical fitness, it is best not to take aggressive anti-tumor therapy, but to choose Symptomatic and supportive treatment, such as pain relief, dehydration and intracranial pressure reduction, nutritional support, etc.