Fong Thomas, Morgensztern Daniel, Govindan Ramaswamy
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Thorac Oncol. 2008 Mar;3(3):303-10. doi: 10.1097/JTO.0b013e3181645477.
Tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR), erlotinib and gefitinib, are active agents in the treatment of advanced non-small cell lung cancer (NSCLC). Although platinum-based doublet chemotherapy remains the cornerstone for the first-line treatment of metastatic NSCLC, several phase II and III trials have been conducted utilizing EGFR TKIs in this setting. Patients with advanced NSCLC who are life long never-smokers, those with EGFR TK mutations, and those with bronchioloalveolar cell carcinoma histology seem to have promising efficacy with first-line therapy with EGFR TKIs compared with unselected groups of patients receiving the same agents. Phase III trials have clearly demonstrated no improvement in survival when EGFR TKIs were combined with conventional platinum-based doublets, with the exception of subset analysis in nonsmokers. This review will summarize the results of clinical trials on erlotinib or gefitinib in the first-line treatment of select and unselected patients with NSCLC and describe ongoing studies with these agents in NSCLC.
表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）厄洛替尼和吉非替尼是治疗晚期非小细胞肺癌（NSCLC）的有效药物。尽管铂类双联化疗仍是转移性NSCLC一线治疗的基石，但在此背景下已开展了多项使用EGFR TKIs的II期和III期试验。与未经过选择而接受相同药物治疗的患者群体相比，晚期NSCLC中终身不吸烟者、具有EGFR TK突变者以及具有细支气管肺泡癌组织学特征者，接受EGFR TKIs一线治疗似乎具有良好的疗效。III期试验已明确表明，EGFR TKIs与传统铂类双联化疗联合使用时，除了对不吸烟者的亚组分析外，生存率并无改善。本综述将总结厄洛替尼或吉非替尼一线治疗选择性和非选择性NSCLC患者的临床试验结果，并描述这些药物在NSCLC中的正在进行的研究。
