Department of Medical Oncology, Christie Hospital, Manchester, UK.
Lung Cancer. 2013 Feb;79(2):101-3. doi: 10.1016/j.lungcan.2012.10.016. Epub 2012 Nov 22.
The composition of the multidisciplinary team (MDT) that treats lung cancer varies by region and practice setting but generally includes a thoracic medical oncologist, a thoracic surgeon, a thoracic radiation oncologist, and an interventional radiologist, as well as a pathologist, pulmonologist, and specialist nurses. Growing clinical evidence supports a personalized approach to non-small cell lung cancer (NSCLC) treatment, and clinical trials in advanced disease have shown the value of testing for epidermal growth factor receptor gene (EGFR) mutations prior to first-line therapy with erlotinib or gefitinib and testing for anaplastic lymphoma kinase gene (ALK) rearrangements prior to therapy with crizotinib. The most recent National Comprehensive Cancer Network (NCCN) guidelines also recommend sequential EGFR and ALK testing for patients with a diagnosis of recurrent or metastatic adenocarcinoma, large cell carcinoma, or not otherwise specified histology, and simultaneous molecular screening has also been proposed. Here, we explore potential challenges for the MDT implied by the move toward personalized therapy in NSCLC and the increasing need for molecular diagnoses, and anticipate how the working roles and responsibilities of team members may develop to accommodate them.
治疗肺癌的多学科团队（MDT）的组成因地区和实践环境而异，但通常包括胸内科肿瘤学家、胸外科医生、胸放射肿瘤学家和介入放射学家，以及病理学家、肺病学家和专科护士。越来越多的临床证据支持对非小细胞肺癌（NSCLC）采用个体化治疗方法，晚期疾病的临床试验表明，在一线使用厄洛替尼或吉非替尼治疗前检测表皮生长因子受体基因（EGFR）突变，以及在使用克唑替尼治疗前检测间变性淋巴瘤激酶基因（ALK）重排具有价值。最近的国家综合癌症网络（NCCN）指南还建议对诊断为复发性或转移性腺癌、大细胞癌或其他未指定组织学的患者进行序贯 EGFR 和 ALK 检测，同时也提出了同时进行分子筛查。在这里，我们探讨了 NSCLC 个体化治疗和分子诊断需求不断增加对 MDT 带来的潜在挑战，并预计团队成员的工作角色和职责将如何发展以适应这些挑战。
