University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R8, Canada.
Department of Medical Oncology, McMaster University, Hamilton, ON, L8S 4L8, Canada.
J Pers Med. 2012 Sep 10;2(3):77-92. doi: 10.3390/jpm2030077.
The traditional approach to the treatment of advanced non-small cell lung cancer (NSCLC) relied on the uniform use of cytotoxic chemotherapy. Over the last eight years, this paradigm of care has been shifting towards the use of molecularly targeted agents. Epidermal growth factor receptor (EGFR) mutations have emerged as an important biomarker for these targeted agents and multiple studies have shown that tyrosine kinase inhibitors (TKI) that inhibit EGFR are superior to traditional chemotherapy in patients possessing an EGFR mutation. Nationally funded health care systems face a number of challenges in implementing these targeted therapies, most related to the need to test for biomarkers that predict likelihood of benefiting from the drug. These obstacles include the challenge of getting a large enough tissue sample, workload of involved specialists, reliability of subtyping in NSCLC, differences in biomarker tests, and the disconnect between the funding of drugs and the related biomarker test. In order to improve patient outcomes, in a national healthcare system, there is a need for governments to accept the changing paradigm, invest in technology and build capacity for molecular testing to facilitate the implementation of improved patient care.
传统的晚期非小细胞肺癌（NSCLC）治疗方法依赖于细胞毒性化疗的统一应用。在过去的八年中，这种治疗模式已经转向使用分子靶向药物。表皮生长因子受体（EGFR）突变已成为这些靶向药物的重要生物标志物，多项研究表明，抑制 EGFR 的酪氨酸激酶抑制剂（TKI）在具有 EGFR 突变的患者中优于传统化疗。国家资助的医疗保健系统在实施这些靶向治疗方面面临着许多挑战，这些挑战主要与测试预测药物获益可能性的生物标志物有关。这些障碍包括获得足够大的组织样本的挑战、涉及的专家的工作量、NSCLC 亚型的可靠性、生物标志物测试的差异，以及药物资金和相关生物标志物测试之间的脱节。为了改善患者的治疗效果，在国家医疗保健系统中，政府需要接受这种治疗模式的转变，投资于技术并建立分子检测能力，以促进改善患者护理的实施。
