Russo Alessandro, Franchina Tindara, Ricciardi Giuseppina Rosaria Rita, Picone Antonio, Ferraro Giuseppa, Zanghì Mariangela, Toscano Giuseppe, Giordano Antonio, Adamo Vincenzo
Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy.
Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, Pennsylvania, USA.
Oncotarget. 2015 Sep 29;6(29):26814-25. doi: 10.18632/oncotarget.4254.
The discovery of Epidermal Growth Factor Receptor (EGFR) mutations in Non Small Cell Lung Cancer (NSCLC) launched the era of personalized medicine in advanced NSCLC, leading to a dramatic shift in the therapeutic landscape of this disease. After ten years from the individuation of activating mutations in the tyrosine kinase domain of the EGFR in NSCLC patients responding to the EGFR tyrosine kinase inhibitor (TKI) Gefitinib, several progresses have been done and first line treatment with EGFR TKIs is a firmly established option in advanced EGFR-mutated NSCLC patients. During the last decade, different EGFR TKIs have been developed and three inhibitors have been approved so far in these selected patients. However, despite great breakthroughs have been made, treatment of these molecularly selected patients poses novel therapeutic challenges, such as emerging of acquired resistance, brain metastases development or the need to translate these treatments in earlier clinical settings, such as adjuvant therapy. The aim of this paper is to provide a comprehensive review of the major progresses reported so far in the EGFR inhibition in this molecularly-selected subgroup of NSCLC patients, from the early successes with first generation EGFR TKIs, Erlotinib and Gefitinib, to the novel irreversible and mutant-selective inhibitors and ultimately the emerging challenges that we, in the next future, are called to deal with.
非小细胞肺癌(NSCLC)中表皮生长因子受体(EGFR)突变的发现开启了晚期NSCLC个性化医疗的时代,导致该疾病治疗格局发生了巨大转变。在对EGFR酪氨酸激酶抑制剂(TKI)吉非替尼有反应的NSCLC患者中发现EGFR酪氨酸激酶结构域的激活突变十年后,已经取得了多项进展,EGFR TKIs一线治疗在晚期EGFR突变的NSCLC患者中已成为一种既定选择。在过去十年中,已经开发出了不同的EGFR TKIs,目前已有三种抑制剂在这些特定患者中获批。然而,尽管已经取得了重大突破,但治疗这些经过分子筛选的患者仍带来了新的治疗挑战,如获得性耐药的出现、脑转移的发生,或者需要将这些治疗应用于更早的临床阶段,如辅助治疗。本文旨在全面回顾迄今为止在这个经过分子筛选的NSCLC患者亚组中EGFR抑制方面所报道的主要进展,从第一代EGFR TKIs厄洛替尼和吉非替尼的早期成功,到新型不可逆和突变选择性抑制剂,以及最终我们在未来需要应对的新出现的挑战。