Department of Medical Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, BC, Canada.
Royal Marsden Hospital, London, UK.
Clin Lung Cancer. 2018 Jan;19(1):42-50. doi: 10.1016/j.cllc.2017.05.019. Epub 2017 Jun 8.
The optimal treatment sequence for patients with metastatic epidermal growth factor receptor (EGFR) mutation-positive (EGFR-M) non-small-cell lung cancer (NSCLC) continues to evolve, related largely to an increasing number of breakthroughs and studies in the field. The efficacy of tyrosine kinase inhibitors in the treatment of these patients is well established; however, the treatment decision-making process is becoming more complex as our knowledge of EGFR mutations and resistance pathways grows and more treatment options become available. Thus, treating physicians must consider an increasing number of factors. We present a stepwise approach to personalizing the treatment of patients with EGFR-M NSCLC, emphasizing some of the real world challenges faced by treating physicians. We reviewed the decision criteria for selecting the best first-line therapy, highlighted the importance of repeat biopsy on disease progression to determine the most appropriate next-line therapy, and discussed the options for third-line therapy and beyond. We also present an algorithm designed to optimize the sequencing strategies for prolonging survival and maintaining quality of life in our patients with EGFR-M NSCLC.
对于表皮生长因子受体（EGFR）突变阳性（EGFR-M）非小细胞肺癌（NSCLC）患者的最佳治疗顺序不断发展，这在很大程度上与该领域越来越多的突破和研究有关。酪氨酸激酶抑制剂在这些患者中的疗效已得到充分证实；然而，随着我们对 EGFR 突变和耐药途径的认识不断加深，以及更多的治疗选择变得可用，治疗决策过程变得更加复杂。因此，治疗医生必须考虑越来越多的因素。我们提出了一种个性化治疗 EGFR-M NSCLC 患者的分步方法，强调了治疗医生面临的一些实际挑战。我们回顾了选择最佳一线治疗的决策标准，强调了在疾病进展时重复活检以确定最合适的二线治疗的重要性，并讨论了三线及以后治疗的选择。我们还提出了一种算法，旨在优化延长生存和维持 EGFR-M NSCLC 患者生活质量的测序策略。
