Advani Suresh H, Malhotra Hemant, Chacko Raju Titus, Basade Maheboob, Keechilat Pavithran, Mahapatra P N, Goswami Chanchal, Sahoo T P, Shah Chirag
Director, Medical Oncology, Jaslok hospital and Research centre, Mumbai, Maharashtra, India.
Division of Medical Oncology, Birla Cancer Centre, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Indian J Cancer. 2017 Dec;54(Supplement):S31-S36. doi: 10.4103/ijc.IJC_520_17.
Advanced nonsmall cell lung cancer (NSCLC) treatment is primarily based on platinum-based chemotherapy. Although epidermal growth factor receptor (EGFR) targeting has shifted the treatment paradigm toward personalized tyrosine kinase inhibitors (TKIs), resistance develops inevitably and EGFR T790M is the most common acquired resistance mechanism. Rebiopsy of resistant NSCLC cases can provide additional information on the underlying resistant mechanisms and therefore can help clinicians in taking better management decisions. An expert panel meeting of renowned cancer oncologists was held to discuss the management of advanced-stage NSCLC. The present paper is based on the recommendations made by the expert panel and is supported by an exhaustive literature search. It was suggested that identification of driver mutation leads to better treatment decisions. TKIs have proven to be better treatment option in EGFR-positive patients as compared to chemotherapy. Third-generation TKIs (osimertinib) promise to bring optimal and improved care for NSCLC cases failing first-line TKI treatment.
晚期非小细胞肺癌（NSCLC）的治疗主要基于铂类化疗。尽管表皮生长因子受体（EGFR）靶向治疗已将治疗模式转向个性化酪氨酸激酶抑制剂（TKIs），但耐药性仍不可避免地出现，而EGFR T790M是最常见的获得性耐药机制。对耐药NSCLC病例进行再次活检可提供有关潜在耐药机制的更多信息，从而有助于临床医生做出更好的管理决策。知名癌症肿瘤学家召开了一次专家小组会议，讨论晚期NSCLC的管理。本文基于专家小组的建议，并得到了详尽的文献检索的支持。研究表明，识别驱动突变有助于做出更好的治疗决策。与化疗相比，TKIs已被证明是EGFR阳性患者更好的治疗选择。第三代TKIs（奥希替尼）有望为一线TKI治疗失败的NSCLC病例带来最佳和改善的治疗。
