Fox Chase Cancer Center, Philadelphia, PA.
J Oncol Pract. 2018 Sep;14(9):529-535. doi: 10.1200/JOP.18.00250.
Lung cancer is the leading cause of cancer-related death worldwide. The majority of these cancers are non-small-cell lung cancer, of which adenocarcinoma is the most common histologic subtype. Most patients are diagnosed at advanced stages when systemic treatment is needed. Whereas prognosis has improved for patients with targetable driver mutations, the majority of patients do not possess tumors with such molecular mutations. Platinum-based chemotherapy has traditionally been the mainstay of treatment, although in recent years immunotherapy has emerged as a treatment option and can result in robust and durable treatment responses in a subset of patients. Recent clinical trials on novel immunotherapy combinations and immunochemotherapy combinations may broaden the number of patients that may benefit from checkpoint inhibitors and elicit responses in those who otherwise may not have experienced a response to monotherapy with an immunotherapy drug. This review will outline the currently available therapies for the first-line treatment of metastatic adenocarcinoma that do not possess a driver mutation and provide a recommended approach and algorithm by which to select the best first-line therapy.
肺癌是全球癌症相关死亡的主要原因。这些癌症大多数是非小细胞肺癌，其中腺癌是最常见的组织学亚型。大多数患者在需要全身治疗时被诊断为晚期。虽然对于可靶向驱动突变的患者，预后已经有所改善，但大多数患者的肿瘤没有这种分子突变。铂类化疗一直是治疗的主要方法，尽管近年来免疫疗法已成为一种治疗选择，并且可以在一部分患者中产生强大且持久的治疗反应。最近关于新型免疫疗法联合和免疫化疗联合的临床试验可能会扩大可能从检查点抑制剂中获益的患者数量，并在那些否则可能对免疫疗法药物单药治疗没有反应的患者中引起反应。这篇综述将概述目前用于治疗无驱动突变的转移性腺癌的一线治疗方法，并提供一种推荐的方法和算法，以选择最佳的一线治疗方法。
