From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA.
Cancer J. 2020 Nov/Dec;26(6):485-495. doi: 10.1097/PPO.0000000000000489.
The initial treatment regimens for advanced non-small cell lung cancer (NSCLC) have drastically evolved over the last 15 years with the rapid development of improved genomic sequencing technologies and the emergence of immune checkpoint inhibitors. Highly active oral kinase inhibitors are now approved for several molecularly defined subsets of NSCLC, including those harboring alterations in the EGFR, ALK, ROS1, BRAF, MET, RET, and NTRK genes, although acquired resistance to these targeted therapies remains a significant clinical challenge. In lung cancers lacking targetable mutations, programmed death 1/programmed death ligand 1 immune checkpoint inhibitors, used alone or in combination with cytotoxic T-lymphocyte-associated protein 4 inhibitors and/or cytotoxic chemotherapy, have led to meaningful improvements in overall survival. With many therapeutic options available to patients, here we review the recommended frontline treatment regimens for advanced NSCLC with and without targetable genomic drivers.
在过去的 15 年中，随着基因组测序技术的快速发展和免疫检查点抑制剂的出现，晚期非小细胞肺癌（NSCLC）的初始治疗方案发生了巨大变化。目前，几种分子定义明确的 NSCLC 亚型已批准使用高活性口服激酶抑制剂，包括 EGFR、ALK、ROS1、BRAF、MET、RET 和 NTRK 基因突变的患者，尽管这些靶向治疗的获得性耐药仍然是一个重大的临床挑战。在没有可靶向突变的肺癌中，单独使用或与细胞毒性 T 淋巴细胞相关蛋白 4 抑制剂和/或细胞毒性化疗联合使用程序性死亡 1/程序性死亡配体 1 免疫检查点抑制剂，可显著改善总生存期。由于患者有许多治疗选择，在这里我们回顾了有和没有可靶向基因组驱动因素的晚期 NSCLC 的推荐一线治疗方案。
