Ninomiya Kiichiro, Teraoka Shunsuke, Zenke Yoshitaka, Kenmotsu Hirotsugu, Nakamura Yukiko, Okuma Yusuke, Tamiya Akihiro, Nosaki Kaname, Morise Masahiro, Aokage Keiju, Oya Yuko, Kozuki Toshiyuki, Sakamoto Tomohiro, Tanaka Kentaro, Tanaka Hisashi, Tanizaki Junko, Miura Satoru, Mizutani Hideaki, Miyauchi Eisaku, Yamaguchi Ou, Ebi Noriyuki, Goto Yasushi, Sasaki Takaaki, Daga Haruko, Morita Satoshi, Yamanaka Takeharu, Amano Shinsuke, Hasegawa Kazuo, Imamura Chiyo K, Suzuki Kenichi, Nakajima Kazuko, Nishimoto Hitomi, Oizumi Satoshi, Hida Toyoaki, Hotta Katsuyuki, Takiguchi Yuichi
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Internal Medicine III, Wakayama Medical University, Wakayama, Japan.
JTO Clin Res Rep. 2020 Oct 12;2(1):100107. doi: 10.1016/j.jtocrr.2020.100107. eCollection 2021 Jan.
Patients with NSCLC in East Asia, including Japan, frequently contain mutations. In 2018, we published the latest full clinical practice guidelines on the basis of those provided by the Japanese Lung Cancer Society Guidelines Committee. The purpose of this study was to update those recommendations, especially for the treatment of metastatic or recurrent -mutated NSCLC. We conducted a literature search of systematic reviews of randomized controlled and nonrandomized trials published between 2018 and 2019 that multiple physicians had reviewed independently. On the basis of those studies and the advice from the Japanese Society of Lung Cancer Expert Panel, we developed updated guidelines according to the Grading of Recommendations, Assessment, Development, and Evaluation system. We also evaluated the benefits of overall and progression-free survival, end points, toxicities, and patients' reported outcomes. For patients with NSCLC harboring -activating mutations, the use of EGFR tyrosine kinase inhibitors (EGFR TKIs), especially osimertinib, had the best recommendation as to first-line treatment. We also recommended the combination of EGFR TKI with other agents (platinum-based chemotherapy or antiangiogenic agents); however, it can lead to toxicity. In the presence of uncommon mutations, except for an exon 20 insertion, we also recommended the EGFR TKI treatment. However, we could not provide recommendations for the treatment of mutations with immune checkpoint inhibitors, including monotherapy, and its combination with cytotoxic chemotherapy, because of the limited evidence present in the literature. The 2020 Japanese Lung Cancer Society Guidelines can help community-based physicians to determine the most appropriate treatments and adequately provide medical care to their patients.
包括日本在内的东亚非小细胞肺癌患者经常存在基因突变。2018年，我们在日本肺癌学会指南委员会提供的基础上发布了最新的完整临床实践指南。本研究的目的是更新这些建议，特别是针对转移性或复发性EGFR突变的非小细胞肺癌的治疗。我们对2018年至2019年间发表的随机对照试验和非随机试验的系统评价进行了文献检索，多位医生独立进行了评审。基于这些研究以及日本肺癌专家小组的建议，我们根据推荐分级、评估、制定和评价系统制定了更新后的指南。我们还评估了总生存期和无进展生存期的益处、终点、毒性以及患者报告的结果。对于携带EGFR激活突变的非小细胞肺癌患者，使用表皮生长因子受体酪氨酸激酶抑制剂（EGFR TKIs），尤其是奥希替尼，作为一线治疗的推荐最佳。我们还推荐了EGFR TKI与其他药物（铂类化疗或抗血管生成药物）联合使用；然而，这可能会导致毒性。在存在不常见突变的情况下，除了20号外显子插入突变，我们也推荐EGFR TKI治疗。然而，由于文献中证据有限，我们无法就免疫检查点抑制剂治疗EGFR突变，包括单药治疗及其与细胞毒性化疗联合使用提供建议。2020年日本肺癌学会指南可以帮助社区医生确定最合适的治疗方法，并为患者提供充分的医疗服务。
