Remon Jordi, Hendriks Lizza E L
Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain.
Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
Mediastinum. 2021 Sep 25;5:22. doi: 10.21037/med-21-8. eCollection 2021.
Until recently, the standard treatment in unresectable stage III non-small cell lung cancer was concurrent chemoradiotherapy, but often with dismal outcome. The introduction of consolidation treatment with immune checkpoint inhibitors has shifted the treatment landscape and prognosis of these patients. However, patients whose tumors harbors an epidermal growth factor receptor (EGFR) mutation derived less benefit, with an increased risk of immune-related adverse events. Moreover, current data suggested that patients with oncogenic addicted tumors, mainly -positive tumors, and also anaplastic lymphoma kinase ()-positive have poorer progression free survival after chemoradiotherapy. Indeed, these tumors have also inferior distant control compared with those who have wild-type disease, especially in the central nervous system, highlighting the need for assessing the role of targeted therapies in this patient population. It is speculated that outcome could probably increase with a consolidation treatment strategy including an EGFR tyrosine kinase inhibitor. However, a personalized treatment approach is not considered standard of care in this setting due to lack of robust evidence, as the majority of trials were performed in unselected patients, number of patients is limited and the majority of these studies were underpowered. In this review we summarize the role of tyrosine kinase inhibitors in unresectable stage III NSCLC, specifically focusing on -mutant tumors.
直到最近，不可切除的 III 期非小细胞肺癌的标准治疗方法还是同步放化疗，但结果往往不佳。免疫检查点抑制剂巩固治疗的引入改变了这些患者的治疗格局和预后。然而，肿瘤携带表皮生长因子受体（EGFR）突变的患者获益较少，且免疫相关不良事件风险增加。此外，目前的数据表明，具有致癌成瘾性肿瘤的患者，主要是 - 阳性肿瘤患者，以及间变性淋巴瘤激酶（）阳性患者，在放化疗后无进展生存期较差。事实上，与野生型疾病患者相比，这些肿瘤的远处控制也较差，尤其是在中枢神经系统，这凸显了评估靶向治疗在该患者群体中作用的必要性。据推测，采用包括 EGFR 酪氨酸激酶抑制剂在内的巩固治疗策略可能会改善预后。然而，由于缺乏有力证据，在这种情况下，个性化治疗方法未被视为标准治疗方案，因为大多数试验是在未经过筛选的患者中进行的，患者数量有限，且这些研究大多效力不足。在本综述中，我们总结了酪氨酸激酶抑制剂在不可切除的 III 期非小细胞肺癌中的作用，特别关注 - 突变肿瘤。
