Suda Kenichi, Mitsudomi Tetsuya
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Kyobu Geka. 2022 Jan;75(1):53-66.
Molecular targeted therapies are now guideline-recommended treatments for unresectable non-small cell lung cancer( NSCLC) patients harboring driver gene mutations as a front-line treatment. Currently, 17 agents have been approved in Japan for the treatment of patients with NSCLC harboring EGFR mutation, ALK/ROS1/NTRK/RET fusions, BRAF V600E mutation, or MET exon 14 skipping mutation. In addition, many novel agents are being developed against NSCLCs with the other driver mutations such as EGFR or HER2 exon 20 insertion mutations and KRAS G12C mutation. In the era of personalized medicine, thoracic surgeons are expected to play an important role, as one of specialists for multidisciplinary treatments of NSCLCs, at the tumor boards/cancer boards, therefore, the knowledge of genetic testing and molecular targeted drugs is becoming essential for thoracic surgeons. In this review, from the standpoint of thoracic surgeons, we briefly summarize current topics on molecular testing in NSCLCs, approved molecular targeted drugs in Japan, acquired resistance mechanisms to these agents, and attempts to use molecular targeted drugs in adjuvant/neoadjuvant settings.
分子靶向治疗现已成为指南推荐的、用于一线治疗携带驱动基因突变的不可切除非小细胞肺癌(NSCLC)患者的治疗方法。目前,日本已批准17种药物用于治疗携带EGFR突变、ALK/ROS1/NTRK/RET融合、BRAF V600E突变或MET外显子14跳跃突变的NSCLC患者。此外,针对具有其他驱动基因突变(如EGFR或HER2外显子20插入突变以及KRAS G12C突变)的NSCLC,许多新型药物正在研发中。在精准医疗时代,胸外科医生作为NSCLC多学科治疗专家之一,有望在肿瘤委员会/癌症委员会中发挥重要作用,因此,基因检测和分子靶向药物知识对胸外科医生而言变得至关重要。在本综述中,我们从胸外科医生的角度,简要总结NSCLC分子检测的当前热点、日本已批准的分子靶向药物、对这些药物的获得性耐药机制,以及在辅助/新辅助治疗中使用分子靶向药物的尝试。