Song Xiaotong, Cao Luchang, Ni Baoyi, Wang Jia, Qin Xiaoyan, Sun Xiaoyue, Xu Bowen, Wang Xinmiao, Li Jie
Department of Oncology, Guang' Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Respiratory, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang, China.
Front Pharmacol. 2023 Apr 7;14:1090500. doi: 10.3389/fphar.2023.1090500. eCollection 2023.
Epidermal growth factor receptor (EGFR) mutations are the most common oncogenic driver in non-small cell lung cancer (NSCLC). Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are widely used in the treatment of lung cancer, especially in the first-line treatment of advanced NSCLC, and EGFR-TKIs monotherapy has achieved better efficacy and tolerability compared with standard chemotherapy. However, acquired resistance to EGFR-TKIs and associated adverse events pose a significant obstacle to targeted lung cancer therapy. Therefore, there is an urgent need to seek effective interventions to overcome these limitations. Natural medicines have shown potential therapeutic advantages in reversing acquired resistance to EGFR-TKIs and reducing adverse events, bringing new options and directions for EGFR-TKIs combination therapy. In this paper, we systematically demonstrated the resistance mechanism of EGFR-TKIs, the clinical strategy of each generation of EGFR-TKIs in the synergistic treatment of NSCLC, the treatment-related adverse events of EGFR-TKIs, and the potential role of traditional Chinese medicine in overcoming the resistance and adverse reactions of EGFR-TKIs. Herbs and active compounds have the potential to act synergistically through multiple pathways and multiple mechanisms of overall regulation, combined with targeted therapy, and are expected to be an innovative model for NSCLC treatment.
表皮生长因子受体（EGFR）突变是非小细胞肺癌（NSCLC）中最常见的致癌驱动因素。表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）广泛应用于肺癌治疗，尤其是晚期NSCLC的一线治疗，与标准化疗相比，EGFR-TKIs单药治疗已取得更好的疗效和耐受性。然而，对EGFR-TKIs的获得性耐药及相关不良事件给肺癌靶向治疗带来了重大障碍。因此，迫切需要寻求有效的干预措施来克服这些局限性。天然药物在逆转对EGFR-TKIs的获得性耐药和减少不良事件方面已显示出潜在的治疗优势，为EGFR-TKIs联合治疗带来了新的选择和方向。在本文中，我们系统地阐述了EGFR-TKIs的耐药机制、各代EGFR-TKIs在NSCLC协同治疗中的临床策略、EGFR-TKIs治疗相关的不良事件，以及中药在克服EGFR-TKIs耐药和不良反应方面的潜在作用。草药和活性化合物有可能通过多种途径和多种整体调节机制发挥协同作用，与靶向治疗相结合，有望成为NSCLC治疗的创新模式。
