"Who should receive epidermal growth factor receptor inhibitors for non-small cell lung cancer and when?".
"Who should receive epidermal growth factor receptor inhibitors for non-small cell lung cancer and when?".
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DOI：
10.1007/s11864-007-0024-2
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发表时间：
2007-02-01
影响因子：
4.3
通讯作者：
Brahmer, Julie R
中科院分区：
文献类型：
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作者：
Hann, Christine L;Brahmer, Julie R
观点声明：抑制非小细胞肺癌（NSCLC）的表皮生长因子受体（EGFR）途径是一个令人兴奋且快速发展的领域。厄洛替尼和吉非替尼是两种EGFR的酪氨酸激酶抑制剂（TKIs），在二线和三线治疗中显示出对晚期NSCLC的活性。II期和III期临床试验的亚群分析表明，这两种药物在非小细胞肺癌患者的某些亚群中具有更高的活性，包括从不吸烟者、亚裔和EGFR fish阳性或突变阳性肿瘤患者。特别是，从不吸烟的患者在厄洛替尼或吉非替尼治疗下的生存率有统计学上的显著改善。EGFR FISH-或突变阳性肿瘤患者对TKI治疗的反应率有所提高，而KRAS突变肿瘤患者没有获得任何益处。在BR.21试验中，厄洛替尼治疗导致总体生存和生活质量的统计学显著改善。因此，虽然谁应该接受EGFR TKI治疗的问题仍然没有完全回答，但所有患者都应该考虑在二线或三线治疗中接受厄洛替尼治疗。在日常临床实践中，目前没有数据支持在这一决策过程中使用EGFR突变或FISH状态。前瞻性试验正在进行中，以确定哪些患者和肿瘤特征可以预测TKI治疗的临床获益。
OPINION STATEMENT: Inhibition of the epidermal growth factor receptor (EGFR) pathway in non-small cell lung cancer (NSCLC) is an exciting and rapidly evolving field. Erlotinib and gefitinib, two tyrosine kinase inhibitors (TKIs) of EGFR, have demonstrated activity in advanced NSCLC in the second- and third-line settings. Subset analyses of phase II and phase III clinical trials lead to the recognition that these two agents had more activity in certain subsets of NSCLC patients including never smokers, people of Asian descent and patients with EGFR FISH-positive or mutation-positive tumors. In particular, never smokers had statistically significant improvements in survival with either erlotinib or gefitinib therapy. Patients with EGFR FISH- or mutation-positive tumors had improved response rates to TKI therapy while those with KRAS mutant tumors did not derive any benefit. In the BR.21 trial treatment with erlotinib resulted in statistically significant improvements in overall survival and quality of life. Thus, while the question of who should receive EGFR TKI therapy is still not completely answered, all patients should be considered for erlotinib therapy in the second- or third-line setting. In daily clinical practice, there is currently no data to support the use of EGFR mutation or FISH status in this decision making process. Prospective trials are ongoing to determine which patient and tumor characteristics are predictive of a clinical benefit from TKI therapy.