晚期非小细胞肺癌化疗及靶向治疗相关分子标记物
Molecular Indices of Chemotherapy and Targeted Therapy for Advanced Non small Cell Lung Cancer
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摘要: 肺癌是发达国家中发病率和死亡率最高的恶性肿瘤之一,其中75%~80%为非小细胞肺癌(NSCLC)。由于缺乏有效的早期诊断方法,60%~70%的非小细胞肺癌患者在确诊时已属晚期,无法对其进行根治性手术切除,仅能通过化疗或放疗缓解,对于其治疗及预后,目前医学领域尚无突破性进展。以铂类为基础的联合化疗是治疗晚期NSCLC的首选方案,但是由于个体之间的差异性,同一种病理类型和分期的NSCLC对标准化疗敏感性差异较大,因此有效率仅为25%~30%,2年生存率小于15%。近年来人们提出了针对不同患者进行个体化治疗的概念。随着对联合化疗分子机制的认识不断进展,目前已发现一些肿瘤分子标志物的改变与化疗敏感性有关。针对不同的分子标记物指定不同的个体化化疗方案对于改善晚期非小细胞肺癌患者生存期具有重要意义;而寻找特定基因的改变作为敏感性和耐药性标志来选择对肿瘤敏感的靶向治疗药物也将会更有效,使治疗更加个性化。要将这些结果应用于临床,仍需要大规模开展临床试验,进一步标化实验检测方法以及规范检测结果评价。Abstract: Lung cancer has a high incidence and mortality in developed countries. About 75%~80% of lung cancersare nonsmall cell lung cancers (NSCLC). Due to deficiency of techniques for early diagnosis, 60%~70% of NSCLC pa-tients are found at advanced stages when diagnosed, leading to little chance for radical operation. Such cases can only betreated with chemotherapy or radiotherapy. There has been no breakthrough in the treatment and prognosis of those cases.The platinumbased combination regimens remain the first priorities for NSCLC cases. But because of individual differ-ences, the response rate is only 25%~30% and the 2year survival is about 15%. The sensitivities to regimens vary greatlyeven in NSCLC cases with same pathology and staging. The concept of individual therapy has been brought forward in re-cent years. Researches on molecular mechanisms of combination regimens have discovered correlations between somecancer molecular indices and the sensitivities by now. Individual regimens targeting different molecular indices may besignificant in improving the survival of patients with late stage NSCLC. Identification of variations in some specific genesas the drug resistance indications will enable the most sensitive therapy for individuals. More multicentered clinical trialsand standardized methods and evaluation of results will be needed for clinical application.