中文 English

Introduction

Lung cancer is a major cause of cancer-related mortality worldwide. In the developed world and developed countries in the developed areas of lung cancer has been the first malignant tumor, is the highest mortality rate of malignant tumors. Lung carcinomas are categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope. For therapeutic purposes, two broad classes are distinguished: non-small-cell lung carcinoma and small-cell lung carcinoma. The three main subtypes of NSCLC are adenocarcinoma, squamous-cell carcinoma and large-cell carcinoma. Nearly 40% of lung cancers are adenocarcinoma, which usually originates in peripheral lung tissue. Squamous-cell carcinoma accounts for about 30% of lung cancers. They typically occur close to large airways. A hollow cavity and associated cell death are commonly found at the center of the tumor. About 9% of lung cancers are large-cell carcinoma. These are so named because the cancer cells are large, with excess cytoplasm, large nuclei and conspicuous nucleoli. Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread, and the person's performance status. Common treatments include palliative care, surgery, chemotherapy, and radiation therapy. Targeted therapy of lung cancer is growing in importance for advanced lung cancer.

Targeted Drugs Screening

One of the most exciting developments in lung cancer medicine is the introduction of targeted treatments. Unlike chemotherapy drugs, which cannot tell the difference between normal cells and cancer cells, targeted therapies are designed specifically to attack cancer cells by attaching to or blocking targets that appear on the surfaces of those cells. People who have advanced lung cancer with certain molecular biomarkers may receive treatment with a targeted drug alone or in combination with chemotherapy. These treatments for lung cancer include:
Erlotinib (Tarceva ). A targeted treatment called erlotinib has been shown to benefit some people with non-small cell lung cancer. This drug blocks a specific kind of receptor on the cell surface—the epidermal growth factor receptor (EGFR). Receptors such as EGFR act as doorways by allowing substances in that they can encourage a cancer cell to grow and spread. Lung cancer cells that have a mutation on the EGFR are likely to respond to treatment with erlotinib instead of chemotherapy. For patients who have received chemotherapy, and are in need of additional treatment, erlotinib can be used even without the presence of the mutation.
Afatinib (Gilotrif). In 2013, the FDA approved afatinib for the initial treatment of metastatic NSCLC in patients with the same EGRF gene mutations or deletions as those who can be treated successfully with erlotinib.
Gefitinib (Iressa). In 2015, the FDA approved gefitinib for the first-line treatment of patients with NSCLC whose tumors harbor specific types of EGFR gene mutations, as detected by an FDA-approved test.
Bevacizumab (Avastin). Just like normal tissues, tumors need a blood supply to survive. Blood vessels grow in several ways. One way is through the presence of a substance called vascular endothelial growth factor (VEGF). This substance stimulates blood vessels to penetrate tumors and supply oxygen, minerals, and other nutrients to feed the tumor. When tumors spread throughout the body, they release VEGF to create new blood vessels. Bevacizumab works by stopping VEGF from stimulating the growth of new blood vessels. (Because normal tissues have an established blood supply, they are not affected by the drug.) When combined with chemotherapy, bevacizumab has been shown to improve survival in people with certain types of non-small lung cancer, such as adenocarcinoma and large cell carcinoma.
Crizotinib (Xalkori). A treatment that has shown benefits for people with advanced non–small cell lung cancer who have the ALK gene mutation. Crizotinib works by blocking ALK and stopping the growth of the tumor.
Ceritinib (Zykadia). This was approved in 2014 for people with metastatic ALK-positive lung cancer who cannot tolerate crizotinib or whose cancer continued to grow while being treated with crizotinib.
Because the genes of cancer cells can evolve, some tumors may become resistant to a targeted treatment. Medications to meet those challenges are being studied now in clinical trials, which often offer important treatment options for people with lung cancer.

Evaluation of the efficacy and side effects of chemotherapy drugs

The development of pharmacogenomics theory and technology has provided us with more information.  Genetics may account for much of the variability in the patients’ responses to drug therapies. Polymorphisms that affect the pharmacokinetics and
pharmacodynamics of specific drugs are common. Testing for certain polymorphisms before prescribing certain drugs could help avoid adverse drug effects and improve efficacy. Pharmacogenomic testing has only recently begun to enter clinical practice, and routine testing is currently limited to a few clinical scenarios. However, additional applications may be just around the corner.

Reference

1. Expert group of epidermal growth factor receptor gene mutations in Chinese patients with non - small cell lung cancer . Expert consensus on the detection of epidermal growth factor receptor gene mutations in Chinese patients with non - small cell lung cancer(2016 edition).Chin J Pathol,2016,45(4):217-220.
2. China Society of Clinical Oncology Guidance Working Committee . Chinese Society of Clinical Oncology (CSCO) primary lung cancer treatment guidelines. 2016 edition
3. Chinese Physician Association Cancer Physician Branch,Chinese Cancer Society of Cancer Clinical Chemotherapy Professional Committee.  Chinese epidermal growth factor receptor gene sensitivity mutation and indirect lymphoma kinase fusion gene positive non-small cell lung cancer diagnosis and treatment guidelines(2015 edition).Chin J Oncol,2015,37(10):796-799.
4.NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer. 2017. V4
5. Expert consensus on diagnosis and treatment of brain metastases in lung cancer in China(Version. 2017). Chin J Lung Cancer,2017,20(1):1-13.