从阳气亏虚探讨非小细胞肺癌表皮生长因子受体-酪氨酸激酶抑制剂耐药及应对策略

Drug Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor in Non-Small Cell Lung Cancer and Coping Strategy: Discussion based on Yang Deficiency

表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)是临床治疗非小细胞肺癌的靶向药物,但几乎所有患者都会发生EGFR-TKI耐药。中医学认为,阳气亏虚是导致肿瘤的发病因素,阳气不足导致癌毒内生、促进有形实邪的形成。临床和实验研究表明,以温阳法为主的中医药治疗可以抑制EGFR-TKI耐药,提高EGFR-TKI疗效,其机制可能与调控miRNA基因以及雌激素受体表达、对抗肿瘤异质性、调节肿瘤微环境有关。因此,阳气亏虚是导致非小细胞肺癌EGFR-TKI耐药的关键病机,而扶阳抑阴是克服EGFR-TKI耐药的中医基本治法。

Epidermal growth factor receptor tyrosine kinase inhibitor（ EGFR-TKI） is a kind of targeted drug for the treatment of non-small cell lung cancer（ NSCLC）,but almost all patients develop EGFR-TKI resistance. In Chinese medicine,it is believed that Yang deficiency is the leading cause of tumor,which could end up with the internal formation of cancer toxin and promote the formation of tangible excess pathogens. Clinical and experimental studies have shown that the Chinese medicine treatment based on Yang-warming method can inhibit EGFR-TKI resistance and improve the therapeutic effect of EGFR-TKI. The mechanism may be related to the regulation of miRNA gene and estrogen receptor expression,being against tumor heterogeneity and the regulation of tumor microenvironment.Therefore,Yang deficiency is the key pathogenesis of the EGFR-TKI resistance in NSCLC,and the method reinforcing Yang and suppressing Yin is the basic therapeutic way in Chinese medicine to overcome EGFR-TKI resistance.