摘要
非小细胞肺癌患者中约30%~50%有脑转移(brain metastases,BM),严重影响生活质量和总生存期。系统性的治疗仍然是转移性疾病的标准策略。到目前为止,化疗与全脑放疗(whole brain radiation therapy,WBRT)的结合,手术或立体定向放射外科(stereotactic radiosurgery,SRS)是脑转移患者常用的治疗手段。针对表皮生长因子受体(epidermal growth factor receptor,EGFR)的靶向治疗,如吉非替尼、厄洛替尼和埃克替尼,对EGFR基因突变阳性的患者取得了显著的疗效,埃克替尼不良反应方面优势明显,临床使用安全性更好,在加量治疗时优势更加突出。报道的客观缓解率和良好的安全性、耐受性使表皮生长因子-酪氨酸激酶抑制剂(EGFR-tyrosine kinase inhibitors,EGFR-TKIs)广泛用于非小细胞肺癌脑转移患者,特别是那些EGFR基因突变阳性的患者。此外,新一代TKIs,比如AZD9291和AZD3759,效果显著,一些试验正在如火如荼的进行。本文对EGFR-TKIs治疗敏感突变肺癌脑转移的研究进展进行综述。
Brain metastases(BM) complicate clinical evolution of non-small cell lung cancer (NSCLC) in approximately 30%-50% of cases, adversely influencing quality of life(QOL) and overall survival (OS). Systemic therapy remains the standard strategy for metastatic disease. To date, the combination of chemotherapy with whole brain radiation therapy(WBRT), surgery or stereotactic radiosurgery(SRS) represent the most common treatments for BM patients. Therapies targeting epidermal growth factor receptor(EGFR), such as gefitinib, erlotinib and icotinib, achieve important improvements in EGFR-mutated NSCLC with favorable toxicity profile. The incidence of adverse reactions in icotinib is lower, the clinical use is safer, and the advantage is more pronounced when increasing the dose. The reported objective response rate (ORR), well safety and tolerance make EGFR-tyrosine kinase inhibitors(TKIs) an interesting valid alternative for NSCLC patients with BM, especially for those harboring EGFR mutations. Furthermore, new-generation TKIs, such as AZD9291 and AZD3759, have already shown important activity on intracranial disease and several trials are still ongoing to evaluate their efficacy. In this review, we want to highlight literature data about the use and the effectiveness of EGFR-TKIs on patients with BM from EGFR-mutated NSCLC.
作者
苏雨栋
陈鹏
SU Yudong CHEN Peng(Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, .Chin)
出处
《肿瘤防治研究》
CAS
CSCD
北大核心
2017年第10期698-700,共3页
Cancer Research on Prevention and Treatment