EGFR-TKI在非小细胞肺癌中的研究进展

Progress of EGFR-TKIs in Non-small Cell Lung Cancer

肺癌是引起人类恶性肿瘤相关性死亡的主要原因,也是世界范围内发病率最高的恶性肿瘤,其中非小细胞肺癌（NSCLC）是其主要类型。近年来,NSCLC的治疗取得重要突破,已由传统的手术、化疗和放疗,发展到精准分子靶向治疗时代和免疫治疗时代。NSCLC分子靶向治疗中,又以表皮生长因子酪氨酸激酶抑制剂（EGFR-TKI）研究最透彻,已广泛应用于EGFR突变人群中。一代EGFR-TKI已是EGFR突变晚期NSCLC患者的标准一线治疗。一代EGFRTKIs药物间疗效无显著性差异,不良反应发生率上厄洛替尼相对更低。二代EGFR-TKI疗效不亚于一代EGFR-TKI,对少见突变患者具有一定疗效。三代EGFR-TKIs作为后起之秀,对EGFR突变患者（包括T790M突变）疗效显著,对脑转移患者亦有作用。新时代下EGFR-TKI联合化疗、放疗、免疫及抗肿瘤血管治疗等其他治疗模式的探索初现成果,TKI联合其他抗肿瘤治疗给患者治疗带来新的选择和方向。EGFR-TKI治疗NSCLC在挑战与机遇中砥砺前行。

Lung cancer is the most common malignancy and the leading cause of cancer-related death worldwide. Non-small cell lung cancer（NSCLC）is the main type of lung cancer. In recent years,the treatment of NSCLC has made important breakthroughs,from traditional surgery,chemotherapy and radiotherapy to an era of molecular-targeted therapy and immunotherapy. The epidermal growth factor tyrosine kinase inhibitor（EGFR-TKI）as the molecular-targeted therapy of NSCLC was well studied and has been widely used in EGFR mutation patients. The first generation EGFR-TKIs has been recommended as the first-line treatment for advanced NSCLC patients with EGFR mutations. There is no significant difference in clinical efficacy among different first generation EGFR-TKI drugs,while the incidence of side effects of erlotinib is relatively lower. The efficacy of the second generation EGFR-TKI is not less than the first generation EGFR-TKI,and it is effective for NSCLC patients with uncommon EGFR mutations. The third generation EGFR-TKIs are particularly effective for patients harboring activating EGFR mutations including T790 M mutation,and for NSCLC patients with brain metastases. The combination of EGFR-TKIs with chemotherapy,radiotherapy,immunotherapy or anti-tumor vascular therapy has achieved promising results,it would be a new option and direction for NSCLC patients.