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Diagnosis and treatment of EGFR-mutant lung cancer patients
Diagnosis and treatment of EGFR-mutant lung cancer patients. Discussion on the first-line diagnosis and treatment strategy for EGFR-mutant lung cancer patients.
With the development of precision medicine, lung cancer targeted therapies are changing with each passing day, new drugs appear frequently, and multiple generations of EGFR-TKI drugs have appeared in the clinic.
This article is reproduced from the public account: Yiyuehui,
Topic of this issue: Discussion on first-line diagnosis and treatment strategies for EGFR-mutant lung cancer patients
- Special guest: Professor Zhiyong He, China Fujian Cancer Hospital
- Special guest: Professor Yang Dongyong, the Second Affiliated Hospital of Fujian Medical University
- Special guest: Professor He Yueming, Quanzhou First Hospital Affiliated to Fujian Medical University
With the development of precision medicine, lung cancer targeted therapies are changing with each passing day, new drugs appear frequently, and multiple generations of EGFR-TKI drugs have appeared in the clinic. Based on your clinical experience, what are the first-line treatment options for advanced NSCLC with EGFR mutations at this stage? What problems still need to be solved urgently in the treatment process? Do you have your own unique experience in treatment?
Professor Zhiyong He: The treatment of EGFR-mutant lung cancer patients has gone through more than ten years, and many new discoveries and experiences have emerged. The concept of clinical diagnosis and treatment is also constantly updated, and new drugs are constantly coming out. Therefore, first-line treatment strategies are constantly changing. From the current point of view, the first, second, and third-generation EGFR-TKIs have appeared in the clinic. As our understanding of the first-line treatment and drug resistance mechanisms of EGFR continues to deepen, the first-line treatment strategy has gradually become clear.
First, first-line and second-generation TKIs are the first choice for first-line treatment. After T790M mutation appears after drug resistance, third-generation EGFR=TKI is used for treatment. This is a sequential treatment strategy. The second is to directly use the third-generation EGFR-TKI for first-line treatment, which is the third-generation direct application strategy. The biggest difference between these two strategies lies in the application timing of the third-generation TKI. The direct application strategy has a better effect on patients with T790M mutations or brain metastases initially diagnosed. The sequential treatment strategy is based on the patient’s full treatment. If the third-generation drug is used as the first-line treatment strategy, after the patient is resistant, We will have no good treatment. The final test for these two treatments is which strategy can make patients survive longer.
The current three generations of EGFR-TKI drugs have common characteristics: all are reversible. In addition, due to drug design defects, they can also block EGFR sites that are not mutated in normal cells. Therefore, this generation of drugs has certain toxic and side effects, and the concentration of drugs used will be relatively large, which is likely to cause drug resistance. Combination therapy can specifically solve the above problems. For example, in recent years, a number of large-scale international multi-center clinical trials have confirmed that targeted therapy combined with chemotherapy and anti-angiogenesis therapy have obvious advantages in patients with PFS, and the results of OS have not yet been announced.
In addition, small-molecule multi-target drugs are completely different from monoclonal antibody anti-angiogenic drugs. They have the characteristics of anti-angiogenic drugs, as well as the characteristics of intracellular site blockade affecting tumor cell growth. At present, our hospital is conducting a clinical study focusing on the combination therapy of a generation of EGFR-TKI icotinib and the small molecule multi-target drug anlotinib, and to explore which is better in the treatment of icotinib combined with anvastin . We also look forward to the results of this experimental study that will surprise us.
With the advent of the era of precision medicine, detection has become an important part of lung cancer diagnosis and treatment. When a respiratory doctor diagnoses and treats lung cancer patients, will they recommend genetic testing during the first diagnosis? What are the preferred detection methods?
Professor Yang Dongyong: At present, most patients with lung cancer may go to the respiratory department first. When seeing a doctor, we need to verify whether it is lung cancer or what type of lung cancer, such as adenocarcinoma, squamous cell carcinoma, and small cell lung cancer. If the patient is tested for lung adenocarcinoma, then we will recommend genetic testing.
For certain specific groups of patients with lung squamous cell carcinoma, we will consider the issue of tumor suppressors based on clinical evaluations, and will also conduct some genetic testing for them, and practice has proved that this method is also clinically beneficial to patients.
At present, in addition to genetic testing for lung adenocarcinoma or squamous cell carcinoma, other patients should choose appropriate genetic testing methods. For example, when selecting a suitable tissue specimen, or when there is no way to detect a tissue specimen, you can choose to perform a liquid biopsy to obtain the first time information of the test. There are many existing testing methods. For most patients, we recommend choosing NGS for testing, which can provide more comprehensive and accurate information.
Respiratory department is often the first consultation department for lung cancer patients, and it plays a vital role in the treatment of patients. In your opinion, what are the advantages and characteristics of the respiratory department in the diagnosis and treatment of lung cancer?
Professor He Yueming: The first consultation department for lung cancer patients is often the respiratory department. In the past, the respiratory department has little experience in the treatment of lung cancer patients. With the continuous increase of our treatment methods, respiratory doctors have begun to recognize the proportion of lung cancer in respiratory diseases.
From the perspective of diagnosis, respiratory doctors have more diagnostic tools, such as bronchoscopy, transsplenic lung puncture, and thoracoscopy, which have been widely used in respiratory medicine. Lung nodules or tumors are not necessarily all malignant, so in the differential diagnosis of benign and malignant, respiratory department also has certain advantages. In terms of treatment, we can learn more advanced treatment methods from the oncology department. In addition, respiratory intervention has great advantages in the treatment of some extreme and isolated lesions, and can even achieve a radical cure.
In addition, for the treatment of some complications, such as airway stenosis, airway fistula, etc., we can use stent intervention for treatment. For the treatment of complications such as interstitial pneumonia or radiation pneumonia, respiratory surgeons are also more advantageous. This is also one of the characteristics of lung cancer treatment in the respiratory department.
(source:internet, reference only)