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肺癌靶向药物

ID #1072

不是所有人都能靶向

“大夫,听说现在有种药吃了不掉头发又不会呕吐,你赶紧给我用吧,多贵都不怕!”近年来,随着靶向药物在肺癌临床治疗上的应用,关于靶向药物治疗肺癌的种种神奇效果在患者中越来越神。对此,天津市肺癌诊治中心主任、市肿瘤医院肺部肿瘤科主任王长利教授日前在接受记者采访时指出,临床存在大量盲目使用靶向药物现象,其实靶向药物并非适用于每一位肺癌患者,个体使用靶向药物疗效差异也很大,患者应理性对待,治疗前需咨询医生、做基因突变检测等以判断是否适合。
据介绍,目前临床上常见的肺癌患者约80%为包括鳞癌腺癌等在内的非小细胞肺癌,这些患者确诊时有85%左右是中晚期,约75%的晚期非小细胞肺癌患者失去了手术根治性治疗机会、常规放化疗的临床效果也不甚理想。分子靶向药物治疗是近年新兴的一种治疗手段,因其具有高度选择性地杀死肿瘤细胞而不杀伤或仅很少损伤正常细胞的特点,安全性和耐受性较好、毒副作用相对较小,不少患者都视其为治疗肺癌的一线生机。然而,恰恰由于靶向治疗是为攻击特异性靶分子而设计,所以须找到合适靶点才能发挥其疗效,而能否在个体患者身上找到合适的“靶”以及能否在采用后控制肿瘤的生长,都是因人而异、因靶而异的。
“很多靶向药物已被证明只对部分肿瘤患者较为有效,而剩下的则是微效和无效。”王长利解释说,肺癌从发病机制上大体可分为两类,一类由吸烟所致,长期大量吸烟会引起K-ras基因突变,多为鳞癌、小细胞癌,目前尚无有效的靶向治疗药物;另一类是人体表皮生长因子受体(EGFR)基因突变,多为非小细胞肺癌,靶向治疗对这类患者效果明显(如印度易瑞沙印度特罗凯等),可采用表皮生长因子受体酪氨酸激酶抑制剂,通过阻断致癌信号的传输达到控制癌症的效果。因此有无K-ras基因和EGFR基因突变成为影响疗效的最重要因素。

“临床条件不同的患者,分子靶向药物治疗的疗效不一样。非小细胞肺癌个体化治疗方案的确定,依赖于基因突变检测的结果,这样靶向药物才能找到合适的靶点并充分发挥疗效。”王长利说,研究发现,女性、腺癌、不吸烟、亚洲非小细胞肺癌患者EGFR基因突变率很高,尤其亚裔患者EGFR基因突变发生率为30%至40%,高于欧洲患者的10%至15%(这里主要使用易瑞沙特罗凯等靶向药)。因对酪氨酸激酶抑制剂高度敏感,这些晚期非小细胞肺癌患者可在确诊初期就选用特异靶向药物治疗,以最大限度提高治疗效果。

==== 汉译英 ====

"Doctor, I heard that hair loss is now a kind of Yao Chi is not without vomiting, you hurry to the bar I used more expensive are not afraid!" In recent years, with the targeted drugs in the treatment of lung cancer application, on target Drug treatment of lung cancer in patients with various magical effects in more and more of God. In this regard, diagnosis and treatment of lung cancer in Tianjin director of the Center City Tumor Hospital, director of lung cancer Professor Wang Changli a recent interview with reporters, pointed out that there is a large number of blind clinical use of targeted drug phenomenon, in fact, targeted drug does not apply to every one patients with lung cancer , individual differences in the use of targeted drug efficacy also great, the patient should be a rational treatment of pre-treatment need to consult a doctor, do gene mutation detection, to determine suitability.
According to reports, the current common clinical about 80% of patients with lung cancer, including squamous cell carcinoma, adenocarcinoma, etc., non-small cell lung cancer, these patients about 85% of the time of diagnosis is the late, about 75% of advanced non-small cell lung cancer Radical surgery in patients with loss of access to treatment, the clinical effects of conventional chemotherapy and radiotherapy is also not ideal. Molecular targeted drug therapy is emerging in recent years as a treatment, because of their highly selective in killing tumor cells without destruction or damage to normal cells, only a few features, safety and tolerability of good relative toxicity smaller, a lot of them as the treatment of lung cancer patients are alive. However, precisely because of targeted therapy is designed to attack specific target molecules, so need to find a suitable target in order to fulfill its efficacy, but the possibility of individual patients to find a suitable "target" and the ability to control the tumor after the introduction of growth, are varies due to target-specific.
"A lot of targeted drug has been proven only to be more effective for some cancer patients, while the rest are minor and ineffective." Wang Lee explained that the incidence of lung cancer from the mechanism can be roughly divided into two categories by smoking -induced, long-term smoking will cause a large number of K-ras gene mutations, mostly for squamous cell carcinoma, small cell carcinoma, at present no effective targeted therapy drugs; the other is the human epidermal growth factor receptor (EGFR) gene mutation, multi - non-small cell lung cancer, targeted therapy for these patients significant effect (such as India, Iressa, Tarceva, India, etc.), can be used epidermal growth factor receptor tyrosine kinase inhibitor, by blocking the cancer-causing signal Transmission to control cancer effect. Therefore, whether the K-ras gene and EGFR gene mutations to become the most important factor affecting efficacy.

"Different clinical conditions of patients, the efficacy of molecular targeted drugs are different. Non-small cell lung cancer to determine individualized treatment programs, depending on the gene mutation test results, so that targeted drug in order to find a suitable target and the full effect of . "Wang Chang-li said the study found that women, adenocarcinoma, non-smoking, Asian non-small cell lung cancer patients a high rate of EGFR gene mutation, particularly in Asian patients with EGFR gene mutation rate was 30% to 40% higher than the European patients of 10% to 15% (mainly used here, such as Iressa and Tarceva target drugs). Due to the highly sensitive to the tyrosine kinase inhibitors, these patients with advanced non-small cell lung cancer can be diagnosed early on the selection of specific targeted drug therapy, in order to maximize therapeutic effect.

Tags: 靶向药使用

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更新日期: 2009-12-01 01:58
作者: : mcyclub
修订: 1.0

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