Download Topic : The progress of therapy for EGFRm NSCLC

洪仁宇 主任
Topic : The progress of therapy for EGFRm NSCLC
Lung cancer remains one of the most complex and
challenging cancers, being responsible for almost a third of
all cancer deaths. This grim picture seems however to be
changing, for at least a subset of lung cancers. The number of
patients who can benefit from targeted therapies is steadily
increasing thanks to the progress made in identifying
actionable driver lesions in lung tumours. The success of the
latest generation of EGFR and ALK inhibitors in the clinic not
only illustrates the value of targeted therapies, but also
shows how almost inevitably drug resistance develops.
Therefore, more sophisticated approaches are needed to
achieve long-term remissions. Although there are still
significant barriers to be overcome, technological advances
in early detection of relevant mutations and the opportunity
to test new drugs in predictive preclinical models justify the
hope that we will overcome these obstacles.
林建中 醫師
Topic : The impact of EGFR mutations on QOL and
brain metastases in patients NSCLC
one and brain metastases are a very common secondary
localization of disease in patients with lung cancer. The
prognosis of these patients is still poor with a median
survival of less than 1 year. Current therapeutic approaches
include palliative radiotherapy and systemic therapy with
chemotherapy and targeted agents. For bone metastasis,
zoledronic acid is the most commonly used bisphosphonate
to prevent, reduce the incidence and delay the onset of
skeletal-related events (SREs). Recently, denosumab, a fully
human monoclonal antibody directed against the receptor
activator of nuclear factor κB (RANK) ligand inhibiting the
maturation of pre-osteoclasts into osteoclasts, showed
increased time to SREs and overall survival compared with
zoledronic acid. The treatment of brain metastasis is still
controversial. Available standard therapeutic options, such
as whole brain radiation therapy and systemic
chemotherapy, provide a slight improvement in local
control, overall survival and symptom relief. More recently,
novel target agents such as the epidermal growth factor
receptor (EGFR) tyrosine kinase inhibitors (TKIs) erlotinib,
gefitinib and afatinib have shown activity in patients with
brain metastasis. Inter alia, in patients harboring EGFR
mutations, the administration of EGFR TKIs is followed by a
response rate of 70–80%, and a longer progression-free and
overall survival than those obtained with standard
chemotherapeutic regimens. This review is focused on the
evidence for therapeutic strategies in bone and brain
metastases due to lung cancer.