Individualizing therapy for non-small-cell lung cancer: a paradigm shift from empiric to integrated decision-making.

摘要: New basic and clinical research findings in non–small-cell lung cancer (NSCLC) are revolutionizing both our concepts about this malignancy practice patterns. Current for selection of therapy patients with advanced-stage NSCLC, many other tumor types as well, is largely empiric. In general, each time a treating oncologist selects therapy, 4 different dimensions (Figure 1) considered the decision-making process: (1) evidence from literature (ie, therapeutic ratio regimens); (2) individual patient characteristics age, sex, performance status, smoking status); (3) preference desire longer life versus quality life); (4) physician experience preference. Although empiric process serves most 2009 paradigm shift has begun which beginning to move “empiric” what can be called an “integrated” approach. As summarized Table 1, variety emerging factors now make it possible consider customizing NSCLC by integrating clinical, histologic, molecular factors. Because list hundreds, only representative examples data appear robust listed 1. First foremost, previous studies have documented that such female never-smoking East Asian ethnicity associated response epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Despite clear association, recently reported IPASS trial, performed entirely adenocarcinoma (94% never 80% female) strikingly demonstrates (EGFR TK domain mutation) “trumps” features predicting benefit EGFR TKI gefitinib.1 study, advanced were randomized gefitinib or chemotherapy, progression-free survival highly mutation status. Those tumors harboring mutations did much better gefitinib, whereas those wild-type fared despite near uniformity would suggested superior outcomes gefitinib. approximately 85% North American