Anti-angiogenesis Therapy in Lung Cancer: a Practical Approach
JCM Ho
Hong Kong J Radiol 2013;16(Suppl):S55-9
In advanced pulmonary carcinoma, determination of epidermal growth factor receptor (EGFR) mutation status, histology, and anaplastic lymphoma kinase (ALK) mutation status can be highly instructive for guiding the course of treatment. EGFR mutation status is a strong predictor of response to EGFR tyrosine kinase inhibitor therapy; non-squamous cell carcinoma predicts response to pemetrexed; and targeted therapy now exists for non–small-cell lung cancer that is positive for the ALK gene mutation. A patient case of advanced non–small-cell lung cancer is presented to provide a practical context for discussing management. The patient is a 55-year-old female never-smoker who presented with a dry, persistent cough, right scapular and persistent upper- / mid-thoracic back pain, and significant, gradual weight loss. She required urgent surgery to relieve spinal cord compression. The diagnosis of primary adenocarcinoma of the lung, positive for CK7 and TTF-1, and negative for CK20, was made following physical examination, imaging, and pathological investigations. The patient was initially treated with standard platinum-based chemotherapy, to which bevacizumab was added following disease progression — a strategy that met with good response and tolerability. Upon disease progression and determination of ALK-positive non–small-cell lung cancer, targeted therapy with crizotinib was initiated, which showed good partial response until the last follow-up in July 2013. The evidence-based rationale for the treatment approach adopted for this patient is described.
中文摘要
肺癌的抗血管生成療法：一個實用的門徑
何重文
在晚期肺癌中，判斷表皮生長因子受體（EGFR）突變狀態、組織學和間變性淋巴瘤激酶突變狀態，對治療過程具相當的指導性。EGFR突變狀態是對EGFR酪氨酸激酶抑制劑治療反應的一個強力預測因素；非鱗狀細胞癌可預測對培美曲塞（pemetrexed）的反應；而對於間變性淋巴瘤激酶（ALK）基因突變呈陽性的非小細胞肺癌，現已有標靶治療可以使用。本文報導一個晚期非小細胞肺癌患者的病例，作為討論病人治療的實用背景。一名55歲、從不吸煙的女性，出現持續乾咳、右肩胛疼痛、上／中胸背部持續疼痛、以及顯著的體重逐步下降。患者需要接受緊急手術以舒緩脊椎壓迫。在身體檢查、影像及病理化驗後，診斷為CK7及TTF-1陽性、CK20陰性的原發性腺癌。患者起初以鉑類為基礎的標準化療進行治療；當疾病惡化，加入了貝伐株單抗（bevacizumab），作為達致良好反應及耐受性的策略。疾病出現惡化並判斷為ALK陽性非小細胞肺癌後，患者開始接受克里唑蒂尼（crizotinib）標靶治療；直至2013年7月的最後一次跟進，患者有良好的局部反應。本文敘述了這名患者治療方案的循證理據。