ABSTRACT
En Colombia, para 2020, el cáncer de pulmón se reportó como la segunda neoplasia con mayor incidencia y la primera con mayor tasa de mortalidad según las cifras del minis-terio de salud de Colombia. El compromiso peritoneal en el cáncer de pulmón es algo extremadamente raro, se considera <1%. A continuación, exponemos un caso de car-cinomatosis peritoneal en cáncer de pulmón en un hospital en la ciudad de Bogotá. Se incorpora una posterior revisión descriptiva de la literatura de los casos clínicos de car-cinomatosis peritoneal en cáncer de pulmón reportados en la literatura mundial en los últimos 20 años, con el objetivo de resumir las principales características de estos pa-cientes que permiten plantear hipótesis de su enfoque terapéutico y pronóstico
In Colombia for 2020, lung cancer was reported as the fifth neoplasm with the highest incidence and the second with the highest mortality rate. Peritoneal involvement in lung cancer is extremely rare, it is considered <1%. Next, we present a case of peritoneal car-cinomatosis in lung cancer in Bogotá, with a subsequent literature review of the litera-ture of clinical cases of peritoneal carcinomatosis in lung cancer reported in the world li-terature in the last 20 years. The aim is to summarize the main characteristics of these patients that allow to hypothesize their prognostic and therapeutic approach
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Peritoneal Neoplasms/therapy , Lung Neoplasms/therapy , Neoplasm Metastasis , Case Reports , Incidence , MortalityABSTRACT
BACKGROUND@#Thyroid function abnormality (TFA) is one of the common adverse reactions in patients with advanced non-small cell lung cancer (NSCLC) treated with immunotherapy, but the risk factors of TFA and its relationship with efficacy are not completely clear. The purpose of this study was to explore the risk factors of TFA and its relationship with efficacy in patients with advanced NSCLC after immunotherapy.@*METHODS@#The general clinical data of 200 patients with advanced NSCLC in The First Affiliated Hospital of Zhengzhou University from July 1, 2019 to June 31, 2021 were collected and analyzed retrospectively. χ² test and multivariate Logistic regression were used to explore the risk factors of TFA. Kaplan-Meier curve was drawn and Log-rank test was used for comparison between groups. Univariate and multivariate Cox analysis was used to explore the efficacy factors.@*RESULTS@#A total of 86 (43.0%) patients developed TFA. Logistic regression analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS), pleural effusion and lactic dehydrogenase (LDH) were factors influencing TFA (P<0.05). Compared with normal thyroid function group, the median progression-free survival (PFS) of patients in the TFA group was significantly longer (19.0 months vs 6.3 months, P<0.001), and the objective response rate (ORR) (65.1% vs 28.9%, P=0.020) and disease control rate (DCR) (100.0% vs 92.1%, P=0.020) of the TFA group were better than those of the normal thyroid function group. Cox regression analysis showed that ECOG PS, LDH, cytokeratin 19 fragment (CYFRA21-1) and TFA were factors influencing prognosis (P<0.05).@*CONCLUSIONS@#ECOG PS, pleural effusion and LDH may be risk factors affecting the occurrence of TFA and TFA may be a predictor of the efficacy of immunotherapy. Patients with advanced NSCLC who have TFA after immunotherapy may obtain better efficacy.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Retrospective Studies , Thyroid Gland , Lung Neoplasms/therapy , Immunotherapy/adverse effects , Pleural EffusionABSTRACT
With the development of precision diagnosis and treatment for non-small cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations, as a rare subset of EGFR mutaions, have gradually attracted attention recently. The heterogeneity of EGFR ex20ins mutations is very high, different variants have different clinical benefits, and the prognosis is extremely poor. The available traditional treatment outcomes are poor in patients with EGFR ex20ins positive NSCLC and polymerase chain reaction (PCR) tests would miss aprocimately 50% of the variants. Therefore, high attention should be paid to EGFR ex20ins positive NSCLC during the clinical practice. The expert panel has formed a consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience, the consensus recommendations including clinicopathologic characteristics, therapies, testing methods and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide medication reference for clinical physicians at all levels.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Consensus , ErbB Receptors/genetics , Exons , Lung Neoplasms/therapy , Mutagenesis, InsertionalABSTRACT
Small cell lung cancer (SCLC) is a malignant tumor with remarkable proliferative and invasive ability, which has very poor clinical prognosis due to lack of effective treatments. In recent years, researches on cells, animal models and tumor samples have promoted the identification of molecular subtypes of SCLC, discovered unique biological and clinical characteristics, and proposed potential specific therapeutic targets for different subtypes. This will encourage the development of more accurate therapeutic strategies towards SCLC, with a view to improving the prognosis of the patients. This article will review the current SCLC molecular subtypes, focus on the clinical characteristics and therapeutic strategies of different SCLC subtypes, and propose reasonable suggestions for the future treatment of SCLC. .
Subject(s)
Animals , Small Cell Lung Carcinoma/therapy , Lung Neoplasms/therapy , Immunotherapy , PrognosisABSTRACT
En el día a día de la atención en salud vemos cómo el cáncer de pulmón sigue siendo una de las patologías oncológicas con peor pronóstico: su tasa global de sobrevida de solo el 20,0 %. Esto se debe, en parte, a que en la mayoría de los casos su diagnóstico se hace en estadios avanzados, cuando ya no hay muchas opciones de tratamiento, más allá de medidas paliativas. A diferencia de otros tipos de cáncer como el de cuello uterino, el de mama o el de próstata, en los cuales existen estrategias de tamizaje y prevención asequibles y que favorecen un mejor pronóstico, en el de pulmón no ha sido posible implementar a gran escala tales intervenciones, lo cual ha favorecido el pobre pronóstico de la enfermedad y ha contribuido a que siga siendo la principal causa de muerte por cáncer en el mundo (1).
In the day-to-day health care we see how lung cancer continues to be one of the oncological pathologies with the worst prognosis: its overall survival rate of only 20.0%. This is due, in part, to the fact that in most cases its diagnosis is made in advanced stages, when there are no longer many treatment options, beyond palliative measures. Unlike other types of cancer such as cervical, breast or prostate cancer, in which there are affordable screening and prevention strategies that favor a better prognosis, in lung cancer it has not been possible to implement such interventions on a large scale, which has favored the poor prognosis of the disease and has contributed to its continuing to be the leading cause of death from cancer in the world (1).
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Lung Neoplasms , Lung Neoplasms/complications , Lung Neoplasms/therapy , NeoplasmsABSTRACT
To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China (2023 edition) through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.
Subject(s)
Humans , Lung Neoplasms/therapy , Carcinoma, Non-Small-Cell Lung/therapy , Protein-Tyrosine Kinases/therapeutic use , Early Detection of Cancer , Proto-Oncogene Proteins , Small Cell Lung Carcinoma , Carcinoid TumorABSTRACT
Resumo O objetivo foi verificar a associação entre fatores individuais e organizativos do sistema de saúde com o tempo para o início do tratamento do câncer de pulmão pelo Sistema Único de Saúde (SUS) em Minas Gerais. Estudo de coorte retrospectiva com pacientes que iniciaram o tratamento para o câncer de pulmão pelo SUS de 2008 a 2015. Foram selecionadas variáveis sociodemográficas, clínicas e organizativas do sistema de saúde. O modelo de regressão logística avaliou a associação do desfecho do início do tratamento em até 60 dias após o diagnóstico com as variáveis explicativas selecionadas. Utilizou-se a odds ratio (OR) e o respectivo intervalo de confiança (95%) para mensurar a força de associação. A maioria dos tratamentos para o câncer de pulmão em Minas Gerais foram iniciados em até 60 dias após o diagnóstico, entretanto, ser do sexo masculino e diagnosticado em estadiamento IV aumentaram a chance de iniciar o tratamento em até 60 dias; todavia o aumento da idade, iniciar o tratamento por radioterapia, e o local de residência, diminuíram. O tempo para início do tratamento está associado a características individuais e à provisão de serviços nas macrorregiões, e as desigualdades observadas possivelmente se originam a partir do melhor ou pior acesso da população aos serviços prestados.
Abstract The aim was to verify the association of individual factors and healthcare system characteristics with time to initiate treatment of lung cancer by the Brazilian National Health System, in Minas Gerais state. A retrospective cohort study, with patients who initiated treatment for lung cancer by the SUS, from 2008 to 2015. Sociodemographic and clinical characteristics of patients, besides organizational variables of the healthcare system were selected. The logistic regression model evaluated the association of selected explanatory variables with the outcome of initiating treatment within 60 days after diagnosis. Odds ratio (OR) and respective 95% confidence interval were used to measure the power of association. Most treatments for lung cancer in the state of Minas Gerais initiated within 60 days after diagnosis. However, being male and diagnosed as stage IV increased the likelihood of starting treatment within 60 days. On the other hand, the patient's age, radiation therapy as first treatment, and the place of residence decreased such chance. Time to initiate treatment is associated with individual characteristics and provision of services in macroregions, and the observed inequalities possibly raised from the better or worse access of the population to the services provided by SUS.
Subject(s)
Humans , Male , Delivery of Health Care , Lung Neoplasms/therapy , Brazil/epidemiology , Retrospective StudiesABSTRACT
Leptomeningeal metastases (LM), a special type of metastasis in advanced lung cancer, is known for its severe clinical symptoms, rapid progression and poor prognosis. LM used to be featured with low clinical diagnosis rate, limited treatment options, poor treatment efficacy, and very short survival if treatment not given. Though cerebrospinal fluid (CSF) cytology remains to be the gold standard for the diagnosis of LM, the positive rate of the first CSF cytology even in patients with suggestive clinical symptoms and positive imaging generally does not exceed 50%, leading to a delay in the diagnosis and treatment of patients with LM. With the progress of targeted therapy for driver gene-positive lung cancer and immunotherapy for driver gene-negative lung cancer, the overall survival of patients with lung cancer has been prolonged, meanwhile incidence of LM has been increasing year by year. Current clinical research in this field center around how to improve diagnosis rate and to find effective treatment approaches. This paper reviews advances in diagnosis and treatment of LM of lung cancer.. .
Subject(s)
Humans , Lung Neoplasms/therapy , Meningeal Carcinomatosis/secondary , Meningeal Neoplasms/therapy , Treatment OutcomeABSTRACT
Although there are many treatment options for patients with stage Ⅳ primary lung cancer, the problems in the diagnosis and treatment process may involve multiple systems and organs due to their complex condition and heterogeneity. Therefore, cooperation between different disciplines is often required in the process of clinical practice. Multi-disciplinary team (MDT) refers to a fixed working group composed of more than two related disciplines, which puts forward the best treatment strategy for individual patient in the form of regular consultation for a certain system disease, and then the related disciplines implement the treatment strategy alone or jointly. MDT is widely used for disease diagnosis and treatment, and especially suitable for cancer patients. MDT has become a standard procedure for cancer treatment worldwide, including stage Ⅳ primary lung cancer. In order to promote the healthy development of MDT and generally improve the level of diagnosis and treatment of stage Ⅳ primary lung cancer in China, Chinese Association for Clinical Oncologists and Medical Oncology Branch of Chinese International Exchange and Promotion Association for Medical and Healthcare co-organized the national experts committee to formulate "Clinical practice guideline for multi-disciplinary team diagnosis and treatment of stage Ⅳ primary lung cancer in China" .
Subject(s)
Humans , China , Lung Neoplasms/therapy , Neoplasm Staging , Patient Care Team , Practice Guidelines as TopicABSTRACT
Lung cancer is the most common malignancy with the highest incidence and mortality in China, which poses a major public health problem. To further standardize the prevention and treatment of lung cancer, improve the prognosis of patients, and provide professional evidence-based medical recommendations to medical professionals across China, the Oncology Society of Chinese Medical Association organized experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology, based on indications approved by China Food and Drug Administration, domestically available drugs, recommendations of international guidelines and current clinical practice in China, integrated the latest evidence-based medical evidence of pathology, genetic testing, immune molecular biomarker detection and treatment methods of lung cancer in recent years. After consensus meetings, the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China was formulated, which provided recommendations to clinicians, and imaging, laboratory, and rehabilitation professionals.
Subject(s)
Humans , Asian People , China/epidemiology , Lung Neoplasms/therapy , Medical Oncology , PrognosisABSTRACT
Molecular hydrogen exerts biological effects on nearly all organs. It has anti-oxidative, anti-inflammatory, and anti-aging effects and contributes to the regulation of autophagy and cell death. As the primary organ for gas exchange, the lungs are constantly exposed to various harmful environmental irritants. Short- or long-term exposure to these harmful substances often results in lung injury, causing respiratory and lung diseases. Acute and chronic respiratory diseases have high rates of morbidity and mortality and have become a major public health concern worldwide. For example, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. An increasing number of studies have revealed that hydrogen may protect the lungs from diverse diseases, including acute lung injury, chronic obstructive pulmonary disease, asthma, lung cancer, pulmonary arterial hypertension, and pulmonary fibrosis. In this review, we highlight the multiple functions of hydrogen and the mechanisms underlying its protective effects in various lung diseases, with a focus on its roles in disease pathogenesis and clinical significance.
Subject(s)
Animals , Humans , Mice , Acute Lung Injury , Aging , Anti-Inflammatory Agents , Antioxidants/chemistry , Asthma/therapy , Autophagy , COVID-19/therapy , Hydrogen/therapeutic use , Hypertension, Pulmonary/therapy , Inflammation , Lung Diseases/therapy , Lung Neoplasms/therapy , Oxidative Stress , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Fibrosis/therapy , Pyroptosis , Reactive Oxygen SpeciesABSTRACT
BACKGROUND@#The advances in the lung cancer screening methods and therapeutics, together with awareness towards deleterious habits, such as smoking, is increasing the overall survival with better quality of life for the patients. However, lung cancer is still one of the most common and fatal neoplasm with a high incidence and consequently burden to public health worldwide. Thus, based on guidelines and recent phases II and III clinical trials studies, this manuscript summarizes the current treatment sequencing strategies in lung cancer.@*METHODS@#A comprehensive search of related articles was performed focused on phases II and III clinical trials studies.@*RESULTS@#The lung cancer management should take into consideration the tumor characteristics, histology, molecular pathology and be discussed in a multidisciplinary team. Lung cancer treatment options comprises surgery whenever possible, radiotherapy associate with/or chemotherapy and immunotherapy as monotherapy, or combined with chemotherapy and best palliative care.@*CONCLUSIONS@#The screening predictability in more patients, smoking reduction, early diagnosis, better disease understanding and individualized, more effective and tolerable therapeutics are related to an increasing in overall survival and quality of life. In the near future improvement of personalized therapy in precision medicine is expected, enhancing new predictive biomarkers, optimal doses and optimal treatment sequencing as well as anti-cancer vaccines development.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Early Detection of Cancer , Immunotherapy/methods , Lung Neoplasms/therapy , Quality of LifeABSTRACT
Immune checkpoint inhibitors (ICIs) have become an important means of cancer treatment, and their application in the clinic is becoming more and more widespread. The adverse reactions caused by ICIs are gradually recognized. Among them, immunotherapy-related diabetes is a rare adverse reaction and type 1 diabetes mellitusis common. With the wide application of ICIs combined with chemotherapy in lung cancer patients, patients with type 2 diabetes mellitus have gradually been discovered during the treatment. However, the effect of continued use of ICIs maintenance therapy on blood glucose and ICIs treatment process in these patients is still unclear. This article reports two cases of type 2 diabetes mellitus induced by immune checkpoint inhibitor combined with chemotherapy, one of whom converted to type 1 diabetes mellitus, in order to increase the understanding of immunotherapy-related diabetes. .
Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Immune Checkpoint Inhibitors , Immunotherapy/adverse effects , Lung Neoplasms/therapy , Molecular Targeted TherapyABSTRACT
Lung cancer is the most lethal malignancy around the world and non-small cell lung cancer (NSCLC) accounts for 80% of all cases. Most of the NSCLC patients has "driver gene mutations" and targeted therapy achieved a relatively good efficacy, but some patients progressed or relapsed after treatment. Previous studies demonstrated that immune checkpoint inhibitor could improve the prognosis of advanced-stage NSCLC and prolong the survival time. However, the efficacy of immune therapy varies in NSCLC patients with different immune and molecular features. The efficacy of immune therapy was controversial in NSCLC patients with driver gene mutation. The present review will summarize the immune characteristics of NSCLC patients with driver mutation and the directions of immunotherapy for patients with driver mutation. .
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/therapy , Immunotherapy , Lung Neoplasms/therapy , Molecular Targeted Therapy , MutationABSTRACT
Lung cancer is one of the most prevalent malignancies with the highest morbidity and mortality rates worldwide. In recent years, with the development of immune-oncology research and several therapeutic antibodies have reach the clinic, many breakthroughs have been made in immunotherapy. The advent of immunotherapy has revolutionized the treatment of NSCLC, but the response and durable clinical benefit are only observed in a small subset of patients. Therefore, strategies to screen the potential beneficial population and improve the efficacy of immunotherapy remain an essential topic. In the current article, the author review the biomarkers that have potential to better predict responders to immunotherapy and to provide ideas for the clinical application of immunotherapy. .
Subject(s)
Humans , B7-H1 Antigen , Biomarkers, Tumor , Carcinoma, Non-Small-Cell Lung/therapy , Immunotherapy , Lung Neoplasms/therapyABSTRACT
Lung cancer is one of the malignant tumors with the highest morbidity and mortality in China. Therefore, the research on the treatment of lung cancer is also deepening. At present, there are mainly systemic chemotherapy, targeted therapy for positive driver genes, the application of immune checkpoint inhibitors, anti-tumor angiogenesis therapy and the combination of the different treatment methods mentioned above. The use of these regimens has significantly improved the prognosis of most lung cancer patients, but the prognosis of patients with advanced lung cancer remains unsatisfactory. Recently, more and more attention has been paid to the study of tumor microenvironment (TME). TME consists of immune cells, fibroblasts, vascular endothelial cells and other cellular components as well as related cytokines, which is the basis for the survival and development of tumor cells. As an important immune cell of TME, tumor-associated macrophages (TAMs) refer to macrophages infiltrating in tumor tissues, which can promote tumor cell proliferation, induce tumor immune tolerance, stimulate tumor angiogenesis, and increase the invasion and metastasis ability of tumor cells. Therefore, targeting TAMs has become a hot topic in lung cancer immunotherapy. In this review, the sources, phenotypes, mechanisms of TAMs in lung cancer, as well as future therapeutic targets of TAMs were reviewed to provide reference for optimal treatment of lung cancer. .
Subject(s)
Humans , Endothelial Cells , Immunotherapy , Lung Neoplasms/therapy , Tumor Microenvironment , Tumor-Associated MacrophagesABSTRACT
Introducción: Los tratamientos oncológicos aplicados en el cáncer de pulmón, en especial la poliquimioterapia, promueven en su mecanismo de acción citotoxicidad y liberación de ciertas especies reactivas del oxígeno. Objetivo: Caracterizar a pacientes con cáncer de pulmón según los marcadores de estrés oxidativo y de defensa antioxidante en el momento del diagnóstico y después de concluido el tratamiento con poliquimioterapia. Métodos: Se realizó un estudio analítico, prospectivo, en 86 casos divididos en dos grupos: casos diagnosticados con cáncer de pulmón (n= 52) y sanos (n= 34) en Hospital Neumológico Benéfico Jurídico en el período comprendido desde mayo de 2016 a mayo de 2018. Resultados: Predominó el sexo masculino (63,5 por ciento) y el 55,8 por ciento con más de 60 años. El tipo histológico más frecuente fue el adenocarcinoma (57,7 por ciento) y el 61,5 por ciento emplearon la modalidad de quimioterapia cisplatino y etopósido. Los pacientes con cáncer de pulmón mostraron un mayor daño oxidativo endógeno a lípidos y a proteínas (40,4 por ciento y 28,8 por ciento) respectivamente, mientras que el 63,5 por ciento mantienen la normalidad de concentraciones plasmáticas de peróxidos totales. En el 40,4 por ciento de los pacientes se incrementaron las actividades de defensa enzimáticas de la superóxido dismutasa, la catalasa y glutation peroxidasa, las cuales tuvieron una tendencia a la normalidad (63,5 por ciento y 48,0 por ciento) respectivamente. El 76,9 por ciento alcanzó niveles normales de glutation s-transferasa concluido el tratamiento oncoespecífico. Conclusiones: La quimioterapia se relaciona con una exacerbación del estrés oxidativo y una disminución del sistema de defensa antioxidante(AU)
Introduction: Oncological treatments used in lung cancer, particularly polychemotherapy, promote cytotoxicity and the release of certain reactive oxygen species in their mechanism of action. Objective: To describe patients with lung cancer according to oxidative stress and antioxidant defense markers at the time of diagnosis and after the end of treatment with polychemotherapy. Methods: An analytical, prospective study was carried out in 86 cases. They were distributed into two groups: subjects diagnosed with lung cancer (n= 52) and healthy subjects (n= 34) at the Pneumological Hospital from May 2016 to May 2018. Results: The male subjects predominated (63.5 percent) and 55.8 percent were over 60 years old. The most frequent histological type was adenocarcinoma (57.7 percent) and 61.5 percent used the cisplatin and etoposide chemotherapy modality. Lung cancer patients showed higher endogenous oxidative damage to lipids and proteins (40.4 percent and 28.8 percent) respectively, while 63.5 percent kept normal plasma concentrations of total peroxides. In 40.4 percent of the patients, the enzymatic defense activities of superoxide dismutase, catalase and glutathione peroxidase increased, which tended to normal (63.5 percent and 48.0 percent respectively. 76.9 percent reached normal levels of glutathione s-transferase after oncospecific treatment. Conclusions: Chemotherapy is related to exacerbation of oxidative stress and a decrease in the antioxidant defense system(AU)
Subject(s)
Humans , Male , Female , Drug Therapy, Combination , Lung Neoplasms/therapy , Prospective StudiesABSTRACT
Lung cancer is one of the leading causes of death in the world. Current treatments act directly on the signal transduction pathways in cancer cells, mainly. One of the main pathways is associated with the Epidermal Growth Factor (EGFR), whose mutations leads to uncontrolled cell proliferation and a higher rate of cell invasion. Activating mutations in the EGFR gene, which includes deletions in exon 19 and the L858R mutation in exon 21, were detected in most patients with non-small cell lung cancer (NSCLC). Studies of EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as Gefitinib, Erlotinib and Afatinib, compared with platinum-based treatments, showed that EGFR-TKIs produce increased disease-free survival, although only in patients whose cancers harbor activating mutations in the EGFR gene. Clinical trials also demonstrated that EGFR-TKIs are effective as first-line therapies in stage IV pulmonary adenocarcinoma. Here, the main aspects of the activation of the EGFR pathway in NSCLC will be reviewed, highlighting the importance for health professionals of correctly identifying activating mutations in the EGFR gene and acting quickly at the molecular level based on aforementioned treatments. (AU)