HER2突变非小细胞肺癌治疗研究进展  

Advances in the diagnosis and treatment of HER2 gene mutations in lung cancer

作　　者：徐加菊 倪春晓[2] 张玲[1] XU Jiaju;NI Chunxiao;ZHANG Ling(Department of Medical Oncology,Taian City Central Hospital,Taian 271000,China)

机构地区：[1]泰安市中心医院化疗科,山东泰安271000 [2]泰安市中心医院肿瘤微创科,山东泰安271000

出　　处：《社区医学杂志》2023年第18期973-980,共8页Journal Of Community Medicine

基　　金：山东省泰安市科技基金(2019NS180)。

摘　　要：表皮生长因子受体2(HER2)突变患者的肺癌驱动机制明确且部分靶向治疗有效,目前临床上已经将HER2基因作为一线治疗Ⅳ期非小细胞肺癌(NSCLC)的有效靶点进行筛查。本综述重点总结HER2突变NSCLC领域的治疗策略和最新研究进展。以“HER2”“非小细胞肺癌”“治疗策略”为关键词,检索2018-01-01至2023-03-31中国知网及PubMed相关文献。纳入标准:HER2突变NSCLC多种治疗方式,包含HER2酪氨酸激酶抑制剂(TKI)、抗体偶联药物(ADC)、免疫检查点抑制剂、三代表皮生长因子受体(EGFR)TKI等治疗措施;研究中报告了药物有效性、药物相关不良反应、患者治疗后疗效评价。排除标准:化疗及生物治疗的相关研究。根据药物种类对HER2突变NSCLC的治疗进行分类,最终纳入分析文献48篇。结果表明,目前HER2突变NSCLC治疗模式主要是联合治疗,其治疗已经从非选择性酪氨酸激酶抑制剂(TKI)单药靶向治疗模式向具有不同作用机制的药物联合治疗模式转变,如ADCs或者非选择性HER2 TKI或选择性HER2 TKI或者免疫检查点抑制剂(ICIs)的联合应用,这些治疗模式将改变HER2突变NSCLC患者的治疗前景。提示,抗体偶联药物DS-8201(T-DXd)治疗HER2突变NSCLC疗效比抗体偶联药物T-DM1、非选择性HER2 TKI、选择性HER2 TKI及免疫检查点抑制剂更有效,不良反应可接受;部分三代EGFR TKI也表现出了HER2突变NSCLC的治疗疗效,但目前的研究多为回顾性研究,且病例数较少。关于DS-8201在HER2突变NSCLC的有效性与安全性,仍需进行大样本、多中心的前瞻性研究验证。The driving mechanism of lung cancer in patients with human epidermal growth factor receptor 2(HER2)mutation is clear and some targeted therapies are effective.Currently,HER2 gene has been clinically screened as an effective target for first-line treatment of stage IV non-small cell lung cancer(NSCLC).This article focuses on the treatment strategies and the latest research progress in HER2 mutant NSCLC.With the key words of"HER2","Mutations"and"NSCLC",Chinese National Knowledge Infrastructure(CNKI)and PubMed were searched from Jan 01,2018 to Mar 31,2023.The inclusion criteria were literature that reported a variety of therapeutic approaches about HER2-mutated NSCLC,including HER2 tyrosine kinase inhibitor(TKI)therapy,antibody drug conjugate(ADC)drugs,immune checkpoint inhibitor therapy,third-generation epidermal growth factor receptor(EGFR)TKI and other therapeutic measures;and that reported the drug efficacy,drug-related adverse reactions and the efficacy evaluation of patients after treatment.Exclusion criteria were studies on chemotherapy and biotherapy for HER2-mutated NSCLC.Then,the effect of therapy for HER2-mutated NSCLC was classified and analyzed according to the treatment methods.Totally 48 publications were included for this article.The results showed the current treatment of HER2-mutated NSCLC is mainly combination therapy,and the treatment has changed from the single-drug targeted therapy of non-selective TKI to the drug combination therapy with different mechanisms of action.For example,the combination of ADCs or non-selective HER2 TKI or selective HER2 TKI or immune checkpoint inhibitors(ICIs),which will change the treatment landscape for patients with HER2-mutated NSCLC.These results suggested that antiboy-coupled drugs,such as DS-8201(T-DXd)was more effective than T-DM1,non-selective HER2 TKI,selective HER2 TKI and ICIs in the treatment for HER2-mutated NSCLC,and the adverse reactions were acceptable.Some third-generation EGFR TKI have also shown therapeutic efficacy in NSCLC with HER2 mutation,b

关 键 词：非小细胞肺癌 HER2 突变 治疗 综述文献 

分 类 号：R734.2[医药卫生—肿瘤]