中国驱动基因阳性非小细胞肺癌脑转移临床诊疗指南(2025版)  

Clinical Practice Guidelines for the Management of Brain Metastases from Non-small Cell Lung Cancer with Actionable Gene Alterations in China(2025 Edition)

作　　者：中国医药教育协会肺癌医学教育专业委员会 北京医学奖励基金会肺癌医学青年专家委员会脑转移协作组 支修益[2] 王洁[3] 赵军[4] 李晓燕[5] Lung Cancer Medical Education Committee of Chinese Medical Education Association;Brain Metastasis Collaboration Group,Youth Specialists Committee of Lung Cancer of Beijing Medical Reward Foundation;Xiuyi ZHI;Jie WANG;Jun ZHAO;Xiaoyan LI

机构地区：[1]不详 [2]首都医科大学宣武医院 [3]中国医学科学院肿瘤医院 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所胸部肿瘤内一科,恶性肿瘤发病机制及转化研究教育部重点实验室 [5]首都医科大学附属北京天坛医院

出　　处：《中国肺癌杂志》2025年第1期1-21,共21页Chinese Journal of Lung Cancer

摘　　要：脑转移已成为非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗全程管理中的重大挑战,在携带驱动基因突变的患者中尤为突出。传统治疗如放射治疗和外科手术的临床获益有限,且常伴随认知功能障碍和生活质量下降。近年来,针对表皮生长因子受体(epidermal growth factor receptor,EGFR)、间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)等靶点的新型小分子酪氨酸激酶抑制剂不断涌现,有效穿透血脑屏障的同时提升了颅内药物浓度、改善患者预后,从而打破了NSCLC脑转移既往的治疗格局。因此,中国医药教育协会肺癌医学教育专业委员会、北京医学奖励基金会肺癌医学青年专家委员会脑转移协作组联合发起并制定了《中国驱动基因阳性非小细胞肺癌脑转移临床诊疗指南(2025版)》。本指南通过整合最新研究成果与临床经验,基于多学科诊疗原则,涵盖驱动基因阳性NSCLC脑转移的诊断、治疗时机及系统和局部治疗选择等内容。同时,指南提出了针对不同驱动基因类型的个体化治疗策略,旨在为临床医师提供参考,提升中国NSCLC脑转移的整体诊疗水平。Brain metastasis has emerged as a significant challenge in the comprehensive management of patients with non-small cell lung cancer(NSCLC),particularly in those harboring driver gene mutations.Traditional treatments such as radiotherapy and surgery offer limited clinical benefits and are often accompanied by cognitive dysfunction and a decline in quality of life.In recent years,novel small molecule tyrosine kinase inhibitors targeting epidermal growth factor receptor(EGFR),anaplastic lymphoma kinase(ALK),and other pathways have been developed,effectively penetrating the blood-brain barrier while enhancing intracranial drug concentrations and improving patient outcomes.This advancement has transformed the treatment landscape for brain metastases in NSCLC.Consequently,the Lung Cancer Medical Education Committee of the Chinese Medical Education Association and the Brain Metastasis Collaboration Group of the Lung Cancer Youth Expert Committee of the Beijing Medical Reward Foundation have jointly initiated and formulated the Clinical Practice Guidelines for the Management of Brain Metastases from Non-small Cell Lung Cancer with Actionable Gene Alterations in China(2025 Edition).This guideline integrates the latest research findings with clinical experience,adhering to multidisciplinary treatment principles,and encompasses aspects such as diagnosis,timing of intervention,and systemic and local treatment options for driver gene positive NSCLC brain metastases.Additionally,it proposes individualized treatment strategies tailored to different driver gene types,aiming to provide clinicians with a reference to enhance the overall diagnostic and therapeutic standards for NSCLC brain metastases in China.

关 键 词：肺肿瘤 脑转移 驱动基因 靶向治疗 临床诊疗指南 

分 类 号：R734.2[医药卫生—肿瘤]