Targeted therapy in EGFR mutation and ALK translocation

Lung cancer is one of the most common cancers and the leading cause of cancer death worldwide. Systemic chemotherapy has been the standard treatment of advanced non-small cell lung cancer (NSCLC) for decades.From several years ago, targeted therapy in patients with driver mutations has resulted in significantly improved therapeutic efficacy in NSCLC. One of the most common drive mutations is the epidermal growth factor receptor (EGFR) tyrosine kinase that is observed in 14 to 50% of patients in different population. EGFR mutation occurs more frequently in non and light smokers and Asian populations. Targeted agents in patients with EGFR mutation in first line treatment are included: Erlotinib, gefitnib, afatinib, osimertinib and dacomitinib. But after progression the treatment differs in some aspects. Osimertinib is a third generation TKIs that is a standard of care in patients who have T790 m mutation.Another driver mutation in NSCLC patients is translocation of anaplastic lymphoma kinas (ALK) tyrosine kinas that is presented in 4-7% percent of NSCLC adenocarcinoma. It is more prevalent in non and light smokers and young adults. Crizotinib is a first generation ALK inhibitors that improves response rate and PFS in patients with ALK translocation adenocarcinoma. Second generation ALK inhibitors including ceritinib, alectinib and brigatinib are approved in refractory disease and in patients who do not tolerate crizotinib. These agents are also more active in CNS disease.As these targeted therapies have revolutionized treatment strategies in lung cancer in the past few years, molecular testing is the standard of care in patients with stage IV NSCLC and adenocarcinoma component.

کلیدواژه ها:

lung cancer ، NSCLC ، targeted therapy ، driver mutation