Немелкоклеточный рак легкого является одной из наиболее частых злокачественных опухолей. Несмотря на значительные усилия, предпринимаемые учеными по всему миру, эта болезнь продолжает уносить огромное число человеческих жизней. Впервые отмеченная в ходе ранних исследований низкомолекулярных таргетных ингибиторов рецептора эпидермального фактора роста и впоследствии подтвержденная в крупных рандомизированных исследованиях выдающаяся эффективность у отдельной группы пациентов может считаться наиболее значимым прорывом в лечении данной болезни. На настоящий момент однозначно доказана целесообразность использования таргетных ингибиторов рецептора эпидермального фактора роста у больных немелкоклеточным раком легкого с наличием молекулярно-измененного гена, кодирующего этот рецептор.
Non-small cell lung cancer is one of the most frequent among malignant solid tumors in adults. Despite numerous clinical trials and preclinical efforts undertaken all over the world, this disease continues to be one of the most deadly. Primarily noticed at the early stage of clinical research and afterwards confirmed in a number of large randomized clinical trials outstanding efficacy of small molecule EGFR tyrosine kinase inhibitors may be considered one of the most prominent breakthroughs in the treatment of this disease. For now the reasonability of such target drugs use in NSCLC with altered EGFR should be considered absolutely proven.
1. Asahina H, Yamazaki K, Kinoshita I et al. A phase II trial of gefitinib as first-line therapy for advanced non-small cell lung cancer with epidermal growth factor receptor mutations. Br J Cancer 2006; 95: 998–1004.
2. Cataldo VD, Gibbons Dl, Perez-Soler R et al. Treatment of non-small-cell lung cancer with erlotinib or gefitinib. N Engl J Med 2011; 364: 947–55.
3. Costa DB, Kobayashi S, Tenen DG et al. Pooled analysis of the prospective trials of gefitinib monotherapy for EGFR-mutant non-small cell lung cancers. Lung Cancer 2007; 58: 95–103.
4. Greulich H, Chen TH, Feng W et al. Oncogenic transformation by inhibitor-sensitive and resistant EGFR mutants. PLoS Med 2005; 2: 313.
5. Gridelli C, De Marinis F, Di Maio M et al. Gefitinib as first-line treatment for patients with advanced non-small-cell lung cancer with activating epidermal growth factor receptor mutation: Review of the evidence. Lung Cancer 2011; 71: 249–57.
6. Imyanitov EN, Grigoriev MY, Gorodinskaya VM et al. Partial restoration of degraded DNA from archival paraffin-embedded tissues. Biotechniques 2001; 31: 1000–2.
7. Inoue A, Kobayashi K, Usui K et al. First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 2009; 27: 1394–400.
8. Keedy VL, Temin S, Somerfield MR et al. American Society of Clinical Oncology provisional clinical opinion: epidermal growth factor receptor (EGFR). Mutation testing for patients with advanced non-small-cell lung cancer considering first-line EGFR tyrosine kinase inhibitor therapy. J Clin Oncol 2011; 29: 2121–7.
9. Langer CJ. The «lazarus response» in treatment-naive, poor performance status patients with non-small-cell lung cancer and epidermal growth factor receptor mutation. J Clin Oncol 2009; 27: 1350–4.
10. Lynch TJ, Bell DW, Sordella R et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004; 350: 2129–39.
11. Maemondo M, Inoue A, Kobayashi K et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med 2010; 362: 2380–8.
12. Mitsudomi T, Kosaka T, Endoh H et al. Mutations of the epidermal growth factor receptor gene predict prolonged survival after gefitinib treatment in patients with non-small-cell lung cancer with postoperative recurrence. J Clin Oncol 2005; 23: 2513–20.
13. Mitsudomi T, Morita S, Yatabe Y et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG 3405): an open label, randomised phase 3 trial. Lancet Oncol 2010; 11: 121–8.
14. Moiseyenko VM, Procenko SA, Levchenko EV et al. High efficacy of first-line gefitinib in non-Asian patients with EGFR-mutated lung adenocarcinoma. Onkologie 2010; 33: 231–8.
15. Mok TS, Wu YL, Thongprasert S et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361: 947–57.
16. Molina JR, Yang P, Cassivi SD et al. Non-small cell lung cancer: epidemiology, risk factors, treatment and survivorship. Mayo Clin Proc 2008; 83: 584–94.
17. Paez JG, Janne PA, Lee JC et al. EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science 2004; 304: 1497–500.
18. Pao W, Miller V, Zakowski M et al. EGF receptor gene mutations are common in lung cancers from «never smokers» and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci USA 2004; 101: 13306–11.
19. Paz-Ares L, Soulieres D, Melezinek I et al. Clinical outcomes in non-small-cell lung cancer patients with EGFR mutations: pooled analysis. J Cell Mol Med 2010; 14: 51–69.
20. Pfizer Inc: CP-358, 774 Investigator Brochure 1999.
21. Riely GJ, Politi KA, Miller VA et al. Update on epidermal growth factor receptor mutations in non-small cell lung cancer. Clin Cancer Res 2006; 12: 7232–41.
22. Rosell R, Moran T, Queralt C et al. Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 2009; 361: 958–67.
23. Sandler A, Gray R, Perry MC et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006; 355: 2542–50.
24. Schiller JH, Harrington D, Belani CP et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002; 346: 92–8.
25. Sequist LV, Martins RG, Spigel D et al. First-line gefitinib in patients with advanced non-small-cell lung cancer harboring somatic EGFR mutations. J Clin Oncol 2008; 26: 2442–9.
26. Sharma SV, Bell DW, Settleman J et al. Epidermal growth factor receptor mutations in lung cancer. Nat Rev Cancer 2007; 7: 169–81.
27. Shigematsu H, Lin L, Takahashi T et al. Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst 2005; 97: 339–46.
28. Sordella R, Bell DW, Haber DA et al. Gefitinib-sensitizing EGFR mutations in lung cancer activate anti-apoptotic pathways. Science 2004; 305: 1163–7.
29. Yamamoto H, Toyooka S, Mitsudomi T. Impact of EGFR mutation analysis in non-small cell lung cancer. Lung Cancer 2009; 63: 315–21.
30. Zhou C, Wu YL, Chen G et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG 0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 2011; 12: 735–42.
1 ФГУ НИИ онкологии им. Н.Н.Петрова Минзравсоцразвития РФ, Санкт-Петербург;
2 Санкт-Петербургская медицинская академия последипломного образования федерального агентства по здравоохранению и социальному развитию