Individual lung cancer treatment
July 6th, 2007 Guage
Guangdong Provincial People’s Hospital-WU Yu 21 lung cancer treatment is moving towards standardization, and the individualized evidence-based medicine direction rapid progress. The so-called individual treatment of lung cancer, which refers to the design of treatment strategies for a special lung cancer patients. An individual’s lung cancer treatment strategy, we must rely on clinical factors, more dependent on functional genomics and functional proteomics factors.
Based on the clinical factors individualized treatment of lung cancer
Staging of lung cancer is one of the most important clinical prognostic indicators, it is also extremely important predictors of treatment. Based on the phased development strategy for the treatment of lung cancer, is recognized as the individual treatment of one of the basic criteria. By the end of 2005 published “China lung cancer diagnosis and treatment guidelines” and the United States Comprehensive Cancer Network (Update in NCCN) lung cancer guidelines, the most commendable is the essence of the best part is phased treatment and phased implementation details of the treatment : I, Phase II preferred surgical treatment of lung cancer, lung cancer Phase III needs multidisciplinary organic arrangements, IV lung cancer was systemic treatment such as chemotherapy or targeted therapy.
In recent years the large-scale clinical trials, has clearly some clinical factors as predictors of prognosis. The simplest indicator is the physical state of patients (PS) index and weight loss. If PS “two or weight loss Index” 5%, chemotherapy or radiation therapy significantly reduced, or even counterproductive.
A very interesting study, According to the United States such as the United States Hoang eastern tumor Cooperative Group (ECOG) of two large-scale randomized controlled study ECOG ECOG5592 1594 and the establishment of clinical prediction models. 1,436 cases for the 3rd generation chemotherapy of non-small cell lung cancer (NSCLC) patients enrolled in the study. weed out a total of six independent prognostic factors : subcutaneous transfer, low PS, reduced appetite, liver metastasis, 4 metastatic sites and no previous history of surgery. Researchers under six clinical factors to establish initial forecast of NSCLC patients a two-year survival rate of clinical model (Figure 1). From the map, we can see that if the six negative factors exist, as many as 216 total hours Then the corresponding one-year survival rate was only 0.6%. If only a subcutaneous transfer factors, its integration was 66 minutes, corresponding to the one-year survival rate of around 30%. 2-year survival rate was less than 10%. From this, we can determine which patients need an active anti-tumor treatment, which patients only need the active support of the treatment.
Based on the clinical factors individualized treatment of lung cancer, although better than simply based on the experience of the treatment has taken a huge step forward, But it is still not truly meaningful individualized treatment. For example, I lung cancer is a very large group, based on the principle of phased treatment groups using the same surgical treatment strategy still 20% ~ 30% of patients fail to survive more than five years. That some patients actually is not acceptable to the individual treatment.
Based on Functional Genomics and Proteomics of individualized treatment of lung cancer
Every individual unique in that it is a unique spectrum of genes. Therefore, based on functional genomics and proteomics to the individualized treatment of lung cancer, it possible for every one of our patients with lung cancer tailored to the unique design, best effect and minimum side effects of treatment programs.
Based on the molecular characteristics of tumors anticancer drug choice
Hailed as the past five years, the lung cancer study found that the most important one is that determine the tyrosine kinase inhibitors gefitinib targeting crowd of Oriental crowd of non-smoking patients with adenocarcinoma. Our studies suggest that China’s human lung adenocarcinoma EGFR mutation rate of 34.1%. much higher than other types of lung cancer 5.7% (P “0.05). In fact, the East crowd, women, non-smoking and adenocarcinoma of this four clinical factors can be attributed to the EGFR mutation of this unique molecular characteristics. Therefore, According to EGFR mutations in lung cancer patients choose a suitable and gefitinib treatment of lung cancer is expected to enable more individualized treatment.
Based on biomarkers of chemotherapy options
Customized” has been frequently and “chemotherapy” at the same joint. Tailor chemotherapy, and that is based on biomarkers of chemotherapy options. In the field of lung cancer, interesting is the ERCC1 and cisplatin, RRM1 and gemcitabine, beta-tublin taxane drugs and the relations between them. In 2005 the American Society of Clinical Oncology (ASCO) annual meeting, Roselló report the first molecular markers based on the type of chemotherapy in a prospective randomized clinical study, ERCC1 low expression of cisplatin with the two drug programs 56.6% of the maximum response rate; Unfortunately, ERCC1 high expression of non-cisplatin only 37.7% of efficiency, there is no indication of a high efficiency results.
We adjuvant chemotherapy in a Phase III randomized controlled clinical experiments (CSLC0201) Discussion of beta-tublin III NSCLC in predicting postoperative adjuvant chemotherapy in value. Patients were completely resected NSCLC, after he supported multi-West game carboplatin four cycles of chemotherapy. The results showed that the median time to recurrence in beta-tublin Ⅲ positive group only six months, the negative group at 26 months (P = 0.006); Adjuvant chemotherapy ineffective group 66.7% of patients with beta-tubulin III positive, significantly higher than the effective adjuvant chemotherapy group of 14.3% (P = 0.063).
Furthermore, the polymorphism RRM1 also decided gemcitabine resistance problem. Multi-drug resistance gene MDR-1 expression implies the right doxorubicin and paclitaxel resistance.
Trap or a way out?
Functional genomics research results dazzling.Do we have reason to believe that the individual cancer treatment immediately advent of the era? In fact, laboratory, Clinical small sample of research findings and clinical application still exist between the great divide to cross that gap will not be easy. Therefore, in the present circumstances, it would be inappropriate to have been the initial cognitive easily applied to clinical practice. It can be said that the individualized cancer treatment, there are many traps everywhere is the way out, the key is how to fill the laboratory and clinical practice the gap between.
Source : China Medical Tribune
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1. Individual lung ca&hellip | July 19th, 2007 at 1:31 am
[...] rapid progress. The so-called individual treatment of lung cancer, … article continues at admin brought to you by cancer.medtrials.info and [...]
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