一文全面总结不同EGFR突变类型的晚期NSCLC一线如何选择用药，后续治疗又该何去何从？( 四 )

结论
在EGFR敏感突变的晚期NSCLC患者中，精准靶向治疗已经成为最大化患者生存获益，延迟无化疗间期的标准治疗方案。尽管目前已有1/2/3代TKIs问世，但如何充分发挥各代TKIs的优势，在TKIs顺序治疗方案中如何排列组合，仍然是困扰临床医生治疗决策的痛点。本文从2代EGFR TKI阿法替尼独特的作用机制出发，探讨了其一线治疗广泛的应用价值， “2+3”序贯治疗模式可行性的最新证据，展望了奥西替尼二线治疗耐药后后续治疗的方向，期望能为临床实践中EGFR敏感突变的晚期NSCLC患者的全程管理提供参考。参考资料：[1]Kris MG, et al. JAMA. 2014 May21;311(19):1998-2006.[2]Yuankai Shi, et al. J Thorac Oncol. 2014;9:154-162.[3]Masahiro Fukuoka, et al. J Clin Oncol. 2011 Jul 20;29(21):2866-74.[4]Yang et al. J Thorac Oncol. 2020 May;15(5):803-815.[5]Ashiq Masood, et al. Semin Oncol. 2019 Jun; 46(3): 271-283.[6]Li, et al. Oncogene. 2008 Aug 7;27(34):4702-11.[7]Liao BC, et al. Curr Opin Oncol 2015;27:94-101.[8]Kobayashi Y, et al.Cancer Sci. 2016 Sep;107(9):1179-86.[9]Sequistet al. J Clin Oncol. 2013;31:3327. [10]Wu YL, et al. OncoTargets Ther. 2018 Nov 30;118575-8587[11]Keunchil Park, et al.Lancet Oncol. 2016 May;17(5):577-89.[12]YL Wu, et al. Lancet Oncol. 2017Nov;18(11):1454-1466.[13] Kim Y, et al. CancerRes Treat. 2019;51(2):502‐509.[14]Burak Bilgin, et al. JCancer Res Clin Oncol. 2021 Jan 12. doi: 10.1007/s00432-020-03501-6.[15]Park S, et al. BMC Cancer. 2021 Jan 11;21(1):52.[16]Kohsaka, et al. SciTransl Med. 2017;9:eaan6566.[17]Adam J Schoenfeld, etal. Clin Cancer Res. 2020 Jun 1;26(11):2654-2663.[18]Julia Lai-Kwon, et al. Crit Rev Oncol Hematol. 2021 Mar;159:103225.[19]Kohsaka, et al.Future Oncol. 2019 Feb;15(6):637-652.[20]Arcila ME, et al. Clin Cancer Res. 2011; 17(5): 1169-1180.[21]Sequist LV, et al. Sci. Transl. Med. 2011; 3(75): 75ra26. [22]Yang JC, et al. J. Clin. Oncol. 2017; 35(12): 1288-1296.[23]Hochmair M, et al. J. Thorac.Oncol. 2017; 12(11): S2137.[24]Shuo Yang,et al.Lung Cancer. 2020 Jan;139:133-139.[25]Hochmair, M, et al. Future Oncol. 2020:1479-6694[26]Tamiya M, et al. Anticancer Res.2019 Jul;39(7):3923-3929.[27]Yosuke Miyashita, et al. Thorac Cancer. 2021 Feb;12(3):329-338.[28]MokTS, et al. N Engl J Med. 2017 Feb 16;376(7):629-640.[29]V.A.Papadimitrakopoulou, et al.Annals of Oncology. 2018; 29(Suppl 8): viii741.[30]Saito et al. Lancet Oncol 2019; 20:625.[31]Maemondo et al. ASCO 2020. Abstract 9506.[32]Nakagawa et al. Lancet Oncol. 2019;20:1655-1669.[33]Ninomiya et al. ESMO 2019. Poster 1525P.[1]Kris MG, et al. JAMA. 2014 May21;311(19):1998-2006.[2]Yuankai Shi, et al. J Thorac Oncol. 2014;9:154-162.[3]Masahiro Fukuoka, et al.J Clin Oncol.2011 Jul 20;29(21):2866-74.[4]Yang et al. J Thorac Oncol.2020 May;15(5):803-815.[5]Ashiq Masood, et al.Semin Oncol.2019 Jun; 46(3): 271-283.[6]Li, et al. Oncogene.2008 Aug 7;27(34):4702-11.[7]Liao BC, et al. Curr OpinOncol 2015;27:94-101.[8]Kobayashi Y, et al.Cancer Sci. 2016 Sep;107(9):1179-86.[9]Sequistet al. J Clin Oncol.2013;31:3327. [10]Wu YL, et al. OncoTargets Ther. 2018 Nov 30;118575-8587[11]Keunchil Park, et al.Lancet Oncol. 2016 May;17(5):577-89.[12]YL Wu, et al. Lancet Oncol. 2017Nov;18(11):1454-1466.[13]Kim Y, et al. Cancer ResTreat. 2019;51(2):502‐509.[14]Burak Bilgin, et al. JCancer Res Clin Oncol.2021 Jan 12. doi: 10.1007/s00432-020-03501-6.[15]Park S, et al.BMC Cancer.2021 Jan 11;21(1):52.[16]Kohsaka, et al. SciTransl Med. 2017;9:eaan6566.[17]Hyun Ae Jung, et al.Biology(Basel).2020 Oct 7;9(10):326.[18]Shen YC, et al.Lung Cancer.2017 Aug;110:56-62.[19]Chih-Yen Tu, et al.Oncotarget. 2018 Feb 4;9(36):24237-24247.[20]Kobayashi Y, et al.Clin Cancer Res. 2015 Dec 1;21(23):5305-13.[21]Adam J Schoenfeld, et al.Clin Cancer Res. 2020 Jun 1;26(11):2654-2663.[22]Julia Lai-Kwon, et al. Crit Rev Oncol Hematol. 2021Mar;159:103225.[23]Kohsaka, et al.Future Oncol. 2019 Feb;15(6):637-652.[24]Arcila ME, et al. Clin Cancer Res. 2011; 17(5): 1169-1180.[25]Sequist LV, et al. Sci. Transl. Med. 2011; 3(75): 75ra26. [26]Yang JC, et al.J. Clin. Oncol. 2017; 35(12): 1288-1296.[27]Hochmair M, et al.J. Thorac.Oncol. 2017; 12(11): S2137.[28]Shuo Yang,et al.Lung Cancer.2020 Jan;139:133-139.[29]Hochmair, M, et al.Future Oncol. 2020:1479-6694.[30]Tamiya M, et al.Anticancer Res. 2019 Jul;39(7):3923-3929.[31]Yosuke Miyashita, et al. Thorac Cancer.2021 Feb;12(3):329-338.[32]MokTS, et al. N Engl J Med. 2017 Feb 16;376(7):629-640.[33]V.A.Papadimitrakopoulou, et al.Annals of Oncology. 2018; 29(Suppl 8): viii741.[34]Hong et al. ESMO 2020. Abstract 1257O.[35]J?nne et al. AACR-NCI-EORTC InternationalConference on Molecular Targets 2019.[36]Hofmann et al. AACR Virtual Annual Meeting I. 2020.Abstract1091.*此文仅用于向医学人士提供科学信息，不代表本平台观点