Thursday, September 17, 2009

Therapy in Non-Small Cell Lung Cancer

Context.-The development of targeted therapy provides an exciting prospect for treatment of advanced non- small cell lung cancer. In the last few years the epithelial growth factor receptor has emerged as one of the most important targets in very selected patients.

Objective.-To review current data on the role of the targeted therapy in advanced non-small cell lung cancer and offer some perspectives for the practitioner.

Conclusions.-Despite the remarkable development of targeted therapies in advanced non-small cell lung cancer, there is not yet a real improvement in overall survival.

Gene therapy is an exciting prospect for treatment of lung cancer because genes can be transduced into cancer cells to correct genetic lesions or inactivate oncogenes.

Epidermal growth factor receptor mutations are present in about 10% of cases of non-small cell lung cancers in the United States and Europe and in about 30% to 50% of non-small cell carcinomas in Asians. More than 50% of adenocarcinomas with bronchioloalveolar features that arise in nonsmokers have EGFR mutations.

Mutations in codons 12 and 13 of the KRAS gene, present in 30% of non-small cell lung cancers, and a history of cigarette smoking are usually associated with resistance to TK-Is. Recent data suggest that EGFR mutations and KRAS mutations are mutually exclusive in non- small cell lung cancer.

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