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非小细胞肺癌初步评估与临床分期NCCN2017v2-17

发表者:张品良 人已读

Initial Evaluation and Clinical Stage 初步评估与临床分期

CLINICAL   PRESENTATION

HISTOLOGIC   SUBTYPE山东第一医科大学附属肿瘤医院呼吸内科张品良

TESTING a

TESTING RESULTS a

Metastatic   Disease

* Establish   histologic subtype a with adequate tissue for molecular testing   (consider rebiopsy ff if appropriate)

* Smoking   cessation counseling

* Integrate   palliative care c (See NCCN Guidelines for Palliative Care)

* Adenocarcinoma

* Large Cell

* NSCLC not   otherwise specified (NOS)

* Molecular   testing

▶ EGFR mutation testing (category 1)

▶ ALK testing (category 1)

▶ ROS1 testing jj

▶ Testing should be conducted as part of broad molecular profiling gg  

* PD-L1 testing kk  

Sensitizing EGFR   mutation positive

See First-Line   Therapy (NSCL-18)

ALK positive

See First-Line   Therapy (NSCL-20)

ROS1 positive

See First-Line   Therapy (NSCL-22)

PD-L1 positive kk   and EGFR, ALK, ROS1 negative or unknown

See First-Line   Therapy (NSCL-23)

EGFR, ALK, ROS1,   PD-L1 are negative or unknown

See First-Line   Therapy (NSCL-24)

Squamous cell   carcinoma

* Molecular   testing

▶ Consider EGFR mutation and ALK testing hh in never smokers   or small biopsy specimens, or mixed histology ii

▶ Consider ROS1 testing jj

▶ Testing should be conducted as part of broad molecular profiling gg  

* PD-L1 testing kk

Sensitizing EGFR   mutation positive

See First-Line   Therapy (NSCL-18)

ALK positive

See First-Line   Therapy (NSCL-20)

ROS1 positive

See First-Line   Therapy (NSCL-22)

PD-L1 positive   and EGFR, ALK, ROS1 negative or unknown

See First-Line   Therapy (NSCL-23)

EGFR, ALK, ROS1,   PD-L1, are negative or unknown

See First-Line   Therapy (NSCL-25)

临床表现

组织学亚型

检测a

检测结果a

转移性疾病

*确定有足够的组织用于组织学亚型a与分子检测(如果合适考虑再活检ff)

*戒烟咨询

*整合姑息治疗c(见姑息治疗NCCN指南)

* 腺癌

*大细胞

*非小细胞肺癌未特指(NOS)

*分子检测

▶EGFR突变检测(1类)

▶ALK检测(1类)

▶ROS1检测jj

▶实施的检测应作为广泛分子表达谱的一部分gg

* PD-L1检测kk

EGFR敏感突变阳性

见一线治疗(NSCL-18)

ALK阳性

见一线治疗(NSCL-20)

ROS1阳性

见一线治疗(NSCL-22)

PD-L1阳性kk以及EGFR、ALK、ROS1阴性或未知

见一线治疗(NSCL-23)

EGFR、ALK、ROS1,PD-L1阴性或未知

见一线治疗(NSCL-24)

鳞癌

*分子检测

▶从不吸烟者或小的活检标本或混合型组织学Ⅱ考虑EGFR突变并ALK检测hh

▶考虑ROS1检测jj

▶实施的检测应作为广泛分子表达谱的一部分gg

* PD-L1检测kk

EGFR敏感突变阳性

见一线治疗(NSCL-18)

ALK阳性

见一线治疗(NSCL-20)

ROS1阳性

见一线治疗(NSCL-22)

PD-L1阳性以及EGFR、ALK、ROS1阴性或未知

见一线治疗(NSCL-23)

EGFR、ALK、ROS1、PD-L1阴性或未知

见一线治疗(NSCL-25)

a See Principles of Pathologic Review (NSCL-A).
a 见病理学检查原则(NSCL-A)。

c Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-742.
c Temel JS,Greer JA,Muzikansky,等。转移性非小细胞肺癌患者的早期姑息治疗。N Engl J Med 2010;363:733-742。

ff If repeat biopsy is not feasible, plasma biopsy should be considered.
ff 如果重复活检不可行,应考虑血浆活检。

gg The NCCN NSCLC Guidelines Panel strongly advises broader molecular profiling with the goal of identifying rare driver mutations for which effective drugs may already be available, or to appropriately counsel patients regarding the availability of clinical trials. Broad molecular profiling is a key component of the improvement of care of patients with NSCLC. See Emerging Targeted Agents for Patients With Genetic Alterations (NSCL-H).
gg NCCN非小细胞肺癌指南强小组强烈建议广泛的分子表达谱检测,旨在发现罕见的驱动突变,可能已有可用的有效药物,或可以恰当建议患者参加相应的临床试验。广泛的分子表达谱是提高非小细胞肺癌患者医疗保健的关键。见遗传学改变患者的新型靶向药物(NSCL-H)。

hh In patients with squamous cell carcinoma, the observed incidence of EGFR mutations is 2.7% with a confidence that the true incidence of mutations is less than 3.6%. This frequency of EGFR mutations does not justify routine testing of all tumor specimens. Forbes SA, Bharma G, Bamford S, et al. The catalogue of somatic mutations in cancer (COSMIS). Curr Protoc Hum Genet 2008;chapter 10:unit 10.11.
hh 在鳞癌患者中,观察到EGFR突变率2.7%,相信,真实的突变发生率不到3.6%。这个EGFR突变率并不能在所有肿瘤标本的常规检测中证实。Forbes SA, Bharma G, Bamford S,等。恶性肿瘤体细胞突变目录(COSMIS)。Curr Protoc Hum Genet 2008;第10章:10.11节。

ii Paik PK, Varghese AM, Sima CS, et al. Response to erlotinib in patients with EGFR mutant advanced non-small cell lung cancers with a squamous or squamous-like component. Mol Cancer Ther 2012;11:2535-2540.
ii Paik PK, Varghese AM, Sima CS,等。厄洛替尼治疗EGFR突变的鳞状或鳞样成分的晚期非小细胞肺癌的疗效。癌症分子治疗2012;11:2535-2540。

jj Shaw AT, Ou S-HI, Bang Y-J, et al. Crizotinib in ROS1-rearranged non-small cell lung cancer. N Engl J Med 2014;371:1963-1971.
jj Shaw AT, Ou S-HI, Bang Y-J,等。克唑替尼治疗ROS1重排的非小细胞肺癌。N Engl J Med 2014;371:1963-1971。

kk PD-L1 expression levels of ≥50% are a positive test result for first-line pembrolizumab therapy.
kk 对于一线派姆单抗治疗,PD-L1表达水平≥50%为阳性检测结果。

NSCL-17

本文是张品良版权所有,未经授权请勿转载。
本文仅供健康科普使用,不能做为诊断、治疗的依据,请谨慎参阅

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发表于:2016-11-08 17:09

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