According to the pathological analysis of the World Health Organization (WHO), lung cancer is divided into four main tissue types: small cell lung cancer and non-small cell lung cancer, which can be further divided into adenocarcinoma of the lung, squamous epithelial cell carcinoma and large cell carcinoma.
The general early symptoms include these
1.Age over 35 years old, with prolonged cough, especially frequent choking cough, the cause of which cannot be found within a short period of time.
2.After a cold or bronchitis, the cough is not cured for a long time and the symptoms are gradually aggravated.
3.Patients with recurrent and prolonged hemoptysis with intermittent chest pain that is not fixed.
4.Patients with original tuberculosis and chronic bronchitis and sudden change in the original cough pattern.
5.Sudden onset of progressive shortness of breath, chest tightness, chest X-ray suggesting pleural effusion.
6.Chest X-ray shows “inflammation of the lung”, which cannot be completely controlled by treatment, and the symptoms recur or worsen.
7.Unexplained persistent pain in joints and muscles, numbness and burning pain in the skin, fever, but systemic symptoms are not obvious.
8.People with long-term smoking history, family history of cancer, and more chances of exposure to carcinogenic substances such as asbestos, asphalt, arsenic, chromium, coal tar, etc. in daily work, and those with respiratory symptoms.
Clinical stage of lung cancer
Stage I: Cancer exists only in the lung.
Stage II: The cancer has spread to the adjacent lymph nodes.
Stage III: Cancer has spread to adjacent tissues, such as to the chest cavity.
Stage IV: The cancer has spread to other parts of the body, such as to the liver and bones.
It is generally considered that stage III and stage IV of non-small cell lung cancer can be considered as advanced stage of lung cancer.
Proportion of EGFR mutations
About 15% of Caucasians and 30-50% of East Asians have EGFR mutations, and for those East Asians without a history of smoking, the rate is as high as 50-60%.
The frequency of EGFR mutations was high in women (61.1%) and never smokers (60.7%), but EGFR mutations were higher in men (44%), occasional smokers (51.6%), and those with a history of smoking (43.6%). However, EGFR mutations were also common in men (44%), occasional smokers (51.6%), and those with a history of smoking (43.2%). For the Asian region, the frequency of EGFR mutations was highest in Vietnam (64.2%) and lowest in India (22.2%).
EGFR complex amino acid kinase inhibition targeted therapy
1. The role of genetic testing
EGFR tyrosine kinase inhibitor targeted therapy genetic test is used to evaluate the suitability of targeted therapy with small molecule EGFR tyrosine kinase (EGFR-TKI) in patients with small cell lung cancer. The test detects EGFR gene and KRAS gene mutation status in tissue or plasma free DNA, and gives dosing recommendations on the appropriateness of EGFR-TKI by analyzing the mutation detection results for sensitization or resistance.
(1) Targeted therapy with small molecule EGFR tyrosine kinase (EGFR-TKI) is recommended for individuals with detectable sensitizing mutations.
(2) Treatment with Tagrisso (Osimertinib) is recommended for individuals with detected EGFR T790 mutations.
(3) Targeted therapy with small molecule EGFR tyrosine kinase inhibitors (EGFR-TKI) is not recommended for individuals with other drug resistance mutations detected.
Chinese expert consensus on blood EGFR mutation testing for non-small cell lung cancer: standardizing EGFR blood testing in China. Promoting precision lung cancer treatment.
In recent years, targeted agents such as epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have become one of the important treatment modalities for patients with advanced lung cancer. EGFR mutation testing is a prerequisite for treatment with EGFR-TKIs for patients with advanced lung cancer. Current guidelines including the National Comprehensive Cancer Network (NCCN), the European Society of Clinical Oncology (ESMO) and the Chinese Expert Consensus on EGFR mutation testing in lung cancer all unanimously recommend that EGFR testing should be routinely performed in lung cancer patients. However, the uptake rate of EGFR testing among lung cancer patients in China is relatively low. It has been reported that the detection rate of EGFR mutation in lung cancer in China was about 20%-30% in 2012, which is significantly lower than the detection rate in developed countries or regions. The most common reasons for not being tested are mainly due to the lack of sufficient tumor tissues, limitations of pathological histological types (e.g. squamous carcinoma) and long testing cycles. How to improve the detection rate of EGFR and other genetic variants in China is one of the key factors to improve the precise diagnosis and treatment of lung cancer in China.
2.The significance of genetic testing
Detecting whether EGFR gene or KRAS gene mutation exists in patients with non-small cell lung cancer can make prospective prediction on the effect of targeted therapy, provide good reference for doctors’ clinical use, and improve the accuracy and precision of targeted therapy. If the patient has the mutation, targeted therapy can be used to bring positive therapeutic effect to the patient. If the patient does not have the mutation, other more suitable treatments can be found for the patient, saving valuable time and avoiding unnecessary expenses.
United Gene Group
”Targeted Medication Genetic Testing”, which enables clinicians to refer to a patient’s genetic information analysis through genetic testing, “tailor-made” to guide the safe and rational use of medication, significantly improve drug efficacy, reduce side effects, lower medical costs and reduce patient It can significantly improve drug efficacy, reduce side effects, lower medical costs and reduce patient pain. United Gene has “targeted drug genetic testing” for the four most prevalent cancers: stomach cancer, lung cancer, breast cancer and colorectal cancer, which is not only highly accurate but also provides excellent services.