Molecularly targeted drug therapy for lung cancer

  People often have the feeling that the number of people having cancer around them seems to be increasing. Indeed, the overall incidence rate of malignant tumors has been on a rapid rise in the past two decades, and by the end of the last century, it has risen to the first place among the causes of death in China’s big cities. Lung cancer is one of the diseases with the greatest increase in incidence and mortality: in 1970, China ranked 4th in the world in terms of incidence of lung cancer, and after just 30 years, it has now risen to the 1st place, and the low early detection rate of lung cancer and the lack of immediate treatment means make its mortality rate top the list of various malignant tumors for a long time.  Since the 1990s, some new antitumor drugs with better efficacy in lung cancer have been developed one after another, such as paclitaxel, irinotecan, vincristine, gemcitabine, etc. The application of these drugs has greatly improved the prognosis of patients with mid- to late-stage lung cancer. New platinum-containing drug combinations have become the first-line standard chemotherapy regimen for intermediate-stage lung cancer (especially non-small cell lung cancer), yet the results of randomized studies on the use of these drugs in combination with platinum have all shown that the efficacy of these new drugs is also not yet satisfactory.  Fortunately, recent developments in molecular biology and human genomics have led to a better understanding of the molecular mechanisms of lung cancer carcinogenesis, invasion and metastasis, as well as some biological signaling pathways, and have provided opportunities for early diagnosis and development of new therapeutic approaches for lung cancer. “Molecular targeted therapy” is one of the “gifts” contributed to mankind by the pharmaceutical industry at the end of the 20th century. “Molecular targeted therapy” can be considered as a kind of “biological missile”, which means that these new drugs can hit tumor cells precisely like a laser-guided missile, with little impact on normal tissue cells. A variety of molecularly targeted therapies have been introduced, including those targeting the epidermal growth factor receptor (EGFR), which has emerged as a clinical treatment.  Tumor cells often have a lot of EGFR, and most lung cancer patients also have a lot of these receptors, which is like a signal indicator inside the tumor cells, guiding the direction of our “biological missiles” to attack lung cancer cells. By inhibiting EGFR with anti-EGFR monoclonal antibodies or EGFR tyrosine kinase inhibitors, we can inhibit the growth of tumor cells or even kill them directly.  Three such “biological missiles” have already been approved for clinical use in the treatment of non-small cell lung cancer: Eressa (gefitinib, Iressa or ZD1839), Troche (erlotinib, erlotinib or OSI-774) and cetuximab (IMC- C225, cetuximab).  Eressa and trospium are structurally similar small molecule EGFR tyrosine kinase inhibitors. 2002 American Congress of Clinical Oncology reported for the first time that eressa alone was effective in the treatment of non-small cell lung cancer with tumor progression after first-line chemotherapy. The remission rate for symptoms associated with lung cancer was 40%, with most patients experiencing tumor remission with corresponding improvement in disease-related symptoms. The most common side effects of ERSA were mild rash and diarrhea, and the incidence of serious adverse drug reactions was extremely low, with no accumulation of long-term toxicity and no correlation with chemotherapy drug toxicity. This clearly demonstrates that in patients with advanced non-small cell lung cancer who have failed conventional therapy, ERSA still has significant antitumor effects, can reduce symptoms, and has a fairly good safety profile.  In patients with non-small cell lung cancer whose tumors progressed or recurred after chemotherapy with platinum-containing regimens treated with troche, 11% of patients had partial remission and 39% had stable disease. The main side effects were gastrointestinal reactions and rash, most commonly acne-like dermatitis (78.6%). All patients in partial remission experienced different types of rash, suggesting that the presence of a rash could be used to determine treatment response.  Cetuximab targets the portion of EGFR that is exposed on the surface of tumor cells, thereby attacking them. In combination with Tasutil, it has been shown to treat patients with advanced non-small cell lung cancer who have failed general chemotherapy, with 20% of patients achieving partial remission after 6 weeks of treatment and 30% having stable disease, for an overall efficacy rate of 50%. It is also worth mentioning that patients have fewer side effects and can tolerate the treatment.  Although the efficacy of these new drugs has yet to be proven, we can be sure that “molecularly targeted therapy” is bringing benefits to lung cancer patients. This new treatment may be just a ray of sunshine now, but it will certainly light up a straight path to recovery for lung cancer patients!