Data released by the World Health Organization’s International Agency for Research on Cancer predicts that by 2020, the incidence of cancer worldwide will increase by 50% compared to today, and the number of new cancer patients will reach 15 million per year worldwide. The report also lists the highest incidence of cancer in the world as lung cancer, with 1.2 million new patients each year. In China, the mortality rate of lung cancer has increased by 465% in the past 30 years, ranking first in the world, and has replaced liver cancer as the first cause of death from malignant tumors in China. 1.What is called targeted therapy? Targeted therapy is to inhibit the proliferation of tumor cells by targeting one or several targets in tumor cells with specific drugs. If we take war as an analogy, chemotherapy is an indiscriminate bombardment of human body cells, then targeted therapy is a laser-guided precise targeted bombardment of cancer cells. 2.Compared with traditional chemotherapy, molecular targeted therapy (1) individualized treatment is possible. For example, the efficiency of EGFR-TKI treatment for non-small cell lung cancer with EGFR mutation is over 90%, so the treatment efficacy can be predicted by tissue EGFR detection. (2) Target specificity and mild toxic side effects. (3) The treatment method is simple and easy to use. At present, many targeted drugs are administered orally, with good patient compliance and tolerance, and can be administered in outpatient clinics and at home, which is easily accepted by patients. (4) Improvement of quality of life. Targeted drugs can usually improve patients’ symptoms rapidly and the side effects of treatment are small. (5) The combination of molecular targeted drugs and chemotherapy can improve the efficacy. For example, the combination of anti-angiogenic drugs and chemotherapy can significantly improve the efficiency without any significant increase in toxic side effects. 3. Appropriate groups of targeted therapy Lung cancer targeted drugs ERSA and Trocaire are not effective for all patients, which lung cancer patients are suitable for targeted drug therapy? We have several systems to select the population of targeted lung cancer drugs, one is to use the evidence from clinical studies as the indications of the target benefit population: the first is non-smokers, adenocarcinoma, especially alveolar cell carcinoma, from which the proportion of benefit is higher, and the selection of efficiency is also high; the second is EGFR gene testing. From the current study, EGFR mutation patients with EGFR-TKI as first-line treatment has better efficacy than chemotherapy, with an efficiency of about 70%, but as second-line treatment, the efficiency is 30%-40%. If EGFR-TKI is chosen as first-line therapy, patients should be routinely tested for EGFR mutations, and EGFR gene testing can also be combined with KRAS gene testing. If
If EGFR is not mutated but KRAS is mutated, EGFR-TKI should not be considered as first-line treatment. 4. What are the relevant tests to be done before taking oral targeted drugs? Routine blood tests, biochemistry, electrocardiogram, cardiac function and other relevant tests should be performed. It is also necessary to clarify the condition of the lesion for comparison after the drug is administered. 5.Side effects of targeted drugs and related therapeutic measures Most of the side effects of molecular targeted drugs are mild and do not need to be treated. Adverse events reported by more than 10% of the subjects were rash (44.0%), pruritus (15.7%) and diarrhea (11.3%). Interstitial lung disease was rare, and the overall incidence of interstitial lung disease was approximately 0.28%. Generally mild to moderate adverse reactions that are tolerated by the patient generally do not require special treatment. If there are severe adverse reactions, the patient can not tolerate, affecting the patient’s quality of life must be discontinued and make the corresponding symptomatic treatment. Discontinuation is generally controlled within 7-14 days, preferably not more than 14 days. In general, after a period of discontinuation, the side effects will be significantly reduced when the drug is taken again. In the face of the side effects of targeted drugs, we must pay attention to them and not be sloppy, especially to follow medical advice and use them correctly. 6.Therapeutic measures after drug resistance of targeted drugs Targeted drugs are more and more widely used in the treatment of non-small cell lung cancer, but their gradual development of drug resistance is becoming a major clinical problem. Current studies suggest that multiple molecular mechanisms are involved in the development of drug resistance, and the exact mechanisms of drug resistance need to be further explored and studied. Patients can choose chemotherapy and other targeted drugs after drug resistance, depending on the patient’s condition and gene mutation.