Individual treatment of lung cancer

21 of lung cancer treatment, are moving towards standardized, individual direction of the rapid advance of evidence-based medicine. The so-called individual treatment of lung cancer, which is developed by the special treatment strategy for a certain lung cancer patients. An individual's lung cancer treatment strategy, we must rely on clinical factors, but also to rely on functional genomics and functional proteomics factors.

Based on the clinical factors of individual treatment of lung cancer

Stages of lung cancer is one of the most important indicators of prognosis, it is also extremely important predictor of treatment. Based on the phased development of lung cancer treatment strategy is now recognized individual one of the basic standards of treatment. The end of 2005 "published by the Chinese lung cancer diagnosis and treatment guidelines" and the United States Comprehensive Cancer Network (NCCN) guidelines lung cancer, the most commendable and most of the best part is that the principle of phased treatment and staging of the implementation details: Ⅰ, Ⅱ preferred surgical treatment of lung cancer, Ⅲ lung cancer need a multidisciplinary organic arrangements, Ⅳ lung cancer while systemic treatment such as chemical treatment or mainly targeted therapy.

In recent years carried out a large-scale clinical trial has clearly some clinical factors as predictors of prognosis. The easiest targets are in the physical state (PS) index and weight loss. If the PS> 2 or weight loss index> 5%, chemotherapy or radiation therapy greatly reduced, or even counterproductive.

A very interesting study, the United States, such as the U.S. eastern Hoang tumor Cooperation Group (ECOG) of the two large randomized controlled study ECOG1594 and ECOG5592 the establishment of clinical prediction model. 1436 cases of third-generation chemotherapy for non-small cell lung cancer (NSCLC) patients entered the study, to screen a total of six independent prognostic factors: transfer of the skin, low PS, reduce appetite, liver metastases, four places and had not transferred the history of surgery . According to the researchers this six clinical factors predict the early establishment of governance in patients with NSCLC 1 to 2-year survival rate of model (Figure 1). Can be seen from the plan, six if there are negative factors, total as much as 216 points, corresponding to the one-year survival rate of only 0.6 percent. If only a transfer of the skin, compared with its integral 66 points, corresponding to the 1-year survival rate around 30 percent, 2-year survival rate of less than 10 percent. From this we can determine what the basic needs of patients with active anti-cancer therapy, which only patients with active support treatment.

Based on the clinical factors of individual treatment of lung cancer, although based on experience than simply the treatment has been a major step forward, but it is still not the real significance of the individual treatment. For example, Ⅰ lung cancer is a rather large groups, based on the principle of phased treatment groups use the same treatment strategy, there are still 20 percent to 30 percent of patients fail to survive more than five years, some patients actually receive the Is not the individual treatment.

Based on functional genomics and proteomics individual treatment of lung cancer

Each individual unique, because of its unique gene spectrum. Therefore, based on functional genomics and proteomics individual treatment of lung cancer, it is possible for us to tailor each of lung cancer patients, designed a unique, the best effect and minimum side effects of treatment.

Based on the molecular characteristics of tumors anti-cancer drug choice

Hailed as the past five years in the lung cancer study found that one of the most important thing is to determine the tyrosine kinase inhibitors gefitinib the target population for the East-smoking crowd in patients with adenocarcinoma. Our research suggests that China's human lung adenocarcinoma of the EGFR mutation rate was 34.1 percent, far higher than other types of lung cancer 5.7% (P <0.05). In fact, the Oriental people, women, non-smoking and adenocarcinoma of the four factors of EGFR mutations can be attributed to the molecular biology of this unique characteristics. Therefore, in accordance with EGFR mutation in the choice of suitable patients with lung cancer and gefitinib treatment of lung cancer is expected to make more individualized treatment.

Based on biological markers of chemotherapy options.

"Tailor" has been frequently and "chemotherapy" with the use. Tailor chemotherapy foundation, is based on biological markers of chemotherapy options. In the field of lung cancer, interesting is the ERCC1 and cisplatin, RRM1 and gemcitabine, β-tublin taxane drugs and the relationship between. In 2005 the American Society of Clinical Oncology (ASCO) annual meeting, Rosell report the first molecular markers based on the type of chemotherapy choice of prospective randomized controlled clinical study, ERCC1 with low expression of the two drugs cisplatin programme 56.6 percent have the highest response rate is very regrettable that, ERCC1 expression of non-platinum group only 37.7 percent of the programme is efficient, effective and do not show the results.

One of our adjuvant chemotherapy for stage Ⅲ randomized controlled clinical experiments (CSLC0201), on the β-tublin Ⅲ NSCLC in the forecast of adjuvant chemotherapy in value. Patients are complete with NSCLC, after supplemented with docetaxel Jiaka Platinum 4 cycle of chemotherapy. The results showed that the median time in the non-recurrence of β-tublin Ⅲ positive group only six months, the negative group was 26 months (P = 0.006); chemotherapy invalid group 66.7 percent of patients with β-tubulin Ⅲ positive, significantly higher than that Adjuvant chemotherapy effective group of 14.3% (P = 0.063).
In addition, RRM1 polymorphism also decided to gemcitabine resistance of the problem. Multi-drug resistance gene MDR-1 over-expression means that the doxorubicin and paclitaxel resistance.

Trap or a way out »

Functional genomics research people dazzling. Do we have reason to believe that the individual treatment of cancer era about to come »In fact, laboratory, clinical small sample of the findings and clinical application still exist between the great divide, to straddle this divide is not easy. Therefore, under the present circumstances, it is not appropriate to have a preliminary understanding easily applied to clinical practice. It can be said that the individual treatment of cancer, there are traps everywhere, there is a way out, the key lies in how the laboratory and clinical practice to fill the gap between.