What to do if osimertinib is resistant
Osimertinib is currently the first-line drug for EGFR-positive non-small cell lung cancer (NSCLC) patients, and it is also the first third-generation lung cancer targeted drug to be marketed. In the field of lung cancer treatment, excellent results have been achieved: the latest clinical research shows that as a first-line drug, osimertinib has an overall survival time of up to 38 months and a progression-free survival time of 19 months, creating the highest level in the history of lung cancer targeted drugs. Long survival record.
Ochinib (Teresa) resistance
Patients with lung cancer with EGFR mutations will mostly choose osimertinib (Teresa) for treatment, but after taking osimertinib for a period of time, some patients will develop resistance. The mutations that develop resistance are often different: about 13% of patients have C797S mutations, and 19% of patients have MET amplification. In addition to these two common resistance mechanisms, there are BRAF V600E mutations and HER2 amplification.
Anti-angiogenesis factor inhibitor
Primary tumors can cause angiogenesis. The growth and metastasis of primary tumors depend on tumor angiogenesis. VEGF is the most important pro-angiogenic growth factor in the process of tumor angiogenesis. VEGF is overexpressed in lung cancer and its prognosis Badly related. Current studies have proven that VEGF can increase vascular permeability, thereby promoting tumor metastasis.
Anti-angiogenic growth factor inhibitors target VEGF to inhibit tumor angiogenesis and achieve anti-tumor effects. Commonly used anti-angiogenic growth factor inhibitor drugs include: bevacizumab, ramucirumab, apatinib, carbohydrate Botinib, Anlotinib, Levatinib, etc.
Anlotinib is a domestic multi-target tyrosine kinase inhibitor, which can control VEGFR, PDGFR, FGFR, c-Kit and other kinases, and has the effect of anti-tumor angiogenesis and inhibiting tumor growth.
At the ASCO annual meeting held this year, the domestic team announced the research results of anlotinib combined with osimertinib in the treatment of osimertinib (teresa)-resistant EGFR-mutant NSCLC. The results showed that anlotinib combined with osimer The median progression-free survival of patients treated with tinib was significantly prolonged (4.0 months vs 0.40 months, P = 0.0076, HR = 0.108), and the median survival (OS) was also significantly prolonged (10.1 months vs 2.20 months, P = 0.03, HR = 0.071).
Cabozantinib is a potent inhibitor of RET, VEGFR2 and MET, which targets and binds to tyrosine kinase receptors and inhibits the activity of a variety of tyrosine kinases (including RET, MET and VEGF) on the cell surface . By binding to these receptors, cabozantinib blocks important pathways that promote cancer cell division to achieve anti-cancer effects.
Phase I clinical trial (NCT01553656) research shows that cabozantinib treats advanced non-small cell lung cancer with a disease control rate of 80%.
Cabozantinib is not currently on the market in China, but there are generic drugs in Bangladesh, and patients with a heavier financial burden can consider it.
Luvatinib is an oral multi-target tyrosine kinase inhibitor, its targets include: VEGFR, PDGFRα, C-Kit, RET, FGFR. Levatinib has a strong inhibitory ability on the kinase activity of vascular endothelial growth factor VEGF receptors VEGFR1, VEGFR2 and VEGFR3, which can effectively prevent tumor angiogenesis and achieve anti-cancer effects. At present, levatinib is found in a variety of cancers. Batch, showing excellent anti-cancer efficacy.
Related news can be seen that lenvatinib combined with osimertinib (Teresa) is highly effective and has almost no side effects. However, there are currently fewer studies on renvatinib combined with osimertinib, and it remains to be further research.