110-1 醫學(三) 第37題
一位40歲亞裔女性病人,沒有抽菸史,最近被診斷有非小細胞肺癌第四期。下列何種基因檢測對她的治療選擇最重要?
  • K-ras突變
  • EGFR突變
  • VEGF receptor突變
  • BRAF突變

本題詳解

1. 沒有抽菸史: 較可能為肺腺癌

2. 非小細胞肺癌:

stage1,2和一些3A:能開就開乾淨

stage3B和4:

a. 無EGFR突變肺腺癌先考慮化療: cisplatin based regimen (+pemetrexed / pacitaxel)

b. 有EGFR突變肺腺癌先考慮標靶藥物: TKI 

Uptodate: Guidelines from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association of Molecular Pathologists recommend analysis of either the primary tumor or of a metastasis for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) for all patients whose tumor contains any component of adenocarcinoma histology, or who have light- or never-smoking history. (即使沒有EGFR突變,可驗ALK等其他突變,也有相對應的標靶藥物)