5 common medication misunderstandings you must know before targeted therapy!

In recent years, with the emergence of targeted therapy drugs, the treatment options of cancer patients are gradually increasing
.
However, many patients' understanding of targeted therapy is still very vague and there are many misunderstandings
.
Today, I will take you to know several common misunderstandings of targeted drugs
.

▲Source: Maker Post

1.
Targeted therapy can replace traditional therapy

As a new therapeutic method, targeted drugs bring new hope to tumor treatment, but they cannot replace traditional surgery and chemoradiotherapy
.

Because the occurrence and development of tumors are multi-target, multi-channel formation, targeted therapy must choose the appropriate "target" to have efficacy, however, there are only a few targets and targets found so far, and whether the appropriate target can be found in individual patients is different from person to person
.

Therefore, it cannot simply be assumed that targeted drugs can replace traditional chemotherapy drugs
.
For example, in lung cancer, if the genotype detected is appropriate, then a single targeted drug treatment can be used, while in digestive tract tumors, such as bowel cancer or gastric cancer, it is still a combination of chemotherapy and targeted therapy that has clinical significance
.

2.
Blind trial of targeted drugs saves money

Many cancer patients believe that the cost of genetic testing is high, and if the mutation cannot be detected, it may be "a bamboo basket empty", so they choose "blind trial" targeted drugs
.

However, if genetic testing is not performed, it is likely that cancer patients will spend a lot of money to buy and take targeted drugs, and the results of the treatment will not be satisfactory
.

A previous study on lung cancer analyzed the effectiveness of targeted therapy between the general population and the corresponding gene mutation population, and the study pointed out that the first-generation EGFR-targeted drug gefitinib (Gefitinib) produces different effects in patients with EGFR mutation-positive and EGFR-negative non-small cell lung cancer [2]: The median survival of patients taking gefitinib (Gefitinib) was only 0.
4 months
longer than that of those who received optimal supportive care (no medication).
However, IPASS studies have found that gefitinib has a significant effect on patients with EGFR-sensitive mutations in non-small cell lung cancer, with an effective rate of 71.
2%, compared with only 1.
1% in EGFR-negative patients [3
].

All in all, blind testing of targeted drugs, betting on luck, using targeted therapy without knowing whether there is a genetic mutation, is likely to cost a lot of money, and ultimately has no effect
.

3.
Use a first-generation drug, use a second-generation drug after drug resistance, and then use a third-generation drug

Many patients believe that second-generation targeted drugs should be used after the first-generation targeted drug is resistant, and the third-generation drug
should be used after the second-generation drug is resistant.

This view is
not correct.

For example, the first and second generation drugs that also target EGFR-sensitive mutation targets have a role to distinguish
.
The main reason for the resistance of first-generation targeted drugs is because of the T790M mutation, which cannot be solved
by second-generation drugs.

Therefore, second-generation drugs cannot be used as a treatment plan after first-generation drug resistance, but should be selected according to the re-genetic detection after drug resistance, and drugs that target T790M mutation targets such as third-generation targeted drugs ametinib and so on
.

On the other hand, third-generation drugs can also be used as first-line treatment
for advanced cancer.
For example, the third-generation EGFR-TKI osimertinib also has rich clinical experience
in the first-line treatment of EGFR mutation-positive advanced non-small cell lung cancer.
Data suggest that osimertinib has an objective response rate of 80 percent (76 percent in the control group), a duration of response of 17.
2 months, and an 18-month survival rate of 83 percent (71 percent in the control group) [4].

All in all, the first, second and third generations of targeted drugs are suitable for different populations, so the order of 1, 2 and 3 is not simple in use
.

4.
Targeted drugs with reduced side effects are drug resistance

There is no
one-size-fits-all approach.

There is no definite relationship between side effects and whether targeted drugs are effective, and of course, it cannot be used as a basis
for judging drug resistance.

Clinically, the vast majority of patients, when there are side effects, the drug efficacy is also very good
.
However, some patients who take targeted drugs do not have any side effects after taking the drug, but the drug treatment effect is also surprisingly good; Some patients have a very severe rash after taking targeted drugs, or diarrhea many times a day, almost dehydrated, but the drugs have no effect
.

How to determine targeted drug resistance?

Commonly used clinical evaluation methods are imaging methods such as CT, MRI and bone ECT, of course, the patient's own subjective feelings are also important, and the efficacy can be evaluated
through symptom-related examinations.

After the trend of drug resistance in patients, it can be divided into symptomatic and asymptomatic progression mode, rapid progression and slow progression mode
.
After drug resistance, you can "block the water and cover the soil", after all, there are many treatment methods
after drug resistance.

5.
The effect of targeted joint work must be better

Any combination of two drugs may cause drug interactions, especially the superposition of toxicity may be life-threatening
.
Therefore, the different combination schemes currently used in clinical applications have been verified by clinical dose escalation tests, and the adapted population, tolerated dose and toxicity of the combination regimen have been clinically recognized in order to form a suitable combination regimen
.

For example, although immunotherapy is in the limelight, for patients with non-small cell lung cancer with positive driver genes for targeted therapy, combination immunotherapy is not only beneficial to the efficacy but also poses a safety risk!

Therefore, the combination of drugs must follow the guidelines, can not take for granted that 1+1>2, clinically there have been many cancer patients blindly use targeted drugs, not only not beneficial to the disease, but also may accelerate the spread of cancer cells, before taking must respect the guidelines and professional advice
.

Correctly understanding targeted drugs, escaping misunderstandings, and avoiding "stepping on thunder" can delay the arrival
of drug resistance to the greatest extent.
In addition, it is necessary to pay attention to tactics, relax mentality, and relax mentality is very important
for the control of the disease.

With the continuous advancement of medical technology, the effectiveness of cancer treatment is also steadily improving
.
For cancer patients, it is important
to choose an authoritative expert and develop an appropriate treatment plan according to the condition.
HOPU Ark has long-term and in-depth cooperation with many authoritative cancer treatment hospitals in Japan and the United States, and can provide remote consultation and one-stop overseas medical services
for patients in need in China.
To learn more about cancer treatment, you can contact us
at 400-081-6600 or add WeChat to DrHopeNoah.

Reference source:

[1] FAN Yiping, DU Ming, YU Fuyao, et al.
Research progress of lung cancer driver genes, detection methods and targeted therapy[J].
Modern Oncology,2020,28(2):330-334.
)

[2] Thatcher N, Chang A, Parikh P, et al.
Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study ( Iressa Survival Evaluation in Lung Cancer).
Lancet.
2005, 366(9496):1527-1537.

[3] Mok TS, Wu YL, Thongprasert S, et al.
Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma.
N Engl J Med.
2009, 361(10):947-957.

[4] Osimertinib in Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer | NEJM

class="weui-dialog__ft"> 

UnCancel Allow

： ，
。   ， ，