Lung cancer has long been the biggest killer of the 10 deadliest cancers in Taiwan and, compared with other cancers, lung cancer cells are especially likely to migrate to the brain. One woman of over 80 years old was confirmed as having lung adenocarcinoma that spread into the brain, but fortunately targeted therapy proved effective and, after receiving medication managed to maintain a good quality of life, without needing to receive chemotherapy even two years into the treatment.
According to Hsieh Yao-yu, a doctor in the Hematology and Oncology Department of Shuangho Hospital, the woman developed lung adenocarcinoma, which then moved to the brain. The brain tumor had to be surgically removed, while the lung cancer was treated mainly with targeted therapy.
In Taiwan, lung adenocarcinoma affects women more than men, and these women often have no history of smoking. Medical and academic research looking into the reasons that these non-smokers still develop lung adenocarcinoma are ongoing.
File Photo: Liberty Times
照片：自由時報資料照
Hsieh says that epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes are the main driver mutation genes behind lung adenocarcinoma, and that EGFR gene mutations are seen in between 50 to 60 percent of patients of East Asian descent, and as such are seen as a main cause for the disease. Targeted therapies have proven to be very effective against mutations in these receptor genes in late stage lung cancer. Prior to receiving these targeted therapies, the patient must first undergo genetic testing, to determine whether this kind of gene is present.
The experience of Taiwan’s National Health Insurance system shows that, at present, the second generation of EGFR-targeted therapies appear to reduce the risk of mortality by 18 percent compared to the previous generation, and also reduce the treatment failure risk by between 20 and 30 percent, extending the life of the patient and elongating the progression-free period by at least three months.
When considering which type of treatment to follow, whether to use targeted therapies and which medication is the most appropriate, Hsieh recommends that patients consult with their doctor on factors such as the specifics of their condition and the economic burden of the treatment — for example, whether or not the treatment is covered by health insurance — as well as being mindful of the potential side effects of the medication and the optimum time to have the treatment. Lung cancer patients nowadays are still able to enjoy a good quality of life.
(Translated by Paul Cooper, Taipei Times)
肺癌長年佔據國人十大死亡癌症之首，且相較其它癌症，肺癌癌細胞特別容易轉移到腦部。一名八十多歲婦人被確診肺腺癌轉移腦部，但幸好標靶藥物有效，服藥後生活治理能力維持得不錯，服藥兩年仍不需要做化療。
雙和醫院血液腫瘤科醫師謝燿宇說，這名婦人罹患肺腺癌還轉移到腦部，對腦部腫瘤需要開刀，對肺部腫瘤仍先以標靶藥物治療為主。
國內肺腺癌病患多是女性、且常沒有吸菸史，對於這類不抽菸卻仍罹患肺腺癌的原因，目前醫界和學界仍在探討。
謝燿宇說，肺腺癌的主要驅動突變基因分別是「EGFR」(表皮生長因子受體)和「ALK」(間變性淋巴瘤激酶)，EGFR基因突變在東亞裔病人約占五到六成左右，而肺腺癌病患算大宗，標靶藥物對有此受體突變的晚期肺癌都有很好的療效，接受標靶藥物治療前得先做基因檢測，看有無此基因突變。
根據台灣健保實際使用經驗分析，目前第二代的EGFR標靶藥物與第一代相比，看起來降低了百分之十八的死亡風險，同時降低二到三成的治療失敗風險，並延長生存且無惡化的時間至少近三個月。
該用哪種治療方式、是否該使用標靶藥物或適合哪種藥物，謝燿宇建議病患最好和醫師多討論，包括病況、經濟負擔──譬如藥物有無健保給付等──並留意藥物副作用與及時處理，現在的肺癌病患也可以享有良好的生活品質。
(自由時報)
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