325.2 🩺 國考版

325.2.1 高頻考點

325.2.1.1 Treatment by Stage

  • Stage I: lobectomy
  • Stage II: surgery + adjuvant chemo; + atezolizumab if PD-L1+ (IMpower010); + osimertinib if EGFR+ (ADAURA)
  • Stage III unresectable: chemoradiation + durvalumab (PACIFIC) or osimertinib (LAURA EGFR+)
  • Stage IV: molecular profiling → targeted or IO

325.2.1.2 EGFR Treatment

  • 1st-line: osimertinib (FLAURA) — 80 mg daily
  • Adjuvant: osimertinib (ADAURA) × 3 years
  • Stage III unresectable: osimertinib consolidation (LAURA 2024)
  • Resistance: C797S, MET amplification, histologic transformation

325.2.1.3 ALK Treatment

  • 1st-line: alectinib, brigatinib, lorlatinib (most potent)
  • Trials: ALEX, ALTA-1L, CROWN

325.2.1.4 ROS1

  • Crizotinib, entrectinib, repotrectinib (2023)

325.2.1.5 KRAS G12C

  • Sotorasib (CodeBreaK 100), adagrasib (KRYSTAL-1)
  • 35% response

325.2.1.6 MET Exon 14

  • Capmatinib, tepotinib

325.2.1.7 HER2 Mutation

  • Trastuzumab deruxtecan (DESTINY-Lung)

325.2.1.8 BRAF V600E

  • Dabrafenib + trametinib

325.2.1.9 NTRK

  • Larotrectinib, entrectinib (rare)

325.2.1.10 RET

  • Selpercatinib, pralsetinib (rare)

325.2.1.11 Immunotherapy

  • PD-L1 ≥ 50%: pembrolizumab monotherapy
  • PD-L1 < 50%: pembrolizumab + chemo
  • Combo regimens: nivolumab/ipilimumab + chemo (CheckMate 9LA, 227)

325.2.1.12 Neoadjuvant Immunotherapy (NEW)

  • CheckMate 816 (2022): nivolumab + chemo → pCR 24% vs 2%
  • AEGEAN (2023): durvalumab + chemo
  • KEYNOTE-671 (2023): pembrolizumab perioperative

325.2.1.13 Trials Landmark

  • ADAURA, LAURA: osimertinib early stages
  • ALEX, CROWN: ALK TKIs
  • CodeBreaK 100: sotorasib KRAS G12C
  • DESTINY-Lung: trastuzumab deruxtecan HER2
  • PACIFIC: durvalumab stage III
  • KEYNOTE-024, 189, 407: pembrolizumab in NSCLC
  • IMpower010: atezolizumab adjuvant

325.2.2 易混淆比范

Driver Therapy Trial
EGFR Osimertinib FLAURA, ADAURA, LAURA
ALK Alectinib, lorlatinib ALEX, CROWN
ROS1 Repotrectinib TRIDENT-1
KRAS G12C Sotorasib, adagrasib CodeBreaK, KRYSTAL
MET Capmatinib GEOMETRY-mono
HER2 Trastuzumab deruxtecan DESTINY-Lung
BRAF Dabrafenib + trametinib BRF113928
NTRK Larotrectinib NAVIGATE
RET Selpercatinib LIBRETTO

325.2.3 Special Topics

325.2.3.1 Osimertinib + LAURA Trial

  • Stage III unresectable EGFR+
  • After chemoradiation
  • Median PFS 39.1 months (vs 5.6 months placebo)
  • Game-changing 2024

325.2.3.2 Lung Cancer in Asian Women

  • Often EGFR+
  • Non-smokers common
  • Better response to TKIs
  • Distinct epidemiology