Chii chinonzi EGFR Positive Lung Cancer?

Kutungamirirwa kweEGFR Positive Lung Cancer

Chii chinonzi EGFR mutation uye nei zvichikosha nekenza yemapapu? Izvi zvinoedzwa sei uye zvinoshandiswa sei? Ndiani anowanzove neEGFR mutation uye zvinorevei maererano nekutaura kwako?

Overview

EGFR chirwere chemapapu chemapapu chinoreva mapepa emapapu anoedza kuti ave nechirwere cheEGFR. EGFR inomiririra epithelial kukura factor receptor, puroteni inowanikwa pamusoro pemasero ose emakenza emukenza emukenza semakenza emukenza emapapu.

EGFR mutations inowanzoonekwa nevanhu vane mapapu adenocarcinoma (chimiro chekasi-duku chekenza yemapapu emapapu,) inonyanya kufanana nemukenza wemapapu mune vasiri kusvuta , uye inowanzoonekwa kune vakadzi kupfuura varume.

Kushandurwa kwegeneti kunyoresa EGFR ndiyo inonyanya kuchinja "kuchinja" mutsauko pakati pevanhu vane kenza yemapapu, zvinoreva kuti ndiyo inowanzoshandiswa pakuchinja kwema genetic iyo kune marapirwo anowanikwa anonyatsotarisa mapepa emukenza emapapu. Kufambira mberi kwakakurumbira kwakaitwa pakurapa makondombera emapapu neiyo majekiseni akawanda mumakore achangobva kupfuura. Kutanga nekubvumirwa kweIressa (gefitinib) muna 2003-panguva apo tisina kumboziva zvishoma pamusoro peEGFR-inenge hafu yemishonga mitsva yakagamuchirwa kurapwa kwekenza yemapapu sezvo muna 2016 inotarisa iyi yakawandisa.

Chii chinonzi EGFR Mutation?

Kuchinja kweEGFR kunoreva kuchinja (kuora) kune chikamu cheDNA mumukenza wekenza yemapapu inotakura "recipe" yekuita EGFR (epidermal growth factor receptor) mapuroteni.

Iko kamuti rimwe nerimwe remasero edu rine DNA yedu, iyo yakazogadzirwa nejeni. Aya mazamu akaita sechirongwa chemaprotini ose akabudiswa mumitumbi yedu. Mune mamwe mazwi, majini edu akafanana nemashoko ari mubhuku rekurayiridza rinotsanangura kuti tingavaka sei zvinhu zvose zvemuviri wedu.

Zvimwe zveprotini zvakabudiswa uchishandisa aya mazita ekuberekwa anobatanidzwa mukugadzirisa kuwedzera nekuparadzaniswa kwemasero.

Apo geni rinotakura mirayiridzo yekusika EGFR inokuvadza-inoshandiswa-inoshandurirwa kuva mapuroteni asina kukwana.

munyaya iyi, epistlial growth receptor (EGFR) mapuroteni asina kukwana. Aya mapuroteni asina kukodzera, zvakare, anoita "zvisingawanzo" basa mukuraira kukura kwesero. Kune nzira dzakawanda dzakasiyana umo iyo geni inogona kuchinjwa (ona pasi apa).

Chii Chaicho Chaizvo EGFR?

Masero edu ane antigens akawanda (mapuroteni asina kukwana) pamusoro. EGFR (epidermal growth factor receptor) ndeimwe yemapuroteni anowanika pamusoro pekenza masero pamwe chete nemasero akajairika. EGFR inogona kufungidzirwa sechitsinho chechiedza. Apo kukura kwezvinhu (munyaya iyi tyrosine kinases) zvakabatanidzwa neEGFR kune kunze kwekamuri, zvinoguma mu chiratidzo chinotumirwa kune nucleus yesero inouudza kuti ikure nekuparadzanisa.

Mune mamwe majekiseni emukenza, puroteni iyi inonyanyisa kufungidzirwa. Chigumisiro chacho chinopindirana nechigadziri chechiedza chakasara mu "pane" nzvimbo, ichiudza sero kuti ramba richikura uye ikakamura kunyange kana ichifanira kumira. Nenzira iyi, kuchinja kwe EGFR dzimwe nguva kunonzi "kushanduka kwekuchinja".

Isu iye zvino tine mishonga inowanikwa-tyrosine kinase inhibitors-iyo inonyanya "kuisa" puroteni iyi mune mamwe masero emukenza.

Iyi mishonga inovhara zviratidzo zvinosvika mukati memusero, uye kukura kwesero kunomira.

Njodzi Zviitiko uye Kuwanda

EGFR mutation iripo inenge 15 muzana yevanhu vane kenza yemapapu muUnited States, kunyange zvazvo nhamba iyi inowedzera kusvika 35 kusvika ku50 muzana kune vanhu vokuEastern Asia vanobva.

Iyo inowanikwa kazhinji kune vanhu vane rudzi rusina kamudiki rwekenza yemapapu emapapu inonzi lung adenocarcinoma. (Aya makondombera anonziwo "muto wekenza wemapapu isiri mutsvuku.") Panguva ino mauto anenge makumi mapfumbamwe nemazana mashanu emakirini emapapu asiri maduku ekenza mapepa emapapu, uye kune aya, anopfuura 50 muzana mapapu adenocarcinomas.

EGFR mutations ndeyi:

• Zvinowanzoonekwa kune vakadzi kupfuura varume. (Pane zvakawanda zvakasiyana pakati pemukenza wemapapu mukenza nevakadzi nemapapu mune varume ,)
• Yakawanda inowanikwa nevanhu vane mapapu adenocarcinoma (asi inogona kuwanika kune vanhu vane mamwe maitiro emusana wechidiki wemukenza wemapapu.)
• Kazhinji inowanikwa musamboputa kana vanhu vanoputa zvishoma. (Haasati asvuta anotsanangurwa seumwe munhu akachera fodya zana kana zvishoma pamusana pehupenyu hwavo.) Kunyange zvazvo 15 muzana yemakirini emapapu ehurukuro anoratidza EGFR, makondomu emapapu mune vasina kusvuta anonyanya kuve nokuchinja uku.
• Zvinyanya kuwanzana kune vechidiki vechidiki vane mutsa wemapapu. (EGFR mutations iripo inenge 50 muzana yemakenza emapapu muvanhu vaduku .)
• Inowanzozivikanwa muAsia, kunyanya vanhu veEast Asia heritage.
• Zvisingakoshi muAfrica America kupfuura Caucasians.

Gene Testing

Iko zvino yakakurudzirwa kuti mumwe nomumwe ane kero kaduku kadiki kemapapu yemapapu-kunyanya mapapu adenocarcinoma-ane majekesi ekuongorora (geni kuongororwa) akaitwa pamakumbo avo kuti atsvake kuvepo kwemaitiro asina kuchena mumasero emukenza emapapu.

Zvinogona kuvhiringidza kunzwa pamusoro pekuchinja kwemajeni mumasero ako ekenza nehurukuro dzose nezvemajeni nekenza yengamu. Kusiyana nemararamiro emararamiro akasiyana-siyana, izvo zvaunotakura kubva pakuberekwa, zvisinei, kuchinja kwemashoko kunowanikwa nekunyora kwema molecular kunowanikwa kuchinja kwemashoko (somatic mutations.) Izvozvo zvinogadziriswa hazvisipo pakuberekwa asi zvinokura gare gare muupenyu sero inova kenza yesero.

Makero emukenza anogona kuchinja-chinja, asi vashomanana chete ndivo vanobatanidzwa zvakananga mukugadzirisa kenza. Izvi zvinotungamirira mukugadzirwa kwemapuroteni asina kukwana anotungamirira kukura uye kukura kwekenza yesero. Aya mapuroteni asina kukodzera "anotengesa" kukura uye kupararira kwekenza uye naizvozvo mararamiro akasiyana-siyana anokonzerwa nekugadzirwa kwawo anonzi "mutambiri wekutenderera." Zvimwe, asi hazvisi zvose zve "kutendeuka kwekushandura" zvinotaridzika kuchinja "kana kuti" kutendeseka kunochinja "izvo zvinoreva kuti vanogona kutarirwa nemishonga.

Zvinofungidzirwa kuti kuchinja kwevatyairi varipo mu 60 muzana yevanhu vane mapapu adenocarcinoma, uye nhamba iyi, pamwe nekuchinja kwevatyairi mune mamwe mimwe yemapapu emapapu, inotarisirwa kukura sezvo kunzwisisa kwedu kwehupenyu hwekenza kuchiwedzera. Zvinowanzochinja mutyairi zvinosanganisira:

• EGFR mutations
• ALK rearrangements
• ROS1 rearrangements
• MET kuwedzera
• KRAS mutations
• HER2 mutations

Nezviverengera zveizvi zvisiri izvo, zvinorapwa zvirongwa zvino zvawanikwa. Iyi mishonga inokonzera masero ekenza zvakanyanya uye inowanzova nemigumisiro shomanana kupfuura tsika dzekodhese remishonga-zvinodhaka zvinotungamirira masero ose anokura nokukurumidza.

Mukuwedzera, zviyero zvemakiriniki zviri munzvimbo dzeimwe mhando dzemutende uye kuchinja kwemajini pamwe chete nemhando dzakasiyana dzemukenza wemapapu. Pakati pevanhu, vanhu havawanzove vanopfuura imwe yezviitiko izvi. Somuenzaniso, hazvigoneki (asi hazviitike) kune mumwe munhu ane mutemo weEGFR uyewo ane rearrangement ye ALK kana kuti mutauro weKRAS mumasero emukenza emapapu.

Kuziva

Tissue Biopsy

Kuti ruzivo rwemajini rwuitwe, samuenzaniso yemarara yako inoda kuwanikwa. Kazhinji yenguva, kuedza kunoda muenzaniso wezvisikwa zvakagadzirirwa panguva yepapu . Izvi zvinogona kuitwa kuburikidza nesimbi yenyuchi, panguva yebronchoscopy, kana kuburikidza nemapapu akazarurwa. Dzimwe nguva kuedza kunoitwa pamusana unenge wakabviswa zvachose panguva yekuvhiyiwa kwekenza yemapapu.

Liquid Biopsy

Muna Kubvumbi ra2016, chiratidzo chitsva chemvura inonzi biopsy chakagamuchirwa kuti chione kuchinja kwe EGFR. Kusiyana nehuwandu hwemhuka dzinoputika, iyi kuedza kunogona kuitwa kuburikidza nekutsvaga kweropa rekuongorora. Panguva ino, iyi miedzo ichiri kuonekwa sekuongorora uye haisashandisi yoga kuti inotungamira kuongororwa uye kurapwa kwekenza yemapapu, asi kupa chivimbiso chikuru. Zvinotarisirwa kuti izvi zvidzidzo zvichapa sarudzo yekuongorora vanhu vane EGFR kanha yemapapu yemapapu munguva chaiyo munguva yemberi. Penguva ino, tinongodzidza kuti chiremara chave chisingawirirani nemishonga inotarisa EGFR kana ikakundikana kupindura (inotanga kukura kana kupararira) pamapapu emapapu. Mishonga yemvura inopa varapi mukana wekudzidza chiremara chave chisingadi-uye saka chinoshandiswa kune kurapa kwakanyanya-nokukurumidza kudarika zvino zvichibvira.

Genetic Changes in Cancer Cells

Kuti unzwisise zviri nani mapurogiramu emakorokari uye zvinotarisirwa kurapwa kwemukenza wemapapu, zvinobatsira kutsanangura zvishomanana zvemashoko ekuberekwa. Kune marudzi akasiyana-siyana akasiyana-siyana emararamiro ekuchinja anokwanisa kuitika mukenza masero. Izvi zvinosanganisira:

• Kuchinja-shanduka - Kushanduka-shanduka kunoshanduka muDNA yakarongeka inoita geni.
• Rearrangements - Mukugadzirisa zvakare, kuenzanirana kweDNA kunogadziriswa zvakare.
• Translocations - Izvi zvinoitika apo chikamu chegene pane chromosome imwe inotamira kune imwe nzvimbo yeDNA.
• Gene fusion - A "fusion" gene rinowanikwa apo shanduko inounganidza pamwe nemajini maviri ayo asingawanzo pamwe chete.
• Amplification inoreva kugadzirwa kwemakopi akawanda ejeni uye inowanzosangana nekenza masero.

Kunewo maitiro akasiyana-siyana emutambo. Zvimwe zvezvi, zvisinganzwisisiki, zvinosanganisira:

• Pfungwa dzinoshanduka - Chimwe chinhu chinoshandura mutauro chinoreva kushanduka kune imwe nheyo inotsiviwa kune imwe.
• Kushushikana - Mukubvisa, chikamu chemajini chinorasika kana chakabviswa kubva kune jeni
• Kuiswa - Mukuisa, chikamu chemajini chinowedzerwa kune jeni.

Aina

Kuchinja kwe EGFR hakurevi kuti rimwe geni rinenge risina kunaka. Pane kudaro, kune marudzi akasiyana-siyana eEGFR mutations anoshandura zvose zviri mumutauro wekuchinja (sezvinotsanangurwa pamusoro) uye mune nzvimbo yekuchinja mutendi. Mune mamwe mazwi, kune nzira dzakawanda umo EGFR inogona kuchinjwa maitiro

Kuchinja kwemuviri muEGFR kunogona kuitika munzvimbo dzakasiyana-siyana pazera remakore 18 kusvika ku21. EGFR yakawanda inoshanduka mutengo (inenge 90 muzana) inenge iri kunze kwekuregererwa 19 (kusina genetic material) kana exon 21 L858 mamiriro ekuchinja. (Ona T790 kuchinja kwemuzasi kunowanzoitika nekuramba.)

Kurapa

Ikozvino pane mishonga inotenderwa neDAA inogamuchirwa inobata EGFR positive lung adenocarcinoma, uye imwe ye squamous cell carcinoma uye imwe yeEGFR yakanaka inopesana nekenza yemapapu. Iyi mishonga inonzi inonzi tyrosine kinase inhibitors. Vanodzivisa basa reprotein yeEGFR.

Mishonga inogamuchirwa yemapapu adenocarcinoma inosanganisira:

• Tarceva (erlotinib)
• Gilotrif (afatinib)
• Iressa (gefitinib)

Mishonga inogamuchirwa yeT790 mutations inosanganisira:

• Tagrisso (osimertinib)

Iwe unogona kunzwa oncologist yako kutaura pamusoro pe "zvizvarwa" zvemishonga iyi. Tarceva ndiro chizvarwa chekutanga cheEGFR inhibitor, Gilotrif wechipiri, uye Tagrisso, wechizvarwa chechitatu EGFR inhibitor.

EGFR Inhibitors yeLung Adenocarcinoma

Ne mishonga mitatu ine mutsara wekutanga weEGFR positive lung adenocarcinoma, vanachiremba vanosarudza sei yeiyi tyrosine kinase inhibitor inogona kushanda zvakanakisisa nokuda kwekenza yako chaiye?

Kusarudzwa kweimwe EGFR inhibitor kunowanzoenderana nekuda kwako kwe oncologist (uye nzvimbo yako) Pane zvimwe zvisiyana zvidiki . Iressa ane mukurumbira wekuve nemashoma emigumisiro uye anogona kutaridzirwa sarudzo yekutanga kune mumwe munhu ane mamwe mishonga yakakura kana yevakwegura. Kusiyana neizvi, Gilotrif angave ane zvimwe zvingava nemigumisiro yakanyanya (kunyanya maronda emuromo) asi inogonawo kuva nehuwandu hupenyu hwehupenyu hunobatsira. Gilotrif inogonawo kushanda zvishoma zviri nani kuvanhu vane exon 19 maitiro ekuderedza. Pane, zvisinei, zvimwe zvinhu zvakawanda izvo iwe oncologist iwe unoda kufungisisa nemumwe wako wekenza.

EGFR uye Squamous Cell Carcinoma yeMapungira

Nzira yeEGFR inogonawo kuendeswa kune vanhu vane squamous cell carcinoma yemapapu avo vasina EGFR mutations, asi nenzira yakasiyana.

Panzvimbo pekuchinja kweEGFR kutyaira idzi kanhara, kukura pane kunobatana neEGFR kukurudzira . Uye panzvimbo yekushandisa tyrosine kinase inhibitors kunotarisana neEGFR mutation, anti-EGFR maitiro anoshandiswa anoshandisa EGFR kune kunze kwechipinda (mumatachiona asina EGFR mutation) kuti asvibise nzira yekucherechedza.

Portrazza (necitumumab) yakagamuchirwa muna 2015 pamwe chete nechemotherapy kune vanhu vane advanced squamous cell carcinoma yemapapu avo vasina kugamuchira kurapwa. Portrazza inonzi monoclonal antibody ( anti -made antibody) inovhara basa reEGFR. Anti-EGFR antibody therapy mishonga-yakadai semishonga Erbitux (cetuximab) uye Vectibix (panitumumab) -ve yakashandiswa pamwe nedzimwe kenzawo.

Kusiyana nemishonga inoshandiswa kweAdenocarcinoma pamusoro apa iyo inopiwa nemuromo, anti-EGFR therapy drug Portrazza inopiwa mukati.

Kuramba Kurapa

Zvinosuruvarisa, kunyange mishonga yepamapapu inogona kupindura zvakanaka kune tyrosine kinase inhibitors pakutanga, inenge yava nguva dzose inopesana nekufamba kwenguva. Nguva yakawanda kusati kwambomira kunowedzera, zvisinei, kunogona kusiyana zvikuru. Kunyange zvazvo nguva yemunguva pakati pekutanga kwerapi uye kukura kwekumirisana kwemwedzi 9 kusvika ku13, mishonga iyi yakaramba ichishanda kune vamwe vanhu kwemakore mazhinji.

Penguva ino, tinowanzoziva kuti chiremara chave chichidzivirira kana chinotanga kukura zvakare kana kupararira. Kudzokorora kudzokorora, kunoteverwa nekunyorwa kwema molecular kunowanzoitwa panguva iyoyo. Sezvakataurwa pamusoro apa, zvinotarisirwa kuti mvura inoshandiswa yemvura ichava nzira yekugadzirisa kuti ronda rinoramba risina simba mune ramangwana.

Kurapa Kwekudzivirira EGFR Positive Lung Cancer

Sezvo kune marudzi akasiyana-siyana eEGFR mutations, kune nzira dzakasiyana-siyana dzinogona kukonzerwa nekenza. Kanzerini masero anoramba achichinja, uye kazhinji anowedzera kuchinja kwezvinhu zvinowedzera kuti zvive zvinopesana nemishonga inoshandiswa.

Munenge inenge hafu yevanhu, chechipiri chekuchinja-exon 20 kubviswa kunonzi EGFR T790 inowedzera. Izvi zvinosanganisira nzvimbo yeEGFR iyo yekutanga uye yechipiri inonzi tyrosine kinase inhibitors (yakadai seTarceva) inosunga, ichiita mishonga yose mitatu pamusoro (Tarceva, Gilotrif, neIressa) isingabatsiri. Kune avo vane metastatic EGFR T790 mutation yakanaka isiri duku duku rekenza yemapapu, mushonga wemishonga Tagrisso kana AZD9291 (osimertinib) yakagamuchirwa zvino. Asi, sezvo kupikisana kunotanga nemishonga yekuzvarwa kwemakore ekutanga, yakagadziriswa inogona kukura kusvika kune chechitatu chizvarwa tyrosine kinase inhibitors pamwe chete. Tariro, zvinodhaka zvicharamba zvichigadziriswa nekuda kwezviremara zvinopesana, kuitira kuti vanhu vazhinji vachakwanisa kurarama nemukenza wemapapu sechimiro chechirwere chisingaperi-chisina kuporesa, asi chinotungamirirwa nemishonga iyi.

Bata kuBra muMetastases

Zvinosuruvarisa, nekuda kwekuvapo kweropa-uropi-chivako-nzvimbo yemasero akaoma zvakagadzikana anokonzera ma-capillaries muuropi-zhinji yemishonga iyi haikwanise kusvika kumagera emukenza akaenda kuuropi. Ropa-uropi huripo hunogadzirirwa kukonesa kukwanisa kwehupfu hwekuwana huropi, asi zvinosuruvarisa, zvinowanzovhara chemotherapy uye zvinorapwa zvirwere kusvika pakuwana uropi zvakare. Sezvo kenza yemapapu ine tsika yekupararira kuuropi, ichi chave chiri dambudziko guru kune avo vane kenza yemapapu neuropi metastases .

Imwe mishonga inenge ichiri kuongororwa mumakirini emakiriniki - AZD3759 yakagadzirirwa kupindira kuburikidza nedambudziko reropa-reropi, uye inotarisira kuti mishonga iyi, kana vamwe kuongororwa, inogona kubatsira avo vane EGFR mutation yakanaka yemapapu emukenza vanewo hutano hwehupfungwa kana leptomeningeal chirwere .

Kuchengetedzwa Kwemazuva Akasiyana

Nyaya yakanyanya kufanana nayo ye tyrosine kinase inhibitors, iyo iripo inenge 80 muzana yevanhu, ichitsvaga ganda. Pashoma nguva, chirwere chinogona kuitika zvakare.

Tarceva (erlotinib) ganda rakasvibiswa (uye rashes kubva kune imwe tyrosine kinase inhibitors) rinofanana nemagne, rinoitika pachiso, kumusoro kwepamusoro, uye kumashure. Maererano nehupamhi hwechimbichimbi, kana pasina mvere chena iripo, inonzi corticosteroid cream (hydrocortisone cream), inoshandiswa. Kana misoro machena iripo uye kukurumidza kutarisa utachiona, muromo wemishonga inorwisa mabhakitiriya inoshandiswa. Dzimwe nguva nguva iyo mishonga yemishonga inoda kuderedzwa.

Clinical Trials

Sezvambotaurwa kare, kufambira mberi kwakakura kwave kuri kuitwa mune zvose kujekeswa kwemajeni kuchinja nemukenza wemapapu uye kunotarisirwa kurapa kurapa kuchinja uku. Kune mishonga yakawanda yemakiriniki ikozvino iri kutarisa kune mamwe mishonga yekurapa EGFR mutation yakanaka yemapirisa yemukenza, uyewo marapirwo emamwe masiyamu anochinja mumasero ekenza.

Maererano neNational Cancer Institute, vanhu vane chirwere chemapapu vanofanira kufunga nezvekubatanidzwa mumakirinikirini. Yakawanda yemishonga ikozvino inoshandiswa yaive inowanikwa sechikamu chekuongororwa kwekliniki nguva pfupi yapfuura yapfuura. Mamwe mapoka emakirini emapapu emapapu akashanda pamwechete kuti aite chirwere chemapirini chekliniki chirongwa chinobatanidza ushumiri kune ani zvake ane chirwere chemapapu. Kuburikidza nebasa iri rekusununguka, vanachiremba vanogona kufanana nemukenza wako wemapapu kumakiriniki ekuedzwa anotorwa chero kupi zvako munyika.

Kutsigira uye Kukunda

Kana iwe uchangobva kuongororwa nemukenza wemapapu, uri kuita chimwe chezvinhu zvakanakisisa zvaungave uchiita-kutora nguva yekudzidza nezvekenza yako. Heano mazano mashomanana ekuwana kuwana ruzivo rwakanaka rwekenza paIndaneti, uyewo mamwe matanho ekutanga kutora apo iwe uchangobva kuongororwa .

Mukuwedzera pakudzidza nezvekenza yako, kudzidza kudzivirira kwako sewe chirwere chekenza kunoita mutsauko kune vakawanda. Kunyange iwe unogona kunge wakajaira ribhanki dzitsvuku pane ruvara rwekenza yemapapu emapapu, munharaunda yemutsigiri wekenza yemapapu, yakasimba uye inowedzera. Vanhu vazhinji vanozviona zvichibatsira kuti tibatanidzwe mumapoka aya ekutsigira uye mharaunda kwete chete senzira yekuwana rubatsiro kubva kune mumwe munhu "akave aripo" asi senzira yekuramba achienzanisa nekutsvakurudza kwekupedzisira pamusoro peswere.

Kurapa-uye kuponesa kwekutenda-yemukenza wemapapu vari kuwedzera, uye kune tariro yakawanda. Paiva nemishonga mitsva yakagamuchirwa pakati pegore ra2011 ne2015 kupfuura yegore remakore makumi mana rakapera gore ra2015. Kunyange zvakadaro, kenza marathon, kwete sprint. Kana uri kurwisana nekenza, svika kune vemhuri yako neshamwari uye uvabvumira kuti vakubatsire. Kuchengeta mafungiro akanaka nekenza kunobatsira pane dzimwe nguva, asi iva nechokwadi chokuti une shamwari shomanana dzepedyo iwe unogona kuzarurirwa zvachose uye utaure zvako kwete-zvakanaka uye unotya kunzwa. Kana iri mudiwa wako uyo akawana chirwere, chengetedza pfungwa idzi pane zvazviri chaizvo kurarama nekenza .

_Sources:

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_{Hasegawa, T., Ando, ​​M., Maemondo, M. et al. Basa rekutsvaira pamusana pekusiya-kusununguka-kusununguka kwevasiri vashoma vemukenza yemapapu emapapu ekuchengetedza kurwisa epidermal kukura factor receptor (EGFR) kuchinja kwekutambira kugamuchira mutsara wekutanga EGFR tyrosine kinase inhibitor pamwe neplatinum doublet chemotherapy: meta-analysis yezvingazoitika maitiro akaoma . Oncologist . 2015. 20 (3): 307-15.}

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_{Tan, D., Yom, S., Tsao, M. et al. The International Association for the Study of Lung Cancer chirevo chekubvumirana pamusoro pekusimudzira kushandiswa kweEGFR mutation yakanaka isina-duku kenza yemapapu yemapapu: mamiriro muna 2016. Nyaya yeTraracic Oncology . 2016 May 20. (Epub pamberi pekudhinda).}

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