随着基因检测技术的进步和新药研发速度的提升，生物靶向治疗已经全面覆盖晚期NSCLC的一线治疗。免疫治疗 的出现让驱动基因野生型的晚期NSCLC患者生存得到了明显改善，中位OS已达到2年左右（15.6~30个月）。EGFR作为最常见 的驱动基因，按照敏感突变的不同亚型（L858R或19del）去选择不同的一线治疗模式：EGFR-TKI单药、TKI联合抗血管药物，TKI 联合化疗已成为共识。从中位PFS这一数据来分析，少见靶点的疗效更为突出，均已超过标准化疗的疗效， 按PFS排序：ALK（阿 来替尼，PFS=34.8个月）、ROS1（塞瑞替尼，PFS=19.3个月）、RET（selpercatinib，PFS=18.4个月）、BRAF（达拉非尼+曲美替尼，PFS= 14.6个月）、NTRK（拉罗替尼，PFS≥12个月）、MET（沃利替尼，PFS=9.7个月）。综上，晚期NSCLC的一线治疗已经进入到基于不 同分子分型的“精准靶向”治疗时代，初诊患者需进行高通量测序已成为共识。

With the progress of gene detection technology and the speed-up in new drug development, biological target therapy has fully covered the first-line treatment of advanced NSCLC. Immunotherapy has significantly improved the survival of advanced NSCLC patients with negative driven genes, and the median OS reaches about 2 years (15.6-30 months). EGFR is the most common driven gene. According to different EGFR mutation subtypes (L858R or 19del), different treatment mode (EGFR-TKI single drug, TKI combined with anti-vascular drugs and TKI combined with chemotherapy) is selected as the first-line treatment, which has become a consensus. Depending on the data of median PFS, the treatment efficacy against rare targets is more prominent, which has exceeded the efficacy ofstandardchemotherap:ALK(alectinib,PFS=34.8months),ROS1(ceritinib,PFS=19.3months),RET (selpercatinib, PFS=18.4 months), BRAF (dabrafenib plus trametinib, PFS=14.6 months), NTRK (larotrectinib, PFS≥12 months) and MET (savolitinib, PFS=9.7 months). In conclusion, the first-line treatment of advanced NSCLC has entered the era of“precision-targeted treatment”based on different molecular typing, and it has become a consensus that high-throughput sequencing is required for newly diagnosed patients.

国家自然科学基金资助项目（No. 81803914、81803004）