Genotipificación del carcinoma de pulmón : del laboratorio al paciente.
Genotyping lung adenocarcinoma : from bench to bedside.
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El cáncer de pulmón que presenta mutaciones en el receptor para el factor de crecimiento epidérmico (EGFR) responde a inhibidores de tirosina quinasa; no obstante, siempre se documenta resistencia a estos medicamentos. Casi todos los tumores que exhiben tolerancia a los inhibidores blanco dirigidos conservan sus mutaciones activadoras originales, y algunos presentan mecanismos adquiridos, incluyendo la mutación T790M o la amplificación del gen MET. Algunos tumores resistentes demuestran inesperados cambios genéticos, entre ellos la amplificación del EGFR y mutaciones en el PI3KCA, mientras que otros progresan a través de la transición epitelio-mesenquimal. En la actualidad, desconocemos cuál es el mejor tratamiento para esta población, aunque varios autores han reportado el uso de los inhibidores reversibles más quimioterapia, quimioterapia sola, radioterapia o cirugía. Otros han observado respuestas tras la reexposición al gefitinib/erlotinib en pacientes previamente respondedores a estos compuestos. A continuación, se reporta el caso de un paciente que se benefició de estos dos enfoques.
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