Resumen
El carcinoma de pulmón de célula no pequeña (CPCNP) representa aproximadamente el 85% de todos los casos de cáncer de pulmón. El principal factor de riesgo es el tabaco, seguido del radón. Los principales subtipos histológicos son el adenocarcinoma y el carcinoma escamoso. En la mayoría de los casos, los pacientes son diagnosticados de CPCNP en estadios avanzados (III-IV), generalmente tras la aparición de una clínica respiratoria y/o constitucional. La primera prueba diagnóstica suele ser una radiografía de tórax en la que se observa un nódulo pulmonar, tras lo cual se debe completar la estadificación con la realización de una tomografía computarizada (TC) tóraco-abdómino-pélvica (y tomografía por emisión de positrones —PET-TC— en caso de enfermedad localizada o locamente avanzada) y TC craneal. Deberá confirmarse el diagnóstico histológico con la realización de una biopsia, en la que se obtenga suficiente tejido no solo para el diagnóstico citomorfológico (subtipo histológico) sino también para el estudio de biomarcadores (diagnóstico molecular y PD-L1). En la última década, se han logrado avances significativos en el tratamiento de los pacientes con CPCNP con la aparición de terapias dirigidas y la inmunoterapia, que han logrado una mejora significativa en la supervivencia. El tratamiento de elección va a depender tanto de las características del paciente (estado general, enfermedades previas, etc.) y sus preferencias como de las características del tumor, el subtipo histológico y la existencia o no de tratamientos dirigidos en función de los resultados de los biomarcadores).
Palabras clave
Carcinoma de pulmón no célula pequeña
Biomarcadores
Medicina personalizada
Inhibidor de tirosina-cinasa
Inmunoterapia
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. The main risk factor is tobacco, followed by radon. The main histological subtypes are adenocarcinoma and squamous cell carcinoma. In most cases, patients are diagnosed with NSCLC in advanced stages (III-IV), usually after the onset of respiratory and/or constitutional symptoms. The first diagnostic test is usually a chest X-ray in which a pulmonary nodule is observed, after which staging should be completed with a thoracic-abdominal-pelvic computed tomography (CT) scan (and a positron emission tomography (PET-CT) scan in case of localized or locally advanced disease) and a cranial CT scan. The histological diagnosis should be confirmed by performing a biopsy. Enough tissue should be obtained not only for cytomorphological diagnosis (histological subtype), but also for the biomarker study (molecular diagnosis and PD-L1). In the last decade, significant advances have been made in the treatment of patients with NSCLC with the emergence of targeted therapies and immunotherapy, which have achieved a significant improvement in survival. The treatment of choice will depend on the patient's characteristics (general condition, previous diseases, etc.) and preferences as well as on the tumor characteristics, the histological subtype, and whether targeted therapies exist or not (depending on the biomarker results).
Keywords
Non-small cell lung cancer
Biomarkers
Personalized medicine
Tyrosine kinase inhibitor
Immunotherapy
Identifíquese
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