[Treatment of advanced NSCLC with unknown EGFR gene status
--TKI or chemotherapy?].

At present, the treatment recommendations of advanced non-small cell lung cancer (NSCLC) with clear epidermal growth factor receptor (EGFR) gene status has reached a consensus: patients with EGFR mutation-positive NSCLC can give priority to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), which can maximize the benefit from the treatment; while the patients with wild-type EGFR gene should regard chemotherapy as first choice whether the first-line or second-line therapy. A large proportion of patients, however, have not received EGFR gene test for various reasons. In the paper, we will thoroughly review the related clinical trial from the point of view of evidence-based medicine, and suggest that the treatment of advanced NSCLC with unknown EGFR gene status should be distinguished according to their race and pathological characters in order to find out the patients who are most likely to benefit from EGFR-TKIs, and thus arrange the treatment sequence scientifically and rationally. 目前对于表皮生长因子受体（epidermal growth factor receptor, EGFR）基因状态明确的非小细胞肺癌患者，其治疗推荐已成共识：对EGFR基因突变患者，可优先选择表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs），其治疗可最大获益；EGFR基因野生型患者，无论一线二线均应首选化疗。但是在临床实践中，仍有大部分患者由于各种原因未行EGFR基因检测，对于这部分基因状态未知患者的治疗，本文以循证医学的视角，回顾了相关临床研究，建议EGFR基因状态未知人群的治疗应依据种族、病理特点精细化分、区别对待，以甄别EGFR-TKI治疗高获益人群，科学合理安排治疗顺序。