Biến đổi gen đích trong ung thư phổi không tế bào nhỏ không vảy: Góc nhìn từ sinh học phân tử và thực tiễn lâm sàng tại Việt Nam

Non-small cell lung cancer (NSCLC) remains a formidable global health challenge, ranking as a leading cause of mortality worldwide and in Vietnam. The advent of targeted therapies and immunotherapies, driven by the discovery of oncogenic gene alterations, has revolutionized treatment paradigms. Precision medicine now crucially relies on identifying specific biomarker profiles prior to treatment. This paper explores the landscape of targetable gene alterations in non-squamous NSCLC, which disproportionately affects non-smokers, younger patients, and Asian populations, where effective gene alteration detection rates can reach up to 80%. The overarching aim is to outline common oncogenic gene alterations treatable by tyrosine kinase inhibitors and to establish practical criteria for selecting molecular biomarker testing strategies tailored to the clinical realities and resource availability within Vietnam.

Oncologists, pathologists, molecular biologists, healthcare policymakers, and researchers involved in lung cancer diagnosis and treatment, particularly within Vietnam and similar resource-constrained settings.

This academic review thoroughly investigates targetable gene alterations in non-squamous non-small cell lung cancer (NSCLC), emphasizing their clinical relevance and diagnostic strategies pertinent to Vietnam. The study systematically reviewed literature from PubMed, along with international guidelines (NCCN, ESMO, AMP) and national regulations from the Vietnamese Ministry of Health. Key findings highlight that the most prevalent targetable alterations include four driver mutations—EGFR, BRAF, KRAS, and HER2—and five gene rearrangements or splice site alterations—ALK, ROS1, RET, NTRK1/2/3, and MET. Each of these alterations represents a potential target for tyrosine kinase inhibitors, marking a significant advancement in precision oncology. While Next-Generation Sequencing (NGS), encompassing both DNA- and RNA-based approaches, offers the most comprehensive detection method for these alterations, the paper acknowledges its resource-intensive nature. Consequently, it proposes practical alternative strategies such as sequential single-gene real-time PCR or multiplex real-time PCR, which remain viable options contingent on the clinical context and available resources in Vietnam. The overarching implication is that optimizing patient benefits while minimizing economic burden necessitates a strategic selection of molecular testing approaches that align with the local healthcare infrastructure and economic conditions. This ensures that a broader patient population can access personalized treatment, fostering equitable healthcare outcomes.