Morfologi, Patogenesis, dan Imunoterapi Kanker Paru Tipe Adenokarsinoma

Abstract

Abstract: Although some common therapies for cancers are available, many patients experience relapse during therapy. Therefore, an understanding of the pathogenesis of lung adenocarcinomas is needed in lung cancer therapies, especially targeted therapies. Immunotherapy has been shown to be effective in the therapy of various tumors, including non-small cell lung cancer (NSCLC). This study was aimed to review the morphology, pathogenesis, and immunotherapy of lung adenocarcinomas. This was a literature review study using databases of Clinical Key, Pubmed, and Google Scholar. The results showed that morphology of lung adenocarcinomas was characterized by the presence of lesions consisting of several morphological spectra, starting with pre-invasive lesions, then minimally invasive adenocarcinomas to invasive adenocarcinomas. Pathogenesis of lung adenocarcinomas was associated with genetic changes of several genes such as EGFR, KRAS, ALK, and ROS1; however, the most frequently involved were EGFR, KRAS, and ALK. The immunotherapies used for lung adeno-carcinomas were nivolumab, pembrolizumab, atezolizumab, tremelimumab, durvalumab, avelumab, cemiplimab, cetuximab, panitumumab, and matuzumab; however, the most commonly used were nivolumab, pembrolizumab, and atezolizumab. In conclusion, morphological spectra of lung adeno-carcinomas are pre-invasive lesions, minimally invasive adenocarcinomas, and invasive adeno-carcinomas. Pathogenesis of lung adenocarcinomas is associated with the presence of genetic changes, especially mutations of EGFR, KRAS and ALK. The most widely used immunotherapies for lung adenocarcinomas are nivolumab and pembrolizumab, which are included in the PD-1 antibody group and atezolizumab in the PD-L1 antibody group.

Keywords: lung adenocarcinoma morphology; pathogenesis; immunotherapy

 Abstrak: Telah tersedia beberapa terapi umum kanker namun banyak pasien mengalami kekambuhan saat terapi. Oleh karena itu dibutuhkan pemahaman tentang patogenesis adenokarsinoma paru dalam terapi kanker paru khususnya terapi target. Imunoterapi dianggap sebagai teknologi yang memberikan harapan dan telah terbukti efektif dalam terapi berbagai tumor, termasuk non-small cell lung cancer (NSCLC). Penelitian ini bertujuan untuk menelaah morfologi, patogenesis, dan imunoterapi dari kanker paru tipe adenokarsinoma. Jenis penelitian ialah literature review menggunakan database Clinical Key, Pubmed, dan Google Scholar. Hasil penelitian mendapatkan morfologi adenokarsinoma paru ditandai adanya lesi yang terdiri dari beberapa spektrum morfologik, diawali dengan lesi preinvasif, selanjutnya lesi adenokarsinoma invasif minimal sampai adenokarsinoma invasif. Patogenesis adenokarsinoma paru berhubungan dengan perubahan genetik beberapa gen, yaitu EGFR, KRAS, ALK, dan ROS1; namun yang paling sering terlibat ialah EGFR, KRAS, dan ALK Imunoterapi yang digunakan untuk terapi adenokarsinoma paru ialah nivolumab, pembrolizumab, atezolizumab, tremelimumab, durvalumab, avelumab, cemiplimab, cetuximab, panitumumab, dan matuzumab; namun terbanyak digunakan ialah nivolumab, pembrolizumab, dan atezolizumab. Simpulan penelitian ini ialah spektrum morfologi dari adenokarsinoma paru berupa lesi preinvasif, adenokarsinoma invasif minimal, dan adenokarsinoma invasif. Patogenesis dari adenokarsinoma paru berhubungan dengan adanya perubahan genetik, terutama mutasi EGFR, KRAS, dan ALK. Imunoterapi yang paling banyak digunakan untuk terapi adenokarsinoma paru ialah nivolumab dan pembrolizumab yang termasuk dalam golongan antibodi PD-1 serta atezolizumab yang masuk dalam golongan antibodi PD-L1.

Kata kunci: morfologi adenokarsinoma paru; patogenesis; imunoterapi