Menene EGFR da Ciwon Cutar Kyau mai Kyau?

by Lynne Eldridge, MD

Gudanar da EGFR Ciwon Cutar Kyau

Mene ne maye gurbin EGFR kuma me ya sa yake da muhimmanci tare da ciwon huhu na huhu? Yaya aka gwada wannan gwada kuma ta yaya aka bi ta? Wanene yana da wani maye gurbin EGFR kuma menene ma'anar game da fitowar ku?

Bayani

Kwayar ciwon huhu na EGFR mai kyau tana nufin ƙwayar cutar huhu wanda ke gwada gwaji don maye gurbin EGFR. EGFR na tsaye ne ga mai karɓar mahaɗin ci gaba, wanda yake samuwa a jikin dukkanin kwayoyin cutar ciwon daji na jiki kamar kwayoyin cutar kanjamau.

Sauye-sauyen EGFR sun fi kowa a cikin mutane da ciwon huhu na huhu (wani nau'i na marasa ciwon ƙwayar cutar ciwon huhu,) yafi kowa tare da ciwon huhu a cikin masu shan taba , kuma sun fi kowa a cikin mata fiye da maza.

Wani maye gurbi a cikin jigilar kwayar halitta ga EGFR shine maye gurbin "mai aiki" wanda ya fi dacewa a tsakanin mutanen da ke fama da ciwon huhu na huhu, yana nufin cewa shi ne canjin yanayi wanda yafi dacewa wanda akwai maganin da ke samuwa wanda ke kai tsaye ga kwayoyin cutar kanjamau. An cigaba da ci gaba mai girma a cikin maganin ciwon huhu na huhu tare da wannan bayanin kwayoyin halitta a cikin 'yan shekarun nan. Da farko tare da amincewa da Iressa (gefitinib) a shekara ta 2003-a lokacin da ba mu fahimta game da EGFR ba - kusan rabin sabbin magunguna da aka yarda don maganin cutar kanjamau a matsayin 2016 magance wannan bayanin kwayoyin.

Mene ne Mutuwa na EGFR?

Hanya na EGFR yana nufin maye gurbin (lalacewa) zuwa sashi na DNA a cikin kwayar cutar ciwon huhu na huhu wanda ke dauke da "girke-girke" don yin EGFR (protector factor growth factor receptor).

Tsarin kowane ɗayan jikinmu ya ƙunshi DNA, wanda daga bisani ya kasance daga kwayoyin halitta. Waɗannan kwayoyin suna aiki ne a matsayin tsari na dukkanin sunadaran da aka samar a cikin jikin mu. A takaice dai, kwayoyinmu suna kama da kalmomi a cikin jagorancin jagora wanda ke kwatanta yadda za a gina dukkanin kayan jikinmu.

Wasu daga cikin sunadarin sunadaran da aka yi amfani da wadannan umarnin kwayoyin sun hada da aiwatar da daidaita tsarin girma da rabuwa da kwayoyin halitta.

Lokacin da jinsin da ke ɗaukar umarnin don ƙirƙirar EGFR ya lalace-an canza shi-an fassara shi zuwa sunadarai masu ciwo.

a wannan yanayin, sunadarin sunadarai mai karuwa mai ciwo (EGFR). Wadannan sunadarin sunadarai, su biyun, suna yin aiki na "mummunan" a cikin daidaita yanayin ci gaban tantanin halitta. Akwai hanyoyi daban-daban da za a iya canza wannan jigilar (duba ƙasa).

Menene Gaskiya ne EGFR?

Kwayoyinmu suna da antigens da yawa (sunadaran sunadarai) akan farfajiya. EGFR (mai karɓar ragowar mai cikewar epidermal) yana daya daga cikin wadannan sunadarin sunadarai da aka samuwa a kan sassan kwayoyin cututtuka da kuma kwayoyin halitta. Ana iya tunanin EGFR azaman haske. Lokacin da wasu ci gaba (a wannan yanayin tyrosine kinases) hade zuwa EGFR a bayan tantanin tantanin halitta, yana haifar da siginar da aka aika zuwa tsakiya na tantanin halitta yana fadada shi don yayi girma da rabawa.

A cikin wasu kwayoyin cututtuka, wannan furotin yana nunawa. Sakamakon ya kasance analogous zuwa haɓakar haske wanda aka bar a cikin matsayi "on", yana gaya wa tantanin halitta don ci gaba da girma da rabawa har ma lokacin da ya kamata a dakatar da shi. Ta wannan hanyar, maye gurbin EGFR wani lokaci ana kiransa "maye gurbin kunnawa."

Yanzu muna da maganin magunguna-masu cin zarafi-tyrosine kinase-wanda "musamman" ke dauke da wannan furotin a wasu kwayoyin cututtuka.

Wadannan kwayoyi sun lalata sakonni da suke tafiya zuwa cikin tantanin halitta, kuma ci gaban tantanin halitta yana dakatar.

Hadarin Faɗakarwa da Yanayi

An maye gurbin EGFR a cikin kashi 15 cikin dari na mutanen da ke fama da ciwon huhu a cikin Amurka, ko da yake wannan lamarin yana ƙaruwa zuwa kashi 35 zuwa 50 cikin mutanen gabashin Asiya.

An samo mafi yawanci a cikin mutane tare da irin ƙwayar cutar ciwon huhu da baƙar fata da ake kira huhu mai adinocarcinoma ba. (Wadannan magunguna kuma ana kiransa "marasa ciwon ƙwayar cutar ciwon huhu a cikin ƙananan ƙwayoyin cutar.) A halin yanzu kimanin kashi 85 cikin dari na cutar ciwon huhu ne marasa ciwon ƙwayar cuta, kuma daga cikin wadannan, fiye da kashi 50 cikin dari ne adenocarcinomas.

Sakamakon EGFR sune:

Yafi kowa a cikin mata fiye da maza. (Akwai wasu bambance-bambance daban-daban tsakanin ciwon daji na huhu a cikin mata da cutar kanjamau a cikin maza ,)
Yawanci a cikin mutane da ciwon huhu adenocarcinoma (amma ana iya samuwa a cikin mutane tare da wasu subtypes na ciwon daji na kananan ƙananan ciwon huhu.)
Sau da yawa ana samun su a cikin taba taba shan taba ko mutane da suke kyafaffi kawai. (Ba wanda ya taba shan taba shine wanda ya taba shan taba 100 ko mota cigaba a rayuwarsu.) Yayinda kashi 15 cikin 100 na huhu na warkad da ciwon baki na EGFR, ƙwayar cutar huhu a wadanda ba su taba shan taba ba zasu iya samun wannan maye gurbin.
Yafi kowa a cikin yara masu fama da ciwon huhu na huhu. (Rabagin EGFR sun kasance a cikin kashi 50 cikin 100 na cutar ciwon huhu a cikin matasa .)
Shin mafi yawan al'ada a Asians, musamman ma mutanen gabashin Asiya.
Mafi yawancin 'yan Afirka na Amirka fiye da Caucasians.

Gene Testing

An yanzu shawarar hakan duk wanda ke da ƙananan ciwon huhu na mahaifa - musamman adenocarcinoma na huhu - suna da labarun kwayoyin (gwajin gwaji) a kan ciwon sukari don neman bayyanuwar cututtukan kwayoyin cutar a cikin kwayoyin cutar kanjamau.

Zai iya zama da damuwa a ji game da maye gurbin mutun a cikin kwayoyin cutar Kanada tare da duk maganganu game da kwayoyin cutar da ciwon nono. Ya bambanta da maye gurbin maye gurbi, waɗanda kuke ɗaukar daga haihuwa, duk da haka, maye gurbin da aka samu tare da kamfurori na kwayoyin halitta samfurori (maye gurbin maye gurbin.) Wadannan maye gurbi ba su kasance ba a lokacin haihuwar amma ci gaba daga rayuwa a cikin tsarin tantanin halitta zama kwayar cutar ciwon daji.

Ciwon daji zai iya samun maye gurbin da yawa, amma kawai wasu daga cikin su suna da hannu cikin tsarin ciwon daji. Wadannan maye gurbi sun haifar da samar da sunadarai masu haɗari wanda ke jagorantar ci gaba da ci gaba da kwayar cutar ciwon daji. Wadannan sunadarin sunadarai sune "girma da yaduwar cutar ciwon daji kuma sabili da haka maye gurbin kwayoyin da ke da alhakin samar da su ana kiransa" gurbatawa. " Wasu, amma ba dukan '' maye gurbin '' '' su ne ma'anar maye gurbi 'ko' 'maye gurbi' 'wanda ke nufin gaskiyar cewa magani zai iya amfani dasu.

Ana kiyasta cewa maye gurbi yana cikin kashi 60 cikin dari na mutanen da ke fama da cutar adinocarcinoma, kuma wannan adadin, da kuma maye gurbin kamuwa da wasu cututtukan ciwon huhu na huhu, ana sa ran girma kamar yadda fahimtar mu akan ilmin halitta na ciwon daji. Kayan gyaran direbobi na yau da kullum sun haɗa da:

EGFR maye gurbin
ALK sake fasalin
ROS1 canje-canje
MET amplifications
Karshen KRAS
Hanyoyin maye gurbin HER2

Domin yawancin wadannan halayen, an riga an samo asibiti. Wadannan magunguna suna cike da kwayar cutar ciwon daji musamman kuma suna da nau'ikan illa mafi yawa fiye da kwayoyi masu ilimin chemotherapy -kwayoyi wadanda ke da mahimmancin kwayoyin halitta.

Bugu da ƙari, gwaji na asibiti yana cikin wuri don wasu nau'ikan maye gurbi da canji na kwayoyin da kuma daban-daban na ciwon huhu na huhu. Gaba ɗaya, mutane ba sa yawanci fiye da ɗaya daga cikin waɗannan maye gurbin. Alal misali, yana da wuya (amma ba zai yiwu ba) ga wani tare da maye gurbin EGFR har ila yau yana da maye gurbin ALK ko maye gurbin KRAS a cikin kwayar cutar kanjamau.

Sanin asali

Biopsy nama

Domin gwada gwaje-gwajen da za a yi, za a samo samfurin tumarka. Yawancin lokaci, gwaji yana buƙatar samfurin nama wanda aka samu a yayin da yake jikin kwayar halitta . Wannan na iya yin ta ta hanyar allurar magunguna, a lokacin da yake da ƙwayar jiki, ko kuma ta hanyar kwayar halitta. Wasu lokuta ana gwada gwajin akan ƙwayar da aka cire gaba daya yayin aikin tiyata.

Liquid Biopsy

A Yuni na shekarar 2016, an amince da sabon gwaji na biopsy don ganewa maye gurbin EGFR. Ba kamar sauran kwayoyin halittu ba, wadanda za a iya gwada wannan gwaji ta hanyar gwajin jini. A halin yanzu, wadannan gwaje-gwaje har yanzu suna binciken bincike kuma ba'a amfani dashi kadai don jagorancin ganewar asali da kuma maganin cutar kanjamau, amma yana ba da alkawarin da yawa. Ana fatan cewa wadannan gwaje-gwaje za su ba da damar yin la'akari da mutanen da ke fama da ciwon huhu na EGFR a ainihin lokaci a nan gaba. A halin yanzu, mun sani kawai ƙwayar cutar ta zama tsayayya ga jiyya wanda ke sa ido ga EGFR lokacin da bai kasa amsa ba (fara girma ko yada) a kan yatsan huhu. Liquid biopsies zai ba likitoci damar da za su koyi ƙwayar cuta ya zama mai tsayayya - sabili da haka canzawa zuwa farfadowa mafi mahimmanci-da sauri fiye da yanzu ya yiwu.

Canje-canjen Halitta a Ciwon Kankara

Don ƙarin fahimtar labarun kwayoyin da kuma magance hanyoyin maganin cutar kanjamau, yana da taimako wajen ƙayyade wasu ka'idojin kwayoyin halitta. Akwai nau'i daban-daban na canjin yanayi wanda zai iya faruwa a cikin kwayoyin cutar kanjamau. Wadannan sun haɗa da:

Sauyawa - Sauyawa shine canji a cikin jerin DNA wanda ya haifar da wata halitta.
Shirye-shiryen - A cikin sake dawowa, an tsara DNA jerin.
Canje-canje - Wadannan canje-canje sun faru yayin da ɓangare na gwargwadon kwayar halitta guda daya aka koma zuwa wani yanki na DNA.
Gene fusion - Rashin "fusion" yakan faru ne yayin da wani fasalin ya hada kwayoyin halitta guda biyu wadanda ba a hada ɗaya ba.
Ƙarfafawa yana nufin samar da takardun yawa daga jinsin kuma yana da yawa a cikin kwayoyin cutar ciwon daji.

Akwai kuma bambancin daban-daban. Wasu daga cikin waɗannan, sau ɗaya, sun haɗa da:

Ƙaryawar layi - Matsayin ma'ana yana nufin maye gurbin wanda aka sauya wani tushe ga wani.
Deletions - A sharewa, wani abu na kwayoyin halitta ya ɓata ko kuma an cire shi daga jinsin
Insertions - A cikin shigarwa, an sanya wani abu na kwayoyin kara zuwa ginin.

Iri

Sake maye gurbin EGFR baya nufin wani nau'in mahaukaci guda daya. Maimakon haka, akwai nau'i daban-daban na maye gurbin EGFR wanda ya bambanta da nau'i na maye gurbin (kamar yadda aka bayyana a sama) kuma a cikin wurin da maye gurbi a cikin wani jigon. A wasu kalmomi, akwai hanyoyi da dama da za a iya canza EGFR na jinsi

Komawa a cikin EGFR na iya faruwa a wurare daban-daban a kan exon 18 zuwa 21. Sauye-sauye na EGFR mafi yawan (kimanin kashi 90) sune ko dai exon 19 halaye (ɓataccen abu) ko exon 21 L858 batu. (Dubi T790 maye gurbin da ke ƙasa wanda sau da yawa yakan faru tare da juriya.)

Jiyya

A halin yanzu akwai magunguna guda uku masu FDA waɗanda aka samo don magance EGFR kyamin adenocarcinoma mai kyau, da kuma daya don ƙwayar cutar kwayar fata kuma daya ga cutar EGFR tabbatacciyar rigakafi. Wadannan magunguna suna kiransa tyrancin kinase. Suna lalata ayyukan da aka gina na EGFR.

Magungunan maganin likitanci na adenocarcinoma sun hada da:

Tarceva (erlotinib)
Gilotrif (afatinib)
Iressa (gefitinib)

Magunguna da aka amince da su don maye gurbin T790 sun haɗa da:

Tagrisso (osimertinib)

Kuna iya jin magungunan likitancinku game da "tsara" daga cikin wadannan kwayoyi. Tarceva mai tsarawa na EGFR na farko, Gilotrif shine ƙarni na biyu, da kuma Tagrisso, mai tsarawa na EGFR na uku.

EGFR Masu hanawa don Lung Adenocarcinoma

Da magunguna guda uku suna samuwa na farko na EGFR mai kyau adenocarcinoma, ta yaya likitoci suka zaba wane daga cikin masu hana masu ciwon tyrosine kinase zai iya aiki mafi kyau don ciwon daji na musamman?

Zaɓin wani maƙallacin EGFR mai mahimmanci ya dogara ne akan aikin likitan ka (da kuma wurinka) Akwai wasu ƙananan bambance-bambance. Iressa yana da suna na ciwon ƙananan cututtukan sakamako kuma ana iya la'akari da ita na farko don wani tare da wasu magunguna magunguna ko tsofaffi. Sabanin haka, Gilotrif yana iya samun sakamako mafi girma (musamman maƙarƙashiya) amma kuma yana iya samun yawan amfanin rayuwa gaba ɗaya. Gilotrif zai iya yin aiki kadan ga mutane tare da nisawa 19 na sharewa. Akwai, duk da haka, wasu dalilai masu yawa wadanda likitanku zasu so suyi la'akari da ciwon daji na musamman.

EGFR da ƙwayoyin ƙwayoyin ƙwayoyin cuta mai kwakwalwa

Hanyar hanyar EGFR ma za a iya niyya ga mutanen da ke dauke da kwayar cutar kwayar cutar ta jiki wanda ba sa da maye gurbin EGFR, amma ta hanyar daban daban.

Maimakon maye gurbin EGFR yana motsa wadannan ciwon daji, ci gaba yana da alaka da ƙaramar EGFR . Kuma maimakon yin amfani da magunguna na tyrosine kinase don ƙaddamar da maye gurbin EGFR, maganin anti-EGFR wani nau'i ne na magungunan da ake amfani dashi ga EGFR a waje na tantanin halitta (a cikin cututtukan da ba su da maye gurbin EGFR) don katse hanyar sigina.

An amince da Portrazza (necitumumab) a shekara ta 2015 tare da chemotherapy ga mutanen da ke dauke da kwayar cutar ta jiki wanda ba a samu ba kafin magani. Portrazza wata ƙungiya ne mai rikici ta mutum (wanda aka sanya mutum) wanda ya kaddamar da aikin EGFR. Anti-EGFR maganin maganin rigakafi-irin su magungunan Erbitux (cetuximab) da Vectibix (panitumumab) - an yi amfani da su tare da sauran magunguna.

Ba kamar magungunan da ake amfani da su ba don maganin adenocarcinoma sama da aka ba da baki, an ba da magungunan magani na EGFR na Portrazza a cikin intravenously.

Resistance zuwa jiyya

Abin takaici, kodayake ƙwayoyin cutar ta iya amsawa sosai ga magungunan tyrosine kinase a farkon, kusan kusan sau da yawa suna yin rikici a tsawon lokaci. Yawan lokaci kafin juriya tasowa, duk da haka, zai iya bambanta sosai. Duk da yake lokacin tsakiyar tsakanin farfasa da ci gaban juriya shine watanni 9 zuwa 13, wadannan magunguna sun kasance masu tasiri ga wasu mutane shekaru da yawa.

A halin yanzu, yawanci muna gano cewa ciwon sukari ya zama mai tsayuwa lokacin da ya fara girma ko kuma yada. Kwayoyin kwayoyin halitta, wanda aka biyo bayan wallafe-wallafen kwayoyin ana yin sau da yawa a wannan lokacin. Kamar yadda aka gani a sama, ana sa ran cewa biopsies na ruwa zasu zama hanyar gano lokacin da tsutsa ya zama mai karfi a nan gaba.

Jiyya na Dama EGFR Ciwon Cutar Kyau

Kamar yadda akwai nau'i daban-daban na maye gurbin EGFR, akwai hanyoyi da dama wanda cutar ta iya zama mai karfi. Ciwon magungunan ƙwayoyin yana canzawa koyaushe, kuma sukan bunkasa maye gurbi wanda zai sa suyi tsayayya da kwayoyi da ake amfani dashi.

A cikin rabin mutane, maye gurbi na biyu-an cire nisa 20 da ake kira EGFR T790. Wannan maye gurbi ne na yankin EGFR wanda magunguna na tyrosine kinase na farko da na biyu (irin su Tarceva) suka ɗauka, yin dukkanin magunguna guda uku (Tarceva, Gilotrif, da Iressa) ba su da amfani. Ga wadanda ke da magungunan cutar ta EGFR T790 marasa lafiya, kwayoyin Tagrisso ko AZD9291 (osimertinib) sun yarda. Duk da haka, kamar yadda juriya ta tasowa tare da magunguna na farko, samuwar juriya na iya bunkasa zuwa magunguna na uku na masu cin zarafin tyrosine kinase. Da fatan, za a ci gaba da yin amfani da kwayoyi don maganin kututtuka, don haka mutane da yawa za su iya rayuwa tare da ciwon huhu na huhu kamar yadda cutar ta ciwo-ba a warke ba, amma ana sarrafawa tare da waɗannan magunguna.

Hanya zuwa Bra a Metastases

Abin takaici, saboda kasancewa da yaduwar kwakwalwa ta jini-wani yanki na ƙuƙwalwar ƙwayoyin da ke cikin kwakwalwa-yawancin wadannan magunguna ba su iya isa ga kwayoyin cutar ciwon da ke tafiya zuwa kwakwalwa. An tsara katangar jini-kwakwalwa don ƙayyadad da ikon yin guba don samun dama ga kwakwalwa, amma rashin alheri, yakan hana chemotherapy da kuma magance hanyoyin kwantar da hankali har zuwa kwakwalwa. Tun da ciwon huhu na huhu yana da hali don yadawa zuwa kwakwalwa, wannan matsala ce ga wadanda ke fama da ciwon huhu tare da kwakwalwar ƙwayar cuta .

Wani magani a halin yanzu anyi nazari a gwaji - AZD3759 an tsara shi don shiga cikin shinge na kwakwalwar jini, kuma ana fatan cewa wannan magani, ko kuma wasu da aka kimantawa, na iya taimakawa wadanda ke da maye gurbin EGFR da ciwon huhu na huhu wanda ke da ƙwayar ƙwayar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta .

Hanyoyin Kiwon Lafiya

Sakamakon mafi rinjaye na maɓallin tyrosine kinase, wanda yake a cikin kimanin kashi 80 cikin dari na mutane, fataccen fata ne. Kadan sau da yawa, zazzaɓi yana iya faruwa.

Tarceva (erlotinib) fatar jiki (da kuma rashes daga sauran masu hana masu cin hanci da ciwon tyrosine kinase) suna kama da kuraje, yana faruwa akan fuska, kirji na sama, da baya. Dangane da ɓangaren raguwa, idan babu kawuna masu farin ciki, ana amfani da cream corticosteroid (mai amfani da hydrocortisone, alal misali). Idan farin fari sun kasance kuma mummunan ya kamu da cutar, ana amfani da maganin rigakafin maganin maganin. Wasu daga cikin lokutan shan magani na magunguna zasu buƙaci ragewa.

Gwaji na Clinical

Kamar yadda muka gani a baya, an samu ci gaba sosai a tantance ganewar maye gurbin kwayoyin cutar tare da ciwon huhu na huhu da kuma magance hanyoyin magance waɗannan canje-canje. Akwai gwaje-gwaje da yawa a halin yanzu a wurin neman wasu magunguna don magance cututtukan EGFR da ciwon huhu na huhu, da magunguna ga sauran kwayoyin canzawa a cikin kwayoyin cututtuka.

A cewar Cibiyar Cancer ta Cibiyar Cancer, mutanen da ke fama da ciwon huhu ya kamata suyi la'akari da shiga cikin gwaji na asibiti. Yawancin magunguna da ake amfani da su yanzu suna samuwa a matsayin wani ɓangare na gwaji na asibiti kaɗan kawai. Da dama daga cikin kungiyoyin ciwon daji na huhu sunyi aiki tare don samar da cutar kwakwalwa ta hanyar kwantar da hankula ga duk wanda ke fama da ciwon huhu na huhu. Ta hanyar wannan sabis na kyauta, likitoci na iya dace da cutar ciwon huhu na musamman a gwajin gwaji na faruwa a ko ina cikin duniya.

Taimako da Kwafi

Idan kwanan nan an gano ku da ciwon huhu na huhu, kuna yin daya daga cikin mafi kyawun abubuwan da za ku iya yi-shan lokaci don koyi game da ciwon daji. Ga wasu matakai akan yadda za'a samu bayanan ciwon daji a kan layi, kazalika da wasu matakai na farko da za a dauka lokacin da aka saba gano ka .

Bugu da ƙari, koyo game da ciwon daji, koyon yadda za a yi wa kanka shawara a matsayin mai ciwon daji yana nuna bambanci ga mutane da yawa. Yayinda kayi amfani da ribbons mai launin ruwan sama fiye da fararen kwakwalwa na huhu, ƙwayar cutar ciwon daji na ciwon huhu, yana da ƙarfi kuma yana samun karfi. Mutane da yawa suna taimakawa wajen shiga kungiyoyi masu goyon baya da al'ummomi ba kawai a matsayin hanyar neman taimako daga wanda ya "kasance a can" amma a matsayin hanya na kasancewa tare da sabon bincike game da cutar.

Sarkar-da kuma godiya ga ciwon rayuwa - domin ciwon daji na huhu yana inganta, kuma akwai bege mai yawa. Akwai sababbin jiyya da aka amince da su tsakanin 2011 da 2015 fiye da shekaru 40 da suka gabata kafin 2015. Duk da haka, ciwon daji shine marathon, ba burin ba. Idan kana shan maganin ciwon daji, ziyarci iyalinka da abokai kuma ka ba su damar taimaka maka. Tsayawa cikin halin kirki da ciwon daji yana taimakawa a wasu lokuta, amma ka tabbata kana da wasu abokan ka da za ka iya buɗewa tare da bayyana furcinka maras kyau da jin tsoro. Idan dan kaunataccen wanda aka gano, duba wannan tunanin akan abin da yake son zama tare da ciwon daji .

_Sources:

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_{Tan, C., Cho, B., da R. Soo.} _{Ci gaba mai girma epidermal girma factor mai karɓar maganin tyrosine kinase a cikin epidermal girma factor mai karbi-mai amfani da kananan kwayar cutar ciwon huhu.} _{Lung Cancer .} _{2016. 93: 59-68.}

_{Tan, D., Yom, S., Tsao, M. et al.} _{Ƙungiyar Ƙungiyar Kasashen Duniya don Nazarin Ciwon Kwayoyin Cutar Canjin Kwayar Kwayar Cutar Kwayar Cutar Kwayoyin Tsarin Kwayar cutar Kanjamau ta yadda za a gudanar da gyare-gyare na maye gurbin EGFR marasa ciwon ƙwayar cutar ciwon ƙwayar cutar ta kananan yara: matsayin a 2016} _{Jaridar Thoracic Oncology .} _{2016 Mayu 20. (Epub gaba da bugu).}

_{Cibiyar Cancer Vanderbilt.} _{MyCancerGenome.org.} _{EGFR a Ciwon Ƙwayar Ciwon Tsuntsar Ƙwayar Ƙananan Ƙananan (NSCLC).} _{Updated 06/18/15.} _{https://www.mycancergenome.org/content/disease/lung-cancer/egfr/}