New chemotherapeutic agents prolong survival and improve quality of life in non-small cell lung cancer: a review of the literature and future directions.
New chemotherapeutic agents prolong survival and improve quality of life in non-small cell lung cancer: a review of the literature and future directions.
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发表时间：
1998-05
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通讯作者：
P. Bunn;K. Kelly
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作者：
P. Bunn;K. Kelly
在过去的几年里，人们对化疗在非小细胞肺癌中的作用持相当悲观的态度。这种悲观情绪很大程度上源于以下事实：基于烷化剂的疗法会缩短生存期并产生严重的副作用。这一点尤其重要，因为绝大多数患者（约 85%）在病程中会出现转移性疾病。 20 世纪 80 年代的随机试验表明，基于顺铂的化疗可以提高患者的生存率，改善患者评估的生活质量，并缓解大多数有症状患者的症状。当化疗在门诊进行时，实际上降低了晚期患者的总护理费用。 20 世纪 90 年代，五种新药，包括两种紫杉烷类药物（紫杉醇、多西紫杉醇）、吉西他滨、长春滨和伊立替康，在 II 期试验中显示，与顺铂或卡铂相比，可产生更高的缓解率和更长的生存期。在随机试验中，与单独使用顺铂或与依托泊苷联用相比，紫杉醇、吉西他滨和长春瑞滨与顺铂的组合可改善晚期患者的生存率。与基于顺铂的治疗相比，新药的毒性特征也有利。早期阶段的初步结果也令人鼓舞。因此，目前对体能状态良好的非小细胞肺癌患者进行化疗可以将生存率提高到与其他实体瘤（例如小细胞肺癌和乳腺癌）相似的程度。
In past years, there has been considerable pessimism over the role of chemotherapy in non-small cell lung cancers. The pessimism was largely derived from the fact that alkylating agent-based therapies shortened survival and produced severe side effects. This was especially important because the vast majority of patients (approximately 85%) develop metastatic disease during their course. Randomized trials from the 1980s showed that cisplatin-based chemotherapy improved patient survival, improved quality of life as assessed by the patients, and relieved symptoms in the majority of symptomatic patients. When chemotherapy was administered on an outpatient basis, it actually lowered the total patient care costs for advanced stage patients. In the 1990s, five new agents, including two taxanes (paclitaxel, docetaxel), gemcitabine, navelbine, and irinotecan, were shown to produce higher response rates and longer survival in Phase II trials compared to cisplatin or carboplatin. In randomized trials, combinations of paclitaxel, gemcitabine, and vinorelbine with cisplatin improved the survival of advanced stage patients compared to cisplatin alone or in combination with etoposide. The toxicity profile of the new agents is also favorable compared to cisplatin-based therapy. Preliminary results in earlier stages are also encouraging. Thus, currently available chemotherapy given to non-small cell lung cancer patients with good performance status can improve survival to a similar extent as other solid tumors, such as small cell lung cancer and breast cancer.