Considerations for second-line therapy of non-small cell lung cancer
Considerations for second-line therapy of non-small cell lung cancer
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DOI：
10.1634/theoncologist.13-s1-28
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发表时间：
2008-01-01
期刊：
影响因子：
5.8
通讯作者：
Socinski, Mark A.
中科院分区：
文献类型：
--
作者：
Stinchcombe, Thomas E.;Socinski, Mark A.
对于功能状态良好的晚期非小细胞肺癌患者，含铂一线化疗可改善生活质量，减少疾病相关症状，提高生存率。在一线治疗中，与卡铂和紫杉醇相比，卡铂和紫杉醇加用贝伐珠单抗可产生更高的缓解率和更长的无进展生存期和总生存期。尽管有这些治疗，但所有患者都不可避免地经历疾病进展。目前有三种药物获批用于治疗在一种既往治疗方案后进展的患者：多西他赛、培美曲塞和厄洛替尼。厄洛替尼也适用于在两个先前方案后进展的患者。这些药物在反应和总生存期方面似乎具有相似的功效，但具有显著不同的毒性特征。目前，药物的选择取决于许多因素，包括患者的合并症、既往治疗的毒性、中性粒细胞减少症的风险、吸烟史和患者偏好。更好地了解二线治疗中的预后因素可能使临床医生能够更好地选择二线治疗的患者，并导致更好地设计二线试验。二线试验中体能状态良好的患者的中位生存期约为9个月，在治疗过程中可能接受两种二线治疗。几种新药在II期试验中显示出活性，将来可能作为单药或与现有药物联合纳入二线治疗。
For patients with advanced non-small cell lung cancer and a good functional status, platinum-based first-line chemotherapy improves quality of life, reduces disease-related symptoms, and improves survival. The addition of bevacizumab to carboplatin and paclitaxel in the first-line setting has been shown to produce a higher response rate and longer progression-free survival and overall survival times than with carboplatin and paclitaxel. Despite these therapies, all patients inevitably experience disease progression. There are currently three agents approved for treating patients who progress after one prior regimen: docetaxel, pemetrexed, and erlotinib. Erlotinib is also indicated for patients who progress after two prior regimens. These Agents appear to have similar efficacies in terms of response and overall survival, but have significantly different toxicity profiles. Currently, the choice of agent depends on a number of factors, including the patient's comorbidities, toxicity from previous treatments, the risk for neutropenia, smoking history, and patient preference. A better understanding of prognostic factors in the second-line setting may allow clinicians to better select patients for second-line therapy, and lead to better-designed second-line trials. Patients with a good performance status in second-line trials have a median survival duration of approximately 9 months, and may receive two second-line therapies during the course of their treatment. Several new agents have shown activity in phase II trials, and may be integrated into second-line therapy as single agents or in combination with current agents in the future.