Chemotherapeutic management of stage IV non-small cell lung cancer
Chemotherapeutic management of stage IV non-small cell lung cancer
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DOI：
10.1378/chest.123.1_suppl.226s
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发表时间：
2003-01-01
期刊：
影响因子：
9.6
通讯作者：
Lilenbaum, R
中科院分区：
文献类型：
--
作者：
Socinski, MA;Morris, DE;Lilenbaum, R
IV期非小细胞肺癌（NSCLC）表示存在转移性疾病，并且使用目前的疗法在很大程度上无法治愈。化疗仍然是该患者人群的治疗选择，并且围绕其在IV期NSCLC患者中的使用存在许多相关问题。美国胸科医师学会肺癌指南委员会提出了11个问题，这些问题通过对现有文献的系统检索得到解决。讨论的问题包括确定预后因素，选择化疗患者和化疗提供的生存益处的关键分析。鉴于几种新的化疗药物的发展。在过去十年中，讨论了这些药物所产生的影响以及关于化疗方案的护理标准的定义。鉴于化疗并不代表治愈性选择，其他问题的解决是治疗的最佳持续时间以及其对症状缓解和生活质量的影响，二线治疗的作用，以及一线和二线化疗的预期结果。什么专业提供化疗的问题也得到了解决。一旦确定了数据，就进行了批判性分析，试图客观地描述数据，以支持对所提出的每一个问题的回答。我们认为，数据支持这样一个事实，即适当选择的患者受益于化疗的生存和姑息治疗的一线和二线设置。似乎在研究一线治疗持续时间的试验中，这种生存和姑息性获益发生较早，不适用于延长治疗。在这种情况下的治疗是具有成本效益的，有几种方案可以被认为是“标准护理”的选择。参与这些患者诊断的医生应该意识到化疗的潜在益处，允许他们根据临床试验数据向患者提供建议。此外，这一认识将使他们能够在适当时转诊给受过化疗管理和接受这种治疗的病人管理培训的医生。
Stage IV non-small cell lung cancer (NSCLC) denotes the presence of metastatic disease and is largely incurable using present-day therapies. Chemotherapy remains a therapeutic option in this patient population, and there are many pertinent issues surrounding its use in patients with stage IV NSCLC. Eleven questions were framed by the American College of Chest Physicians Lung Cancer Guidelines Committee, and these were addressed by a systematic search of the available literature. The issues addressed included the identification of prognostic factors in selecting patients for chemotherapy and a critical analysis of the survival benefit provided by chemotherapy. Given the development of several new chemotherapy agents. over the past decade, the impact that these agents have made was addressed as well as the definition of a standard of care regarding chemotherapeutic regimens. Given the fact that chemotherapy does not represent a curative option, other issues addressed were the optimal duration of treatment as well as its impact on symptom relief and quality of life, the role of second-line therapy, and the outcomes expectations from both first-line and second-line chemotherapy. The question of what specialty delivered the chemotherapy also was addressed. Once the data were identified, a critical analysis was undertaken attempting to objectively portray the data in support of answers for each of the questions posed. We believe the data support the fact that properly selected patients benefit from chemotherapy with regard to survival and palliation in both first-line and second-line settings. It appears that in trials addressing the duration of first-line therapy, this survival and palliative benefit occurs early, and prolonged therapy is not indicated. Therapy in this setting is cost-effective, and there are several regimens that can be considered to be "standard-of-care" options. Physicians involved in the diagnosis of these patients should be aware of the potential benefits of chemotherapy, allowing them to give recommendations to patients that are based on data derived from clinical trials. In addition, this awareness will allow them to make referrals, when appropriate, to physicians who are trained in the administration of chemotherapy and the management of patients undergoing such therapy.