Bunn P A
University of Colorado Cancer Center, Denver 80262, USA.
Semin Oncol. 1999 Feb;26(1 Suppl 4):25-30.
Cisplatin-based chemotherapy regimens were shown to prolong survival, relieve symptoms, and improve quality of life in a cost-effective manner in patients with advanced non-small cell lung cancer. New chemotherapeutic agents introduced in the 1990s, such as gemcitabine, paclitaxel, docetaxel, vinorelbine, and irinotecan, were shown to be as effective or more effective than cisplatin. The doublet combination of these new agents with cisplatin or carboplatin was more active than either as single agents, and randomized trials showed that new combinations such as gemcitabine/ cisplatin, vinorelbine/cisplatin, and paclitaxel/cisplatin were preferred to cisplatin alone or to etoposide/cisplatin. Gemcitabine has a mild toxicity profile that allows it to be combined easily in triplet combinations with other doublets. Phase I-II trials of such triplet combinations show that each drug can be given safely in full dosage. Preliminary efficacy results of these gemcitabine-based triplet combinations are encouraging. Randomized trials comparing triplets such as gemcitabine/paclitaxel/carboplatin with the corresponding doublets are indicated.
在晚期非小细胞肺癌患者中，以顺铂为基础的化疗方案已被证明能以具有成本效益的方式延长生存期、缓解症状并提高生活质量。20世纪90年代引入的新化疗药物，如吉西他滨、紫杉醇、多西他赛、长春瑞滨和伊立替康，已被证明与顺铂一样有效或更有效。这些新药与顺铂或卡铂的双联组合比单药更具活性，随机试验表明，吉西他滨/顺铂、长春瑞滨/顺铂和紫杉醇/顺铂等新组合比单独使用顺铂或依托泊苷/顺铂更受青睐。吉西他滨的毒性较轻，使其易于与其他双联组合形成三联组合。此类三联组合的I-II期试验表明，每种药物都可以全剂量安全给药。这些以吉西他滨为基础的三联组合的初步疗效结果令人鼓舞。有必要进行随机试验，比较吉西他滨/紫杉醇/卡铂等三联组合与相应双联组合的疗效。
