Okamoto H, Watanabe K
Division of Respiratory Medicine, Yokohama Municipal Citizen's Hospital.
Gan To Kagaku Ryoho. 2000 Jul;27(8):1097-104.
With the prolongation of life expectancy in Japan, lung cancer is increasing not only in the elderly but also in poor-risk patients who can not undergo standard chemotherapy. Because survival benefits from chemotherapy are clearly expected in patients with small-cell lung cancer (SCLC), standard chemotherapy should be established for the elderly as well as for poor-risk patients with SCLC. We recently reported that the combination of AUC-based carboplatin and a standard dose of intravenous etoposide was an active and relatively nontoxic regimen for elderly patients with SCLC (J Clin Oncol 17: 3540-3545, 1999). Had chemotherapy with concurrent chest irradiation been used for patients with limited disease (LD), better survival might have been achieved in this study. However, Pignon et al. reported that combined chemoradiotherapy in elderly patients with LD-SCLC is a possible poor prognostic factor in their meta-analysis. A recent randomized controlled clinical trial has shown that vinorelbine monotherapy contributed to longer survival in elderly patients with advanced non-small-cell lung cancer (NSCLC), compared to best supportive care. Several retrospective studies have shown that cisplatin can be safely and effectively administered to elderly patients who are eligible for protocol treatment. However, there have been no randomized trials indicating that cisplatin-based combination chemotherapy improves survival in elderly patients with advanced NSCLC, compared to single-agent chemotherapy. Similarly, the role of combined chemoradiotherapy remains controversial in elderly patients with locally advanced NSCLC. Thus, standard therapies proven to be beneficial to non-elderly patients with lung cancer have not always been proven to be beneficial to elderly patients. In order to solve these difficult problems, phase III studies are warranted in elderly or poor-risk patients with lung cancer. Moreover, new agents with relatively low toxicities recently approved in Japan should be applied in clinical trials for the elderly or poor-risk patients with lung cancer.
随着日本人均寿命的延长，肺癌不仅在老年人中发病率不断上升，在那些无法接受标准化化疗的高危患者中也是如此。由于小细胞肺癌（SCLC）患者显然有望从化疗中获得生存益处，因此应为老年SCLC患者以及高危患者确立标准化化疗方案。我们最近报告称，基于AUC的卡铂与标准剂量静脉注射依托泊苷联合使用，对于老年SCLC患者是一种有效的且相对无毒的治疗方案（《临床肿瘤学杂志》17: 3540 - 3545, 1999）。对于局限性疾病（LD）患者，如果采用化疗联合胸部放疗，本研究可能会取得更好的生存效果。然而，皮尼翁等人在他们的荟萃分析中报告称，老年LD - SCLC患者联合放化疗可能是一个不良预后因素。最近一项随机对照临床试验表明，与最佳支持治疗相比，长春瑞滨单药治疗可使老年晚期非小细胞肺癌（NSCLC）患者生存期延长。几项回顾性研究表明，对于符合方案治疗条件的老年患者，顺铂可以安全有效地给药。然而，尚无随机试验表明，与单药化疗相比，基于顺铂的联合化疗能提高老年晚期NSCLC患者的生存率。同样，联合放化疗在老年局部晚期NSCLC患者中的作用仍存在争议。因此，已被证明对非老年肺癌患者有益的标准治疗方法，并不总是被证明对老年患者有益。为了解决这些难题，有必要对老年或高危肺癌患者进行III期研究。此外，日本最近批准的毒性相对较低的新药应应用于老年或高危肺癌患者的临床试验。
