Schiller J H
University of Wisconsin Hospital and Clinics, Madison, 53792, USA.
Oncology. 2001;61 Suppl 1:3-13. doi: 10.1159/000055386.
Lung cancer is the leading cause of cancer-related death in the United States, accounting for over 30% of cancer deaths in men and 25% in women. Small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) are uniformly aggressive tumors, with rates of regional or distant metastases at diagnosis as high as 70%. Because the majority of these tumors are unresectable, patients with relatively good performance status receive platinum-based chemotherapy. Although no treatment consensus exists, currently recommended regimens for SCLC include PE (cisplatin and etoposide), CAV (cyclophosphamide, doxorubicin, and vincristine), CAE (cyclophosphamide, doxorubicin, and etoposide), and CAVE (cyclophosphamide, doxorubicin, vincristine, and etoposide). Of these, the PE regimen has been widely accepted in the United States, although CE (carboplatin and etoposide) provides better tolerability. For NSCLC, standard chemotherapy regimens have included platinum-based therapy (cisplatin and a vinca alkaloid or PE). Data from recent studies suggest that the addition of paclitaxel to platinum modestly improves tumor response and survival in NSCLC. Although SCLC and NSCLC are both responsive to first-line chemotherapy, most patients relapse and die from their disease, with 5-year survival rates of approximately 15%. Given the disappointing survival rates associated with SCLC and NSCLC, the introduction of new cytotoxic agents has been eagerly anticipated. Evidence of improved response and extended survival is mounting for various combinations of established regimens (e.g., PE) with newer drugs exhibiting novel mechanisms of action and single-agent antitumor activity, such as gemcitabine, paclitaxel, docetaxel, vinorelbine, and topotecan. This article reviews the current standards of care in SCLC and NSCLC, and introduces the potential role of newer agents given in combination with standard chemotherapy.
肺癌是美国癌症相关死亡的主要原因，占男性癌症死亡人数的30%以上，女性的25%。小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC）均为侵袭性肿瘤，诊断时区域或远处转移率高达70%。由于这些肿瘤大多无法切除，身体状况相对较好的患者接受铂类化疗。尽管不存在治疗共识，但目前推荐的SCLC治疗方案包括PE（顺铂和依托泊苷）、CAV（环磷酰胺、多柔比星和长春新碱）、CAE（环磷酰胺、多柔比星和依托泊苷）和CAVE（环磷酰胺、多柔比星、长春新碱和依托泊苷）。其中，PE方案在美国已被广泛接受，尽管CE（卡铂和依托泊苷）耐受性更好。对于NSCLC，标准化疗方案包括铂类治疗（顺铂和长春花生物碱或PE）。近期研究数据表明，在铂类治疗中添加紫杉醇可适度改善NSCLC的肿瘤反应和生存率。尽管SCLC和NSCLC对一线化疗均有反应，但大多数患者会复发并死于该疾病，5年生存率约为15%。鉴于SCLC和NSCLC的生存率令人失望，人们一直热切期待引入新的细胞毒性药物。越来越多的证据表明，既定方案（如PE）与具有新作用机制和单药抗肿瘤活性的新药（如吉西他滨、紫杉醇、多西他赛、长春瑞滨和拓扑替康）的各种组合可改善反应并延长生存期。本文综述了SCLC和NSCLC目前的治疗标准，并介绍了新药与标准化疗联合使用的潜在作用。
