Socinski Mark A, Baggstrom Maria Q, Hensing Thomas A
Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599-7305, USA.
Clin Adv Hematol Oncol. 2003 Jan;1(1):33-8.
Advanced, metastatic non-small-cell lung cancer (NSCLC) remains a challenge to oncologists. There is little doubt that platinum-based combination chemotherapy improves survival and has a palliative effect by improved patients' symptoms and quality of life. Yet chemotherapy is not curative, is associated with toxicity, and can be costly. In most recent phase III trials, the median survival time is 8 to 10 months. Therefore, the optimal duration of therapy-one that balances survival and palliative effects against toxicity, cost, and intrusiveness on patients' lives-remains an important issue. Three recent randomized trials that addressed this in stage IIIB/IV NSCLC are reviewed. Two evaluated brief durations of first-line therapy (3 cycles in one, 4 in the other) versus longer-duration therapy (6 cycles and continuous therapy, respectively). No benefit in response rate, symptom relief, quality of life, or survival was noted for the longer-duration therapy. In addition, cumulative toxicities occurred more frequently in patients who received longer treatment durations. The third trial administered 4 cycles of first-line platinum-based therapy and then randomized responding patients to observation or 6 months of further therapy with vinorelbine. No survival benefit was noted for vinorelbine. There trials suggest that duration of first-line therapy in advanced, metastatic NSCLC should be brief (3 to 4 cycles). Prolonged therapy does not appear to improve survival and carries the risk of cumulative toxicity. Second-line therapy considered in those patients fit enough to receive it at the time of disease progression.
晚期转移性非小细胞肺癌（NSCLC）仍然是肿瘤学家面临的一项挑战。毫无疑问，铂类联合化疗可提高生存率，并通过改善患者症状和生活质量起到姑息治疗的作用。然而，化疗无法治愈疾病，会产生毒性反应，且成本高昂。在最近的大多数III期试验中，中位生存时间为8至10个月。因此，最佳治疗时长——即在生存率、姑息治疗效果与毒性、成本以及对患者生活的干扰之间取得平衡——仍然是一个重要问题。本文将对最近三项针对IIIB/IV期NSCLC解决这一问题的随机试验进行综述。其中两项试验评估了一线治疗的短疗程（一项为3个周期，另一项为4个周期）与长疗程治疗（分别为6个周期和持续治疗）的效果对比。结果发现，长疗程治疗在缓解率、症状缓解、生活质量或生存率方面并无益处。此外，接受较长治疗疗程的患者累积毒性反应更为频繁。第三项试验给予4个周期的一线铂类治疗，然后将有反应的患者随机分为观察组或接受6个月长春瑞滨进一步治疗组。结果发现，长春瑞滨治疗组在生存率方面并无益处。这些试验表明，晚期转移性NSCLC的一线治疗疗程应简短（3至4个周期）。延长治疗似乎并不能提高生存率，反而会带来累积毒性的风险。对于那些在疾病进展时身体状况足以接受二线治疗的患者，可考虑进行二线治疗。
