Dooms Christophe A, Pat Karin E, Vansteenkiste Johan F
University Hospital Gasthuisberg, Respiratory Oncology Unit, Dept of Pulmonology, Herestraat 49, B-3000 Leuven, Belgium.
Expert Rev Anticancer Ther. 2006 Apr;6(4):531-44. doi: 10.1586/14737140.6.4.531.
Differences in survival outcomes with various treatments for advanced non-small cell lung cancer are very modest. Despite this, end points looking at the patients' subjective benefit, such as symptom control, quality of life or clinical benefit, have only been sparsely implemented into clinical trials as primary points of interest. This review focuses on available evidence regarding these patients' subjective end points in recent clinical trials. Compared with best supportive care, chemotherapy offers symptom control, not only in patients with objective response to chemotherapy, but also in a proportion of patients with disease stabilization. However, interpretation of quality-of-life objectives is more difficult, owing to several methodological problems, but improvement in various domains of quality of life is also reported. Different treatment options, such as older platinum-based schedules, modern platinum-based doublets, single-agent treatment with a new drug or nonplatinum-based doublets, are comprehensively reviewed. Future randomized studies should take up the challenge of looking at the patients' benefit as a primary end point.
对于晚期非小细胞肺癌，各种治疗方法在生存结果上的差异非常小。尽管如此，诸如症状控制、生活质量或临床获益等关注患者主观获益的终点指标，在临床试验中仅被少量作为主要关注点采用。本综述聚焦于近期临床试验中有关这些患者主观终点指标的现有证据。与最佳支持治疗相比，化疗不仅能使对化疗有客观反应的患者症状得到控制，也能使一部分疾病稳定的患者症状得到控制。然而，由于一些方法学问题，生活质量目标的解读更为困难，但也有报告称生活质量的各个领域有所改善。对不同的治疗方案，如传统铂类方案、现代铂类双联方案、新药单药治疗或非铂类双联方案进行了全面综述。未来的随机研究应迎接挑战，将患者获益作为主要终点指标进行研究。
