Devlin John G, Langer Corey J
Division of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Clin Adv Hematol Oncol. 2007 Mar;5(3):216-33.
Patients with non-small cell lung cancer,NSCLC, typically have advanced disease on presentation. First-line palliative platinum-based doublet chemotherapy has emerged as the standard of care in fit, younger patients. However, patients with advanced age and/or impaired performance status have been relatively underrepresented in clinical trials. Retrospective analyses and the few existing prospective randomized trials in these populations have suggested a poorer overall prognosis, yet also provide evidence of benefit from systemic therapy. Toxicity is generally manageable, and in most cases, comparable to that of younger, healthier patients. There are clearly expanding roles for nonplatinum chemotherapy agents and newer targeted therapies, which have generally yielded decreased toxicity compared to platinum-based chemotherapy without sacrificing efficacy. Appropriate pretreatment assessment and proper patient selection is of paramount importance; it is imperative to treat patients who are most likely to garner benefit. In summary, data suggest that these relatively neglected populations of NSCLC patients can be safely treated, and can benefit from palliative systemic therapy. Single-agent chemotherapy is generally recommended over combination chemotherapy, although investigation of newer targeted therapies or alternative agents may allow for combination therapy in the near future. Further prospective investigation is absolutely warranted.
非小细胞肺癌（NSCLC）患者通常在确诊时就已处于疾病晚期。一线姑息性铂类双联化疗已成为适合的年轻患者的标准治疗方案。然而，年龄较大和/或体能状态较差的患者在临床试验中的代表性相对不足。对这些人群的回顾性分析以及少数现有的前瞻性随机试验表明，总体预后较差，但也提供了全身治疗有益的证据。毒性通常是可控的，在大多数情况下，与年轻、健康的患者相当。非铂类化疗药物和更新的靶向治疗的作用显然在不断扩大，与铂类化疗相比，它们通常在不牺牲疗效的情况下降低了毒性。适当的预处理评估和正确的患者选择至关重要；必须治疗最有可能获益的患者。总之，数据表明，这些相对被忽视的NSCLC患者群体可以得到安全治疗，并能从姑息性全身治疗中获益。一般推荐单药化疗而非联合化疗，不过对更新的靶向治疗或替代药物的研究可能在不久的将来允许进行联合治疗。绝对有必要进行进一步的前瞻性研究。
