Socinski Mark A, Crowell Richard, Hensing Thomas E, Langer Corey J, Lilenbaum Rogerio, Sandler Alan B, Morris David
Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7305, Chapel Hill, NC 27599, USA.
Chest. 2007 Sep;132(3 Suppl):277S-289S. doi: 10.1378/chest.07-1381.
Stage IV non-small cell lung cancer (NSCLC) remains a treatable but incurable disease.
A MEDLINE search was performed to identify pertinent peer-reviewed articles that addressed the questions posed for this section. The writing committee developed and graded recommendations, which were subsequently approved by the American College of Chest Physicians.
Platinum-based doublets remain the standard of care in patients with good performance status (PS); there is no evidence that the addition of a third cytotoxic agent improves survival. Likewise, with only one exception, the addition of a new targeted or biological agent to platinum-based doublets does not improve survival. The one exception is the addition of bevacizumab, an antiangiogenic agent, to carboplatin/paclitaxel in patients with stage IV disease and good PS. Patients for whom bevacizumab is recommended must also be selected on the basis of histology (nonsquamous), absence of brain metastases and hemoptysis, and no indication for therapeutic anticoagulation. In patients with stage IV NSCLC and PS of 2, chemotherapy is recommended, but the optimal approach has not been defined. Elderly patients, defined as >/= 70 years old, also derive benefit from chemotherapy. Most elderly patients should receive single-agent chemotherapy, but elderly patients with good PS and without significant comorbidities seem to derive a similar benefit from platinum-based doublets compared with their younger counterparts without a prohibitive difference in treatment toxicities. Because stage IV NSCLC is incurable, quality-of-life issues are important, and tools exist to monitor a patient's quality of life during therapy. Last, patients need to be informed of the implication of the diagnosis of stage IV NSCLC and be educated about treatment options that are available to them.
Advances have been made in stage IV NSCLC, and the appropriate use of chemotherapy continues to evolve on the basis of well-designed clinical trials that address critical issues in this population.
IV期非小细胞肺癌（NSCLC）仍然是一种可治疗但无法治愈的疾病。
进行了MEDLINE检索，以识别解决本节所提出问题的相关同行评审文章。写作委员会制定并分级了推荐意见，随后这些意见获得了美国胸科医师学会的批准。
对于体能状态（PS）良好的患者，含铂双药联合方案仍然是标准治疗；没有证据表明添加第三种细胞毒性药物能提高生存率。同样，除了一个例外，在含铂双药联合方案中添加新的靶向或生物制剂并不能提高生存率。这个例外是在IV期疾病且PS良好的患者中，在卡铂/紫杉醇方案中添加抗血管生成药物贝伐单抗。推荐使用贝伐单抗的患者还必须根据组织学类型（非鳞状）、无脑转移和咯血、且无治疗性抗凝指征来选择。对于IV期NSCLC且PS为2的患者，推荐进行化疗，但最佳方法尚未明确。定义为年龄≥70岁的老年患者也能从化疗中获益。大多数老年患者应接受单药化疗，但PS良好且无明显合并症的老年患者与年轻患者相比，似乎从含铂双药联合方案中获得了相似的益处，且治疗毒性方面没有过高差异。由于IV期NSCLC无法治愈，生活质量问题很重要，并且有工具可用于在治疗期间监测患者的生活质量。最后，需要告知患者IV期NSCLC诊断的含义，并对他们可获得的治疗选择进行教育。
IV期NSCLC已取得进展，基于针对该人群关键问题的精心设计的临床试验，化疗的合理使用也在不断发展。
