Thatcher Nicholas
Division of Cancer Studies, Faculty of Medical and Human Sciences, University of Manchester, Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 4BX, UK.
BMC Proc. 2008 Sep 24;2 Suppl 2(Suppl 2):S3. doi: 10.1186/1753-6561-2-s2-s3.
Treatment of non-small-cell lung cancer is dependent on disease stage. For patients with metastasis or locally advanced disease, the importance of finding therapeutic schemes that may benefit this population is important. This review discusses therapeutic options for first- and second-line treatment in patients with advanced non-small-cell lung cancer. According to current data, the combination of two cytotoxic agents is the optimum first-line treatment for patients with non-small-cell lung cancer and performance status of 0-1. Addition of bevacizumab has shown to provide an even longer survival and to increase response rate. Within the first-line setting, erlotinib appears to be effective in the treatment of elderly patients who would not derive a benefit from standard chemotherapy or those refusing standard chemotherapy. The administration of erlotinib as first-line maintenance therapy is being assessed. There are currently three drugs approved for second-line treatment of patients with advanced non-small-cell lung cancer after failure of first-line chemotherapy. These drugs have proven to be effective in phase III trials. In the phase III trial BR.21 study, the response rate was 8.9% in the erlonitib group, and less than 1% in placebo; median response duration was 7.9 months and 3.7 months, respectively; and the median survival was 6.7 months and 4.7 with erlotinib and placebo, respectively. One-year survival was 31% and 21% with erlotinib and placebo, respectively. In addition, the BR.21 trial revealed that significantly greater improvements in overall quality of life and in both physical and emotional functioning were observed in the erlotinib arm as compared with the placebo arm. Erlotinib is not significantly associated with hematologic adverse effects. Erlotinib is administered orally, and does not require concomitant administration of other drugs, thus causing patients less inconvenience. Analysis of data from different subgroups included in the BR.21 trial show that overall survival is similar among women and men, among patients with adenocarcinoma and epidermoid carcinoma or Asian patients compared with other ethnicities. Combination of erlotinib and bevacizumab in the second-line treatment of patients with advanced disease has been evaluated as anti-angiogenic properties. This combination therapy has provided promising results which should be confirmed in future studies.
非小细胞肺癌的治疗取决于疾病分期。对于发生转移或局部晚期疾病的患者而言，找到可能使这部分人群受益的治疗方案至关重要。本综述讨论了晚期非小细胞肺癌患者一线和二线治疗的选择。根据目前的数据，两种细胞毒性药物联合使用是体能状态为0 - 1的非小细胞肺癌患者的最佳一线治疗方案。添加贝伐单抗已显示能延长生存期并提高缓解率。在一线治疗中，厄洛替尼似乎对无法从标准化疗中获益或拒绝标准化疗的老年患者有效。厄洛替尼作为一线维持治疗的应用正在评估中。目前有三种药物被批准用于一线化疗失败后的晚期非小细胞肺癌患者的二线治疗。这些药物在III期试验中已被证明有效。在III期BR.21试验中，厄洛替尼组的缓解率为8.9%，安慰剂组低于1%；中位缓解持续时间分别为7.9个月和3.7个月；厄洛替尼和安慰剂组的中位生存期分别为6.7个月和4.7个月。厄洛替尼和安慰剂组的1年生存率分别为31%和21%。此外，BR.21试验显示，与安慰剂组相比，厄洛替尼组在总体生活质量以及身体和情感功能方面均有显著更大的改善。厄洛替尼与血液学不良反应无显著相关性。厄洛替尼口服给药，无需同时服用其他药物，因此给患者带来的不便较少。对BR.21试验中不同亚组数据的分析表明，女性和男性、腺癌和表皮样癌患者或亚洲患者与其他种族患者的总生存期相似。厄洛替尼和贝伐单抗联合用于晚期疾病患者的二线治疗已因其抗血管生成特性而得到评估。这种联合治疗已取得了有前景的结果，应在未来研究中得到证实。
