Jalal Shadia I, Ademuyiwa Foluso O, Hanna Nasser H
Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA.
Curr Opin Oncol. 2009 Mar;21(2):110-5. doi: 10.1097/CCO.0b013e328322cf49.
Advanced nonsmall cell lung cancer (NSCLC) remains a therapeutic challenge. Traditional chemotherapy provides response rates of about 20-40% and median survivals of 8-10 months. The outcome of patients presenting at an advanced stage is therefore disappointing. In order to improve patients' outcomes, there has been a renewed interest in evaluating the role of maintenance or consolidation chemotherapy or both. Therefore, this review is timely and also relevant to clinical practice.
Thirteen randomized clinical trials have reported that consolidation or maintenance therapy or both improves progression free survival in patients with advanced NSCLC who have achieved disease control following their initial therapy. This does not translate into survival benefits in the same patient populations. Furthermore, prolonged therapy results in more treatment-related toxicity without improvements in quality of life as documented in 11 of these trials. We summarize the current data and perspectives of consolidation/maintenance therapy in patients with advanced NSCLC.
Completed trials evaluating consolidation or maintenance therapy or both in patients with advanced NSCLC consistently demonstrate that this strategy will improve progression free survival but not overall survival. Administering maintenance or consolidation therapy to patients with advanced NSCLC to improve progression free survival alone is not recommended.
晚期非小细胞肺癌（NSCLC）仍然是一个治疗挑战。传统化疗的缓解率约为20%-40%，中位生存期为8-10个月。因此，晚期患者的治疗结果令人失望。为了改善患者的治疗结果，人们对评估维持或巩固化疗或两者的作用重新产生了兴趣。因此，本综述既及时又与临床实践相关。
13项随机临床试验报告称，巩固或维持治疗或两者兼用可改善晚期NSCLC患者在初始治疗后病情得到控制的无进展生存期。但在同一患者群体中，这并未转化为生存获益。此外，如其中11项试验所记录，延长治疗会导致更多与治疗相关的毒性，且生活质量并无改善。我们总结了晚期NSCLC患者巩固/维持治疗的当前数据和观点。
评估晚期NSCLC患者巩固或维持治疗或两者兼用的已完成试验一致表明，该策略将改善无进展生存期，但不会改善总生存期。不建议仅为改善晚期NSCLC患者的无进展生存期而给予维持或巩固治疗。
