Dediu M, Ion O, Ion R, Gal C, Median D, Gongu M
Department of Medical Oncology, Institute of Oncology Alexandru Trestioreanu, Bucharest, Romania.
J BUON. 2009 Sep;14 Suppl 1:S159-64.
First line combination chemotherapy (CT) using platinum-based doublets is established as a standard of care for advanced non-small cell lung cancer (NSCLC). Nevertheless, no significant advances have been recorded during the last years in this field. Therefore, there is a wide consensus among physicians that a plateau has already been reached with this strategy. Targeted therapy using tyrosine-kinase inhibitors (TKIs) and monoclonal antibodies emerged as a new field of development in the NSCLC therapeutics. Recently, the results of the phase III trials testing antibodies against vascular endothelial growth factor-VEGF (bevacizumab) and epidermal growth factor receptor-EGFR (cetuximab) challenged the paradigm of the platinum doublets as a gold standard in advanced NSCLC. Their appearance was enthusiastically commended both by patients and the oncological community. However, all medical oncologists have the responsibility to carefully analyze the real benefits of these new agents, to balance the advantages against the implicit risks of therapy and to make the decision having in mind the best interest of their patients. Last but not least, the associated health economic burden should also be considered. This paper addresses some issues related to the use of cetuximab and bevacizumab in advanced NSCLC. The main controversial aspects regarding patient selection, the real benefit of therapy, the molecular and clinical predictors, and the impact of other independent variables are carefully examined and presented. Due to many unsolved questions, no definite conclusions can be supported. The final decision about the optimal use of these agents is left to the clinical judgment of each treating physician.
使用铂类双联药物的一线联合化疗（CT）已被确立为晚期非小细胞肺癌（NSCLC）的治疗标准。然而，在该领域过去几年中并未取得显著进展。因此，医生们普遍认为这种治疗策略已经达到了一个平台期。使用酪氨酸激酶抑制剂（TKIs）和单克隆抗体的靶向治疗成为NSCLC治疗领域的一个新发展方向。最近，针对血管内皮生长因子-VEGF（贝伐单抗）和表皮生长因子受体-EGFR（西妥昔单抗）的III期试验结果对铂类双联药物作为晚期NSCLC金标准的范例提出了挑战。它们的出现受到了患者和肿瘤学界的热烈赞扬。然而，所有肿瘤内科医生都有责任仔细分析这些新药物的实际益处，权衡治疗的优势与潜在风险，并在考虑患者最佳利益的前提下做出决策。最后但同样重要的是，还应考虑相关的健康经济负担。本文探讨了与西妥昔单抗和贝伐单抗在晚期NSCLC中的应用相关的一些问题。对患者选择、治疗的实际益处、分子和临床预测指标以及其他独立变量的影响等主要争议方面进行了仔细研究和阐述。由于存在许多未解决的问题，无法得出明确结论。这些药物的最佳使用最终决策仍由每位治疗医生的临床判断决定。
