Petrelli Fausto, Ghilardi Mara, Cremonesi Marco, Cabiddu Mary, Barni Sandro
Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, BG, Italy.
Expert Rev Anticancer Ther. 2009 Oct;9(10):1455-65. doi: 10.1586/era.09.112.
Standard treatment of advanced non-small-cell lung cancer consists of platinum-based (doublet) polychemotherapy. The treatment should last for a maximum of four to six cycles. Several randomized clinical trials and some meta-analyses showed that a longer duration of treatment does not lead to an increase in survival. Recent data with new-generation agents (chemo- or targeted therapies) suggest that a maintenance treatment until progression of disease in patients with response or stable disease after the first cycles of induction (platinum-based) chemotherapy confers an advantage in time-to-progression or even overall survival (with pemetrexed) compared with no maintenance treatment. The advent of new agents and the better selection of patients according to histology or mutation of specific tyrosine kinase receptors (e.g., EGF receptor) seems to increase the therapeutic options and improve the prognosis in the advanced disease setting. The paradigm of the duration of therapy in advanced lung cancer appears to change from the use of second-line treatment only at progression of disease to an early introduction of an alternative (second-line) therapy as consolidation and chronic phase of maintenance.
晚期非小细胞肺癌的标准治疗包括铂类（双联）多药化疗。治疗最多持续四到六个周期。多项随机临床试验和一些荟萃分析表明，延长治疗时间并不会提高生存率。有关新一代药物（化疗或靶向治疗）的最新数据表明，与不进行维持治疗相比，在诱导（铂类）化疗的首个周期后对有反应或病情稳定的患者进行维持治疗直至疾病进展，在无进展生存期甚至总生存期（使用培美曲塞时）方面具有优势。新药物的出现以及根据组织学或特定酪氨酸激酶受体（如表皮生长因子受体）突变对患者进行更好的选择，似乎增加了治疗选择并改善了晚期疾病的预后。晚期肺癌的治疗时长模式似乎正在从仅在疾病进展时使用二线治疗转变为早期引入替代（二线）疗法作为巩固和维持的慢性期。
