American Society of Clinical Oncology, 2318 Mill Rd, Suite 800, Alexandria, VA 22314, USA.
J Clin Oncol. 2009 Dec 20;27(36):6251-66. doi: 10.1200/JCO.2009.23.5622. Epub 2009 Nov 16.
The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non-small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy.
本文旨在为 IV 期非小细胞肺癌患者的治疗提供最新建议。通过文献检索，确定了自 2002 年以来发表的相关随机试验。指南的范围缩小到化疗和生物治疗。更新委员会审查了文献并提出了更新建议。有 162 篇出版物符合纳入标准。建议基于可改善总生存的治疗策略。仅改善无进展生存的治疗方法需要仔细审查毒性和生活质量。对于体能状态为 0 或 1 的患者的一线治疗，建议使用含铂的两种细胞毒性药物联合化疗。对于有铂类治疗禁忌证的患者，可以接受非铂类细胞毒性双联化疗。对于体能状态为 2 的患者，单药细胞毒性药物即可。对于未对治疗有反应的患者，在疾病进展或治疗 4 个周期后停止一线细胞毒性化疗。即使对治疗有反应的患者，也应在 6 个周期时停止两药细胞毒性化疗。已知表皮生长因子受体（EGFR）突变的患者可推荐使用吉非替尼一线治疗；对于 EGFR 阴性或未知突变状态的患者，建议使用细胞毒性化疗。贝伐单抗与卡铂紫杉醇联合推荐，除了某些临床特征的患者。免疫组织化学法检测 EGFR 阳性肿瘤的患者，推荐顺铂-长春瑞滨联合西妥昔单抗。多西他赛、厄洛替尼、吉非替尼或培美曲塞推荐作为二线治疗。未接受过厄洛替尼或吉非替尼治疗的患者，推荐厄洛替尼作为三线治疗。无充足数据推荐常规使用三线细胞毒性药物。无充足数据推荐常规使用分子标志物选择化疗。
