Juravinski Cancer Centre at Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
J Thorac Oncol. 2010 Feb;5(2):260-74. doi: 10.1097/JTO.0b013e3181c6f035.
Non-small cell lung cancer (NSCLC) frequently presents at an incurable stage, and a majority of patients will be considered for palliative chemotherapy at some point in their disease. This article reviews the growing evidence for first-line treatment in NSCLC.
Studies of first-line chemotherapy regimens including new agents (docetaxel, gemcitabine, irinotecan, paclitaxel, pemetrexed, and vinorelbine) and targeted agents (bevacizumab, erlotinib, and gefitinib) were identified through Medline, Embase, the Cochrane databases, and web sites of guideline organizations.
Two evidence-based guidelines, 10 systematic reviews, and forty-six randomized trials were eligible for inclusion. Randomized studies suggest that platinum-based doublets (platinum plus new agent) are the standard of care for first-line systemic therapy. No one new agent is clearly superior for use in combination with a platinum agent. The survival advantage of platinum-based doublets over nonplatinum combinations or older combinations is modest. The addition of bevacizumab to carboplatin and paclitaxel has shown improved survival, although multiple exclusion criteria limit the applicability of these data to a subset of patients. In patients at least 70 years of age or with Eastern Collaborative Oncology Group performance status 2, a new single agent is an alternative. Treatment beyond four to six cycles impedes quality of life without prolonging life. Emerging data suggest that the choice of chemotherapy agent may be influenced by histologic subtype.
In NSCLC, a combination of a platinum agent plus a new agent continues to be the standard of care. As differences between regimens are small, toxicity and patient preference should help guide regimen choice.
非小细胞肺癌（NSCLC）常处于不可治愈阶段，大多数患者在疾病的某个阶段将考虑姑息化疗。本文综述了 NSCLC 一线治疗的最新进展。
通过 Medline、Embase、Cochrane 数据库和指南组织的网站，检索包括新型药物（多西他赛、吉西他滨、伊立替康、紫杉醇、培美曲塞和长春瑞滨）和靶向药物（贝伐珠单抗、厄洛替尼和吉非替尼）在内的一线化疗方案的研究。
有 2 项循证指南、10 项系统评价和 46 项随机试验符合纳入标准。随机研究表明，铂类双联方案（铂类加新型药物）是一线全身治疗的标准方案。尚无一种新型药物在联合铂类药物方面明显优于其他药物。与非铂类联合方案或老一代联合方案相比，铂类双联方案的生存优势仅略有改善。贝伐珠单抗联合卡铂和紫杉醇可提高生存率，但多项排除标准限制了这些数据在部分患者中的适用性。对于年龄至少 70 岁或东部肿瘤协作组体能状态 2 的患者，新型单药是一种替代方案。在 4 至 6 个周期以上的治疗会影响生活质量，而不会延长生存期。新出现的数据表明，化疗药物的选择可能受到组织学亚型的影响。
在 NSCLC 中，铂类药物联合新型药物仍是标准治疗方案。由于方案之间的差异较小，毒性和患者偏好应有助于指导方案选择。
