Department of Medical Oncology, IRCCS Oncology Institute, Bari, Italy.
Oncology. 2009;77 Suppl 1:113-21. doi: 10.1159/000258503. Epub 2010 Feb 2.
Two decades ago best supportive care was considered a valid therapeutic option for advanced non-small cell lung cancer (NSCLC) patients until the evidence derived from meta-analysis showed symptom improvement and a survival advantage from systemic chemotherapy. A further advantage was reported when docetaxel and pemetrexed were used as second-line treatment after failure of first-line platinum-based chemotherapy. Furthermore, the biologic therapies targeting the epidermal growth factor receptor - erlotinib and gefitinib - have modified the therapeutic approach to second- and third-line treatment of NSCLC patients. In fact, to date, erlotinib is the only drug to be licensed for third-line therapy worldwide. So, third-line represents a new frontier to be assessed in advanced NSCLC patients. Third-line therapy is very hard to define correctly as it is difficult to interpret the currently available evidence-based data. A better knowledge of cellular biology will certainly encourage clinical research and could allow oncologists to best select patients and treatments. Here we review the state of the art of third-line therapy in the treatment of NSCLC patients.
二十年前，最佳支持治疗被认为是晚期非小细胞肺癌（NSCLC）患者的有效治疗选择，直到荟萃分析的证据表明系统化疗可改善症状和延长生存。二线治疗中使用多西他赛和培美曲塞也有进一步的优势，即在一线铂类化疗失败后。此外，针对表皮生长因子受体的生物疗法——厄洛替尼和吉非替尼——改变了 NSCLC 患者二线和三线治疗的治疗方法。事实上，到目前为止，厄洛替尼是全球唯一获准用于三线治疗的药物。因此，三线治疗代表了晚期 NSCLC 患者需要评估的一个新领域。三线治疗很难正确定义，因为目前基于证据的数据很难解释。对细胞生物学的更好了解肯定会鼓励临床研究，并使肿瘤学家能够更好地选择患者和治疗方法。在这里，我们回顾了晚期 NSCLC 患者三线治疗的最新进展。
