Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta, 8, 83100 - Avellino, Italy.
Curr Med Chem. 2010;17(11):1030-8. doi: 10.2174/092986710790820589.
Lung cancer is the leading cause of cancer mortality worldwide. Non-small cell lung cancer (NSCLC), accounting for about 85% of all lung cancers, includes squamous carcinoma, adenocarcinoma and undifferentiated large cell carcinoma. The majority of patients have advanced disease at diagnosis, and medical treatment is the cornerstone of management. Several randomized trials comparing third-generation platinum-based doublets concluded that all such combinations are comparable in their clinical efficacy, failing to document a difference based on histology. However, recent evidences, arising from the availability of pemetrexed, have shown that histology represents an important variable in the decision making. The major progresses in the understanding cancer biology and mechanism of oncogenesis have allowed the development of several potential molecular targets for cancer treatment such as vascular growth factor and its receptors and epidermal growth factor receptor. Targeted drugs seem to be safer or more effective in a specific histology subtype. All of these data have led to choose the optimal first-line treatment of advanced NSCLC based on histologic diagnosis. However, this scenario raises a diagnostic issue: a specific diagnosis of NSCLC histologic subtype is mandatory. This review will discuss these new evidences in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making.
肺癌是全球癌症死亡的主要原因。非小细胞肺癌（NSCLC）约占所有肺癌的 85%，包括鳞状细胞癌、腺癌和未分化大细胞癌。大多数患者在诊断时已处于晚期疾病，因此医学治疗是管理的基石。几项比较第三代铂类双联药物的随机试验得出结论，所有这些组合在临床疗效上都相当，未能根据组织学证明存在差异。然而，最近的证据表明，培美曲塞的应用表明组织学是决策中的一个重要变量。对癌症生物学和致癌机制的理解的重大进展使得能够开发出几种用于癌症治疗的潜在分子靶标，如血管生长因子及其受体和表皮生长因子受体。靶向药物在特定的组织学亚型中似乎更安全或更有效。所有这些数据都导致根据组织学诊断选择晚期 NSCLC 的最佳一线治疗。然而，这种情况提出了一个诊断问题：NSCLC 组织学亚型的特定诊断是强制性的。这篇综述将讨论这些晚期 NSCLC 一线治疗的新证据及其对当前临床决策的影响。
