Department of Medicine, University of Miami Miller School of Medicine at FAU, Atlantis, FL, USA.
Expert Rev Anticancer Ther. 2010 Apr;10(4):549-57. doi: 10.1586/era.10.30.
For many decades, the use of chemotherapy as second-line therapy in non-small-cell lung cancer relied upon disease progression. Several studies have shown that four to six cycles of chemotherapy administered as front-line therapy treatment offers a survival advantage to patients; however, further chemotherapy beyond this initial treatment was more associated with side effects and no benefit in survival. Until 2009, second-line treatment for lung cancer was well established for three therapeutic agents: docetaxel, pemetrexed and erlotinib. Currently, the timeframe to use these agents has been challenged by two large randomized clinical trials in which pemetrexed (JMEN trial) and erlotinib (Sequential Tarceva in Unresectable NSCLC [SATURN] trial) were used as 'maintenance' therapy and shown to impact progression-free survival and overall survival. This review focuses on the actual dilemma that medical oncologists face in clinical practice in terms of when and to whom maintenance therapy should be applied or if the 'watch and wait' approach prior to start second-line therapy is still advisable.
几十年来，非小细胞肺癌的化疗二线治疗一直依赖于疾病进展。多项研究表明，一线治疗中使用四至六个周期的化疗可为患者带来生存优势；然而，在初始治疗之外进一步进行化疗更多地与副作用相关，而对生存没有益处。直到 2009 年，肺癌的二线治疗已为三种治疗药物确立：多西他赛、培美曲塞和厄洛替尼。目前，两项大型随机临床试验对这些药物的使用时间框架提出了挑战，其中培美曲塞（JMEN 试验）和厄洛替尼（不可切除 NSCLC 的序贯 Tarceva [SATURN] 试验）被用作“维持”治疗，并显示对无进展生存期和总生存期有影响。本综述重点讨论了肿瘤内科医生在临床实践中面临的实际困境，即何时以及向谁应用维持治疗，或者在开始二线治疗之前采用“观察和等待”方法是否仍然可取。
