Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
Cancer Treat Rev. 2011 Apr;37(2):143-50. doi: 10.1016/j.ctrv.2010.05.004. Epub 2010 Jun 26.
Although small-cell lung cancer (SCLC) generally shows an excellent response to initial chemotherapy, most patients finally relapse and salvage chemotherapy is considered. Usually, the response to salvage chemotherapy significantly differs between sensitive and refractory relapse. Sensitive relapse is relatively chemosensitive and re-challenge with the same drugs as used in the initial chemotherapy has been used historically, while refractory relapse is extremely chemo-resistant and its prognosis has been abysmal. To date, a number of clinical trials have been carried out for relapsed SCLC; however, the number of randomized trials is quite limited. At present, topotecan is the only drug approved by the US Food and Drug Administration for relapsed SCLC, and is considered the standard second-line chemotherapy in many countries. More recently, amrubicin has also shown more favorable antitumor activity, and is the most promising at present. Unfortunately, targeted agents have failed to demonstrate effectiveness for SCLC. Better understanding of the molecular mechanisms is clearly needed.
虽然小细胞肺癌（SCLC）通常对初始化疗有极好的反应，但大多数患者最终会复发，需要进行挽救化疗。通常，挽救化疗对敏感复发和难治性复发的反应有显著差异。敏感复发相对化疗敏感，历史上曾使用与初始化疗相同的药物进行再次治疗，而难治性复发则对化疗极度耐药，预后极差。迄今为止，已经开展了多项复发性 SCLC 的临床试验；然而，随机试验的数量相当有限。目前，拓扑替康是唯一获得美国食品和药物管理局批准用于复发性 SCLC 的药物，在许多国家被认为是标准的二线化疗药物。最近，氨柔比星也显示出更有利的抗肿瘤活性，目前最有前途。不幸的是，靶向药物未能证明对 SCLC 有效。显然，需要更好地了解分子机制。
