Maione Paolo, Rossi Antonio, Bareschino Maria Anna, Sacco Paola Claudia, Schettino Clorinda, Falanga Marzia, Barbato Valentina, Ambrosio Rita, Gridelli Cesare
Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta - 83100 Avellino, Italy.
Rev Recent Clin Trials. 2011 Jan;6(1):44-51. doi: 10.2174/157488711793980192.
Platinum-based chemotherapy, with or without the antiangiogenetic drug bevacizumab, is the standard first-line therapy for patients with advanced non-small-cell lung cancer (NSCLC). The epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) gefitinib has been recently approved as treatment of patients with EGFR mutated tumors (including first-line). Three agents are approved for treating non-selected patients who progress after one prior regimen: docetaxel, pemetrexed, and the EGFR-TKI erlotinib. Gefitinib can be used as second-line treatment in patients with EGFR mutated tumors. Although these agents have yelded similar outcomes in terms of antitumor activity and efficacy in unselected NSCLC patients, they have different toxicity profiles, and recently some strong factors that can help in the choice among them have been detected. In particular, the hystotype, the EGFR gene mutational status, the response to previous first-line chemotherapy and the correlation of the safety profile of the agents with Performance Status and comorbidities of the patients, are the most important factors that drive the choice of the second-line treatment. Obviously, the drugs administered in the first-line treatment strongly influence the choice of the second-line treatment because some of the currently available drugs can be used in both settings. Thus, more than in the past, first and second-line treatment of advanced NSCLC are linked, and the choice of second-line treatment is part of a strategy decided when beginning the first-line treatment.
含或不含抗血管生成药物贝伐单抗的铂类化疗，是晚期非小细胞肺癌（NSCLC）患者的标准一线治疗方案。表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）吉非替尼最近已被批准用于治疗EGFR突变肿瘤患者（包括一线治疗）。三种药物被批准用于治疗在一种先前治疗方案后病情进展的未选择患者：多西他赛、培美曲塞和EGFR-TKI厄洛替尼。吉非替尼可用于EGFR突变肿瘤患者的二线治疗。尽管这些药物在未选择的NSCLC患者的抗肿瘤活性和疗效方面产生了相似的结果，但它们具有不同的毒性特征，并且最近发现了一些有助于在它们之间进行选择的重要因素。特别是，组织学类型、EGFR基因突变状态、对先前一线化疗的反应以及药物安全性特征与患者体能状态和合并症的相关性，是驱动二线治疗选择的最重要因素。显然，一线治疗中使用的药物强烈影响二线治疗的选择，因为一些目前可用的药物可在两种情况下使用。因此，与过去相比，晚期NSCLC的一线和二线治疗是相互关联的，二线治疗的选择是开始一线治疗时所决定策略的一部分。
