Servicio de Oncología Médica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Clin Transl Oncol. 2010 Nov;12(11):735-41. doi: 10.1007/s12094-010-0588-3.
The purpose of this article is to provide updated recommendations for the diagnosis and treatment of patients non-small-cell lung cancer (NSCLC). The staging system for lung cancer has recently been revised by the International Association for Study of Lung Cancer and patients with NSCLC shall now be staged according to the UICC system 7th edition. Recommendations for treatment were based on treatment strategies that improve overall survival. In functionally fit patients with stage I-II disease surgical resection is recommended. Four cycles of adjuvant cisplatin-based chemotherapy is recommended in patients with pathologic stage II-III. For patients with stage IIIA and non-bulky mediastinal lymph node survival was significantly improved with induction chemotherapy plus surgical resection. Patients with unresectable or bulky stage IIIA and those with stage IIIB, should be treated with platinum-based chemotherapy and thoracic radiotherapy. For patients with metastatic disease and performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For elderly patients and those with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with platinum-based chemotherapy, except for patients with certain clinical characteristics. Maintenance therapy with pemetrexed or erlotinib increases survival in patients who did not progress after 4 cycles of a platinum based chemotherapy. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs.
本文旨在提供非小细胞肺癌（NSCLC）患者诊断和治疗的最新建议。国际肺癌研究协会（IASLC）最近修订了肺癌分期系统，现在 NSCLC 患者应根据 UICC 第 7 版分期系统进行分期。治疗建议基于改善总生存的治疗策略。在功能状态良好的 I 期- II 期疾病患者中，建议进行手术切除。对于病理分期为 II-III 期的患者，建议进行 4 个周期的顺铂为基础的辅助化疗。对于 IIIA 期有非肿大纵隔淋巴结的患者，诱导化疗加手术切除可显著提高生存率。对于不可切除或肿大的 IIIA 期以及 IIIB 期的患者，应采用铂类为基础的化疗和胸部放疗。对于转移性疾病和体能状态为 0 或 1 的患者，建议使用铂类双药联合细胞毒性药物。对于有铂类治疗禁忌的患者，非铂类细胞毒性双联方案是可接受的。对于老年患者和体能状态为 2 的患者，单一细胞毒性药物即可。对于无应答的患者，在疾病进展或治疗 4 个周期后停止一线细胞毒性化疗。对于有应答的患者，即使在治疗中有应答，也应在 6 个周期后停止双药细胞毒性化疗。对于已知表皮生长因子受体（EGFR）突变的患者，建议一线使用吉非替尼；对于 EGFR 突变状态阴性或未知的患者，建议使用细胞毒性化疗。贝伐单抗联合铂类化疗推荐用于具有某些临床特征的患者。培美曲塞或厄洛替尼维持治疗可增加未接受过基于铂类化疗的患者的生存时间。多西他赛、厄洛替尼、吉非替尼或培美曲塞推荐作为二线治疗。对于未接受过厄洛替尼或吉非替尼治疗的患者，推荐厄洛替尼作为三线治疗。数据不足以推荐常规三线使用细胞毒性药物。
