Penn State Hershey Medical Center, Department of Medicine, Hershey, PA, USA.
Expert Opin Pharmacother. 2012 Apr;13(5):685-97. doi: 10.1517/14656566.2012.668530. Epub 2012 Mar 10.
The concept of maintenance therapy in lung cancer has stirred a great deal of interest over the last decade. Several randomized studies have been conducted to find out the usefulness of maintenance therapies for advanced non-small-cell lung cancer (NSCLC).
This article reviews the major benchmark clinical trials and strategies in the field of maintenance chemotherapy in advanced NSCLC. The two strategies used in maintenance therapy are: i) continuation maintenance - continuation of one of the initial treatments; and ii) switch maintenance - switching to a different agent not administered as initial treatment. Both chemotherapeutic and molecular targeted agents have been studied in the maintenance setting. These include docetaxel, gemcitabine, pemetrexed, bevacizumab, erlotinib and gefitinib. This paper discusses the relevant clinical trials using these agents and the two different strategies in the maintenance therapy in advanced NSCLC.
Despite some controversy regarding the choice or the timing of the maintenance therapy, most of the clinical trials have demonstrated a significant improvement of progression-free survival, translating to a survival benefit with pemetrexed and erlotinib. The approval of pemetrexed and erlotinib by the FDA has certainly shifted the pendulum towards maintenance therapy.
在过去的十年中，肺癌维持治疗的概念引起了极大的关注。已经进行了几项随机研究，以确定维持疗法在晚期非小细胞肺癌（NSCLC）中的作用。
本文综述了晚期 NSCLC 维持化疗领域的主要基准临床试验和策略。维持治疗中使用的两种策略是：i）延续性维持——继续初始治疗之一；ii）转换性维持——改用初始治疗未使用的不同药物。在维持治疗中已经研究了化学治疗药物和分子靶向药物。这些药物包括多西他赛、吉西他滨、培美曲塞、贝伐单抗、厄洛替尼和吉非替尼。本文讨论了使用这些药物的相关临床试验以及晚期 NSCLC 中两种不同的维持治疗策略。
尽管关于维持治疗的选择或时机存在一些争议，但大多数临床试验都表明无进展生存期有显著改善，培美曲塞和厄洛替尼的治疗确实带来了生存获益。Pemetrexed 和厄洛替尼获得 FDA 的批准无疑使维持治疗成为主流。
