From the Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
J Natl Compr Canc Netw. 2014 Jun;12(6):889-97. doi: 10.6004/jnccn.2014.0083.
During the past 10 years, the treatment of advanced-stage non-small cell lung cancer (NSCLC) has become increasingly complex, and debate continues regarding the optimal chemotherapeutic agents and duration of treatment. The addition of bevacizumab to platinum doublet chemotherapy, the use of pemetrexed for nonsquamous histology, and the introduction of maintenance chemotherapy are strategies that have been shown to improve overall survival beyond 12 months. Many acceptable treatment options are recommended in the NCCN Clinical Practice Guidelines in Oncology for NSCLC. This article discusses the first-line treatment of NSCLC with no identifiable mutations with FDA-approved targeted therapies for patients treated outside a clinical trial, particularly focusing on difficult clinical decisions, such as when the use of bevacizumab is appropriate, choosing a platinum partner, and treatment of patients with an ECOG performance status of 2. Data are summarized from several recent maintenance clinical trials, such as PARAMOUNT, AVAPERL, and PointBreak, and the implications these trials have on practical decisions oncologists must make when choosing an optimal treatment strategy for patients with advanced NSCLC are discussed.
在过去的 10 年中，晚期非小细胞肺癌（NSCLC）的治疗变得越来越复杂，对于最佳化疗药物和治疗持续时间仍存在争议。贝伐珠单抗联合铂类双药化疗、培美曲塞用于非鳞状组织学和维持化疗的引入，这些策略已被证明可将总生存期延长至 12 个月以上。在 NCCN 肿瘤临床实践指南中，针对 NSCLC 有许多可接受的治疗选择。本文讨论了无可识别突变的 NSCLC 的一线治疗，包括 FDA 批准的用于临床试验之外患者的靶向治疗，特别是关注一些困难的临床决策，如贝伐珠单抗的适用时机、选择铂类药物以及治疗 ECOG 体能状态为 2 的患者。本文总结了几项最近的维持治疗临床试验，如 PARAMOUNT、AVAPERL 和 PointBreak，并讨论了这些试验对肿瘤学家在为晚期 NSCLC 患者选择最佳治疗策略时做出决策的实际影响。
