Wang Xianfeng, Huang Meijuan, Ren Li, Xu Yong, Li Lu, Hou Mei, Wang Jin, Peng Feng, Zhu Jiang, Wang Yongsheng, Lu You
Department of Thoracic Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China.
Department of Thoracic Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China;State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China.
Zhongguo Fei Ai Za Zhi. 2014 Dec;17(12):839-44. doi: 10.3779/j.issn.1009-3419.2014.12.03.
A common consensus has been reached regarding first- and second-line therapies for advanced non-small cell lung cancer (NSCLC). The newest guideline from National Comprehensive Cancer Network (NCCN) also provides recommendations for third-line therapy. This study focused on fourth-line and enhanced treatments for advanced NSCLC. Treatment results and impact factors were analyzed and discussed.
A total of 140 patients with advanced NSCLC were selected and their data were analyzed. Response rate, survival rate, and prognostic factors were evaluated.
Among the 140 patients, 12.9% (18 cases) showed partial response, 25.7% (36 cases) suffered from a stable disease, and 38.6% (54 cases) exhibited a disease control rate. Median overall survival (OS) and fourth-line therapy OS were 31 months and 10.1 months, respectively. The median progression free survival (PFS) of fourth-line therapy was 2.6 months. Univariate and multivariate analyses indicated different therapy regimens and suggested whether or not patients should undergo follow-up treatments. These parameters were independent prognostic factors of the OS of the fourth-line therapy; by contrast, no independent impact factor of PFS was found. Chemotherapy resulted in better median OS in fourth-line therapy than in targeted therapy (11.7 months vs 7.1 months, P=0.013). Considering the median OS of fourth-line therapy, we observed that single agent therapy did not significantly differ from double agent therapy; likewise, we found that first-time usage did not significantly differ from multiple usage of epidermal growth factor receptor tyrosine kinase inhibitor.
Fourth-line therapy is recommended to increase the survival of advanced NSCLC patients. Nevertheless, the role of fourth-line therapy in advanced NSCLC should be further assessed in clinical trials.
对于晚期非小细胞肺癌（NSCLC）的一线和二线治疗已达成普遍共识。美国国立综合癌症网络（NCCN）的最新指南也提供了三线治疗的建议。本研究聚焦于晚期NSCLC的四线及强化治疗。对治疗结果及影响因素进行了分析和讨论。
共选取140例晚期NSCLC患者并分析其数据。评估缓解率、生存率及预后因素。
140例患者中，12.9%（18例）显示部分缓解，25.7%（36例）病情稳定，疾病控制率为38.6%（54例）。总生存期（OS）中位数和四线治疗OS分别为31个月和10.1个月。四线治疗的无进展生存期（PFS）中位数为2.6个月。单因素和多因素分析表明不同治疗方案并提示患者是否应接受后续治疗。这些参数是四线治疗OS的独立预后因素；相比之下，未发现PFS的独立影响因素。四线治疗中化疗的OS中位数优于靶向治疗（11.7个月对7.1个月，P = 0.013）。考虑到四线治疗的OS中位数，我们观察到单药治疗与双药治疗无显著差异；同样，我们发现表皮生长因子受体酪氨酸激酶抑制剂首次使用与多次使用无显著差异。
推荐进行四线治疗以提高晚期NSCLC患者的生存率。然而，四线治疗在晚期NSCLC中的作用应在临床试验中进一步评估。
