Tong King Mong, Laskin Janessa, Ho Cheryl
Department of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada.
Lung Cancer. 2015 Mar;87(3):296-302. doi: 10.1016/j.lungcan.2014.12.014. Epub 2015 Jan 5.
Maintenance chemotherapy has been incorporated into treatment paradigms for advanced NSCLC. Eligibility criteria include stable disease/partial response and PS 0-1 after a first line platinum doublet. In practice, maintenance can be difficult to deliver due to patient factors and preferences. We propose to examine the proportion of patients eligible for maintenance and factors associated with the delivery of subsequent lines of chemotherapy.
The BC Cancer Agency provides care to a population of 4.5 million. A retrospective review was conducted of all referred Stage IIIB/IV patients in 2009 who received first line systemic therapy. Baseline characteristics, PS and response after first line and subsequent systemic therapy details were recorded. Patients were deemed potentially maintenance eligible or not based on clinical trial criteria; however maintenance therapy was not delivered to these patients as it was not yet available.
330 patients were identified; 98 were potentially maintenance eligible. The reason for maintenance ineligibility in n = 232; no upfront doublet (n = 41), PS ≥ 2 (n = 38), progressive disease (PD) (n = 53), PS ≥ 2 and PD (n = 62), PS ≥ 2 and unknown response (n = 35), PD and unknown PS (n = 3). Further chemotherapy (2nd line or beyond) was administered in maintenance eligible 68% vs ineligible 56%. Reasons for no further chemotherapy were predominantly decline in PS and brain metastasis. Median OS: 7 m for 1st line only versus 16.8m for ≥ 2 nd line (p < 0.001).
In our population based study, 30% of advanced NSCLC patients were eligible to receive maintenance chemotherapy based on the clinical trial criteria. Despite a good initial PS and disease control only 68% of maintenance eligible patients received subsequent therapy. A clear survival benefit was seen with ≥ 2 nd line treatment. Maintenance therapy or initiation of early second line therapy should be considered for advanced NSCLC patients to improve survival outcomes.
维持化疗已被纳入晚期非小细胞肺癌（NSCLC）的治疗模式。入选标准包括疾病稳定/部分缓解以及一线铂类双联化疗后体能状态（PS）为0 - 1。在实际操作中，由于患者因素和偏好，维持化疗可能难以实施。我们建议研究符合维持化疗条件的患者比例以及与后续化疗疗程实施相关的因素。
不列颠哥伦比亚癌症机构为450万人口提供医疗服务。对2009年所有转诊的接受一线全身治疗的IIIB/IV期患者进行回顾性研究。记录基线特征、PS以及一线和后续全身治疗后的反应细节。根据临床试验标准判断患者是否有潜在的维持化疗资格；然而，由于当时尚无维持治疗方案，这些患者未接受维持治疗。
共识别出330例患者；98例有潜在的维持化疗资格。232例患者不符合维持化疗资格的原因如下：未进行前期双联化疗（n = 41）、PS≥2（n = 38）、疾病进展（PD）（n = 53）、PS≥2且疾病进展（n = 62）、PS≥2且反应未知（n = 35）、疾病进展且PS未知（n = 3）。有维持化疗资格的患者中68%接受了进一步化疗（二线或更后续的化疗），而无资格的患者中这一比例为56%。未进行进一步化疗的主要原因是PS下降和脑转移。中位总生存期：仅接受一线治疗的患者为7个月，而接受≥二线治疗的患者为16.8个月（p < 0.001）。
在我们基于人群的研究中，根据临床试验标准，30%的晚期NSCLC患者有资格接受维持化疗。尽管初始PS良好且疾病得到控制，但仅有68%有维持化疗资格的患者接受了后续治疗。接受≥二线治疗有明显的生存获益。对于晚期NSCLC患者，应考虑进行维持治疗或尽早开始二线治疗以改善生存结局。
