De Marinis Filippo, Bria Emilio, Baas Paul, Tiseo Marcello, Camerini Andrea, Favaretto Adolfo Gino, Gridelli Cesare
Thoracic Oncology Division, European Institute of Oncology (IEO), Milan, Italy.
Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Clin Lung Cancer. 2015 Nov;16(6):399-405. doi: 10.1016/j.cllc.2015.04.008. Epub 2015 Apr 30.
The assessment of special categories of non-small-cell lung cancer (NSCLC) patients requires a comprehensive analysis of all factors potentially influencing the daily quality of life and the relative contribution of tumor-related symptoms on the overall patient health status. While for elderly patients prospective evidence and recommendations allow clinicians to better address their patients to a shared treatment, a paucity of reliable data refers to treatment opportunities for these patients, termed frail or unfit, who are not considered eligible for chemotherapy usually administered to adult patients. This consensus was inspired by the absence of clear criteria to define the category of unfit patients in the context of advanced NSCLC in order to share all the available tools for their classification and evaluation and to support decisions for clinical practice on a daily basis. After review of the literature and panelist consensus, a series of items was identified as relevant: age, performance status, renal function, heart failure, previous cerebrovascular events, uncontrolled hypertension, neuropathy, hearing loss, symptomatic brain metastases, severe psychiatric disorders, and absence of caregiver support. On the basis of these factors, a treatment algorithm for clinical practice to categorize unfit NSCLC patient into 3 major clinical scenarios was defined: (1) unfit for cisplatin-based chemotherapy, (2) unfit for carboplatin-based chemotherapy, and (3) unfit for single-agent chemotherapy.
对非小细胞肺癌（NSCLC）特殊类别患者的评估需要全面分析所有可能影响日常生活质量的因素，以及肿瘤相关症状对患者整体健康状况的相对影响。虽然对于老年患者，前瞻性证据和建议使临床医生能够更好地与患者共同确定治疗方案，但对于这些被称为体弱或不适合化疗的患者，可靠数据却很少，他们通常不符合成年患者常用的化疗条件。在晚期非小细胞肺癌的背景下，由于缺乏明确的标准来界定不适合化疗的患者类别，本共识旨在分享所有可用的分类和评估工具，并支持日常临床实践中的决策。在回顾文献并达成专家小组共识后，确定了一系列相关因素：年龄、体能状态、肾功能、心力衰竭、既往脑血管事件、未控制的高血压、神经病变、听力丧失、有症状的脑转移、严重精神障碍以及缺乏护理人员支持。基于这些因素，定义了一种临床实践治疗算法，将不适合化疗的非小细胞肺癌患者分为3种主要临床情况：（1）不适合基于顺铂的化疗；（2）不适合基于卡铂的化疗；（3）不适合单药化疗。
