Fukuoka M, Negoro S, Takada M, Kusunoki Y, Matsui K, Ryu S, Sakai N, Yamamoto H, Masuda N, Takifuji N
Dept. of Internal Medicine, Osaka Prefectural Habikino Hospital, Japan.
Gan To Kagaku Ryoho. 1988 Apr;15(4 Pt 2-1):966-72.
The recent results of chemotherapy for SCLC were reviewed in this paper. The combination chemotherapy with some highly active drugs can be summarized as follows: response rate 74-94% in limited disease (LD) and 63-90% in extensive disease (ED), complete response 39-57% in LD and 20-48% in ED, median survival 10-21 months in LD and 7-12 months in ED. To overcome drug resistance in the treatment of SCLC, non-cross resistant alternating chemotherapy has been explored. In our institute, a randomized study of continuous vs alternating regimen for SCLC was carried out from August 1982 to March 1985. This resulted in the acknowledged superiority of the alternating regimen in CR rate and the overall response rate, but no differences in survival. A current study comparing the standard chemotherapy with cyclophosphamide, adriamycin and vincristine (CAV) to alternating CAV with etoposide (E) and cisplatin (P) has suggested an advantage for alternating chemotherapy, with a statistically superior response rate and survival. The high-dose (HD) chemotherapy for SCLC is also a new strategy to improve the current treatment results. We are now studying the efficacy of HD-E (1.0-1.5 g/m2) with or without P (80-120 mg/m2) for relapsed SCLC. The result suggested that HD-E and P is an effective treatment modality as a salvage therapy. The search for new active drugs is another important way to improve the treatment results. Since 1986, a phase II study of Carboplatin has been performed in Japan. The ongoing data suggest that Carboplatin is a highly active agent against SCLC. Finally, further research will be necessary to investigate novel modalities in order to achieve a breakthrough in the current status.
本文回顾了小细胞肺癌（SCLC）化疗的近期结果。使用一些高活性药物的联合化疗情况总结如下：局限期（LD）的缓解率为74%-94%，广泛期（ED）为63%-90%；LD的完全缓解率为39%-57%，ED为20%-48%；LD的中位生存期为10-21个月，ED为7-12个月。为克服SCLC治疗中的耐药性，人们探索了非交叉耐药交替化疗。在我们研究所，于1982年8月至1985年3月开展了一项关于SCLC持续与交替方案的随机研究。结果显示交替方案在完全缓解率和总缓解率方面具有公认的优势，但生存期无差异。一项当前研究比较了环磷酰胺、阿霉素和长春新碱（CAV）的标准化疗与CAV与依托泊苷（E）和顺铂（P）交替化疗，结果表明交替化疗具有优势，缓解率和生存期在统计学上更优。SCLC的大剂量（HD）化疗也是改善当前治疗结果的一种新策略。我们目前正在研究HD-E（1.0-1.5 g/m²）联合或不联合P（80-120 mg/m²）用于复发性SCLC的疗效。结果表明HD-E和P作为挽救治疗是一种有效的治疗方式。寻找新的活性药物是改善治疗结果的另一个重要途径。自1986年以来，日本开展了卡铂的II期研究。目前的数据表明卡铂是一种对SCLC高度有效的药物。最后，有必要进行进一步研究以探索新的治疗模式，从而在当前状况上取得突破。
