Vokes E E, Green M R
Department of Medicine, University of Chicago, Illinois, USA.
Cancer Invest. 1998;16(2):72-9. doi: 10.3109/07357909809039760.
Since 1984, the Cancer and Leukemia Group B (CALGB) has focused its clinical research in stage IV non-small cell lung cancer (NSCLC) on investigations of new agents and combinations. Currently, efforts are aimed at identifying non-cisplatin-based combinations with an increased therapeutic index. In stage III disease multimodality therapies have been pursued. Dillman et al. reported a study comparing standard radiotherapy versus induction chemotherapy followed by radiotherapy in patients with unresectable stage III NSCLC. The chemotherapy-treated patients were found to benefit with a 4-month increase in median survival time compared with patients receiving radiotherapy alone (13.8 vs. 9.7 months) and an increased 3-year survival rate of 23% versus 11%. This was the first randomized cooperative group study demonstrating a survival advantage resulting from the use of induction chemotherapy in locoregionally advanced NSCLC. In a subsequent study, the administration of additional "posterior" chemotherapy was not found to be feasible because of early disease progression and toxicity, while the administration of induction chemotherapy followed by concomitant chemoradiotherapy was feasible; therefore, the latter approach was studied further in a randomized phase III setting. This study compared a standard of two cycles of cisplatin and vinblastine followed by radiotherapy with an experimental arm of cisplatin and vinblastine followed by radiotherapy and concomitant carboplatin. Accrual to this study has been completed and results are expected in the near future. In resectable stage III disease, studies have focused on the optimal sequencing of multimodality therapy. A randomized study comparing standard regional therapy with radiotherapy and surgery versus a previously piloted approach combining chemotherapy, surgery, and radiotherapy was closed prematurely due to poor accrual. The next generation of studies in stage III NSCLC will focus on the integration of new chemotherapy agents into the treatment armamentarium for NSCLC. A randomized phase II study investigating paclitaxel, gemcitabine, and vinorelbine in combination with cisplatin in the induction setting and as concomitant chemoradiotherapy has recently been activated.
自1984年以来，癌症与白血病B组（CALGB）将其IV期非小细胞肺癌（NSCLC）的临床研究重点放在新药物及联合用药的研究上。目前，研究工作旨在确定基于非顺铂的联合用药方案，以提高治疗指数。对于III期疾病，已采用多模式疗法。迪尔曼等人报告了一项研究，比较了标准放疗与诱导化疗后放疗在不可切除的III期NSCLC患者中的疗效。结果发现，接受化疗的患者与单纯接受放疗的患者相比，中位生存时间延长了4个月（13.8个月对9.7个月），3年生存率提高，分别为23%和11%。这是第一项随机合作组研究，证明在局部晚期NSCLC中使用诱导化疗可带来生存优势。在随后的一项研究中，由于疾病早期进展和毒性，未发现追加“后续”化疗可行，而诱导化疗后同步放化疗是可行的；因此，在随机III期研究中对后一种方法进行了进一步研究。该研究比较了两个周期顺铂和长春花碱后放疗的标准方案与顺铂和长春花碱后放疗并同步卡铂的试验组。这项研究的入组工作已经完成，预计不久将公布结果。对于可切除的III期疾病，研究重点在于多模式治疗的最佳顺序。一项比较标准区域治疗（放疗和手术）与先前试行的化疗、手术和放疗联合方法的随机研究，由于入组情况不佳而提前结束。III期NSCLC的下一代研究将集中于将新的化疗药物纳入NSCLC治疗方案中。最近启动了一项随机II期研究，在诱导治疗及同步放化疗中研究紫杉醇、吉西他滨和长春瑞滨与顺铂联合使用的情况。
