Bunn P A
University of Colorado Cancer Center, Health Science Center, Denver 80262, USA.
Semin Oncol. 1998 Aug;25(4 Suppl 9):55-61.
Lung cancer remains the major cause of cancer-related death in North America and Europe. Lung cancer causes 28% of all cancer deaths, more than breast, prostate, colorectal, and ovarian cancers combined. Eighty-five percent to 90% of cases of lung cancer are known to be a direct consequence of smoking. Despite this, the incidence of the disease continues to increase dramatically in women, although in the United States, the incidence and mortality rates of lung cancer in men have declined slightly in the last few years. Non-small cell lung cancer (NSCLC) represents 75% to 80% of all primary lung cancers, and approximately 70% of these patients present with unresectable disease. These patients are candidates for palliative radiotherapy and/or chemotherapy, but most of these patients will develop locally advanced or metastatic disease. Currently, the 5-year survival rate across all stages of the disease is 14% in the United States. Until recently, chemotherapy was considered to be more successful in the treatment of small cell lung cancer than NSCLC, but this is no longer true. In a recent meta-analysis of randomized trials in NSCLC, cisplatin-based chemotherapy was shown to prolong survival for patients across all stages of the disease. A role for adjuvant cisplatin-based therapy has been shown in early stage disease, and cisplatin-based therapy was shown to improve survival when combined with radiotherapy in locally advanced disease and as a single modality in metastatic disease. Other randomized trials have shown that cisplatin-based therapy improved quality of life in both stage III and IV NSCLC patients and reduced the cost of medical care compared with best supportive care. Cisplatin-based therapy should therefore be considered the standard treatment for all NSCLC patients with locally advanced or metastatic disease. However, over the last 5 years, five new agents have emerged that have increased single-agent response rates, increased survival, and, for the most part, reduced toxicity. The use of these in two-drug combinations with conventional agents will be compared with new two- and three-drug combinations.
肺癌仍然是北美和欧洲癌症相关死亡的主要原因。肺癌导致所有癌症死亡人数的28%，超过乳腺癌、前列腺癌、结直肠癌和卵巢癌死亡人数的总和。已知85%至90%的肺癌病例是吸烟的直接后果。尽管如此，该疾病的发病率在女性中仍继续急剧上升，不过在美国，男性肺癌的发病率和死亡率在过去几年中略有下降。非小细胞肺癌（NSCLC）占所有原发性肺癌的75%至80%，其中约70%的患者表现为不可切除的疾病。这些患者适合接受姑息性放疗和/或化疗，但这些患者中的大多数会发展为局部晚期或转移性疾病。目前，在美国，该疾病所有阶段的5年生存率为14%。直到最近，化疗在治疗小细胞肺癌方面被认为比NSCLC更成功，但现在情况已不再如此。在最近一项对NSCLC随机试验的荟萃分析中，基于顺铂的化疗被证明可延长该疾病所有阶段患者的生存期。在早期疾病中已显示基于顺铂的辅助治疗有作用，在局部晚期疾病中，基于顺铂的治疗与放疗联合使用时可提高生存率，在转移性疾病中作为单一治疗方式也可提高生存率。其他随机试验表明，与最佳支持治疗相比，基于顺铂的治疗改善了III期和IV期NSCLC患者的生活质量并降低了医疗费用。因此，基于顺铂的治疗应被视为所有局部晚期或转移性NSCLC患者的标准治疗方法。然而，在过去5年中，出现了5种新药物，这些药物提高了单药反应率，延长了生存期，并且在很大程度上降低了毒性。将比较这些药物与传统药物的两药联合使用情况，以及新的两药和三药联合使用情况。
