After failure of first-line chemotherapy for advanced non-small cell lung cancer, many patients remain candidates to receive further antitumor treatment. To guide clinical management of these patients and to suggest priorities for clinical research, an International Panel of Experts met in Naples (Italy) in April 2007. Results and evidence-based conclusions are presented in this article. Single-agent chemotherapy with docetaxel or pemetrexed is the recommended option for unselected patients with performance status 0 to 2 who are candidates for second-line chemotherapy for advanced non-small cell lung cancer. Docetaxel has demonstrated superiority compared with best supportive care. Pemetrexed has been shown to be noninferior to docetaxel, with a more favorable toxicity profile. Erlotinib is effective in pretreated patients, and can be given second-line in patients not suitable or intolerant to chemotherapy, and in all patients as third-line treatment after failure of second-line chemotherapy. Gefitinib failed to show superiority to placebo as second- or third-line treatment, but it has been shown to be noninferior to docetaxel. In selected patients such as lifetime nonsmokers or those of East-Asian ethnicity, erlotinib, or gefitinib (where licensed) may be considered as second-line treatment even if they are fit for chemotherapy. Best supportive care in addition to active treatment remains important for all patients, but may be the exclusive option for patients unsuitable for more aggressive therapy. Further research is mandatory, to find better treatments, and to identify clinical and molecular predictive markers of efficacy, both for chemotherapy and for novel biologic agents.
J Thorac Oncol. 2008 Apr;3(4):430-40. 认领翻译，如果48小时内未交稿，请其他战友认领 进展期非小细胞肺癌患者在一线化疗失败后，许多人仍有机会接受进一步的抗癌治疗。为了指导此类病人的临床治疗并优先进行相关临床研究，2007年4月在意大利那不勒斯召开了国际专家小组会。本文列出了结果和循证医学结论。对非选择性的0到2期的进展期非小细胞肺癌患者，二线化疗推荐采用多西他赛或培美曲塞单药化疗。多西他赛证明效果优于最好的支持疗法。培美曲塞效果不逊于多西他赛，甚至在低毒副作用上更胜一筹。埃洛替尼在预处理的病人身上有效，可作为不适合或难以耐受化疗的患者的二线用药，并可作为所有二线化疗失败患者的三线用药。吉非替尼在二线和三线治疗中与安慰剂相比无优势，但其作用不逊于多西他赛。在筛选的病人中，如终生不吸烟者或东亚人种，埃洛替尼或吉非替尼（在许可区域）可考虑作为二线治疗，甚至在它们适于化疗的时候。积极化疗辅以最佳支持治疗对病人仍很重要，但应除外那些不适合更强力化疗的病人。对化疗和生物制剂疗法的进一步研究刻不容缓，以探索更好的治疗方案，鉴定疗效的临床和分子预测指标。 [标签:content1][标签:content2]
作者:admin@医学,生命科学 2011-07-22 05:14