晚期NSCLC患者的巩固及后续治疗现状

Current Research on Consolidation Therapy for Advanced Non-small Cell Lung Cancer

  • 摘要: 对于晚期非小细胞肺癌(NSCLC)同步放化疗或一线化疗后病灶稳定(SD)的患者继续的维持治疗称之为巩固及后续治疗。对于不可手术的干性ⅢB期(N3,对侧纵隔、肺门淋巴结或同/对侧斜角肌、锁骨上淋巴结转移)非小细胞肺癌患者,联合放化疗有明显的疗效,而同步放化疗明显优于续贯放化疗,同步放化疗后继续巩固化疗可能是一个很重要的治疗方法,予标准剂量的2~3个疗程的泰索帝巩固治疗较其它方案更加有优势,而后续是否应该改成生物靶点继续治疗目前还没有定论;对于湿性ⅢB期(恶性胸腔积液)和Ⅳ期患者,在一线治疗结束之后病灶SD立即进入二线治疗,较病灶进展后再接受二线治疗临床获益率明显增高,二线给予小剂量的泰索帝35mg/m2进行巩固治疗2~4个疗程与标准剂量化疗的生存情况类似,但毒副反应更加小;Iressa在获益人群中(东方人,女性,非吸烟,腺癌)一线治疗后作为二线治疗的效果是肯定的,这是因为可能这些患者EGFR基因突变率更加高,然而对于临床工作中不加选择随机入选非靶点人群进行靶向治疗则值得商榷。对于晚期NSCLC患者只有个体化治疗,根据循证医学,选择最合适的治疗方法,才能获得最理想的生存时间。

     

    Abstract: Maintenance therapy for patients with advanced NSCLC with persistent stable disease(SD) remaining after concurrent chemoradiotherapy or first-line chemotherapy is called consolidation therapy. For patients with unresectable stage ⅢB NSCLC, concurrent chemoradiotherapy is superior to sequential chemoradiotherapy. Following concurrent chemoradiother-apy, Docetaxel administration at 75mg/m2 for 2 to 3 cycles is preferable over other treatment plans. The benefit of using Iressa in consolidation therapy remains questionable. For wet stage ⅢB and stage Ⅳ cases, immediate consolidation ther-apy benefits the patients more than treatment given after the disease progresses. Compared with the standard second line therapy, a low dose of Docetaxel at 35mg/m2 for 2 to 4 cycles results in the same survival rate, but with less toxicity. Iressa is effective for treating Asian females with adenocarcinoma because their rate of mutation in the gene encoding epidermal growth factor receptor is high. For late stage lung cancer patients, it is essential to make individual treatment plans.

     

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