Until recently, the first-line treatment of advanced non-small cell lung cancer (NSCLC) required minimal clinical decision making. Patients who were eligible for chemotherapy received a platinum-based doublet, and 5-year survival rates were poor. With the advent of molecularly targeted agents and better tolerated chemotherapies--namely, bevacizumab, erlotinib, and pemetrexed--new therapeutic opportunities have emerged. Some of the strategies that have proven to be successful for the treatment of patients with NSCLC are targeting of the vascular endothelial growth factor, use of maintenance chemotherapy for patients without progression of disease after initial therapy, and tailoring of cytotoxic agents specific to the histology of an individual patient's cancer. Each approach has been independently shown to improve overall survival, but integrating the data from a number of complicated trials into the "best" approach for patients remains challenging. This review attempts to address three fundamental questions clinicians face in choosing first-line and maintenance treatment for advanced NSCLC, particularly nonsquamous histology: Is pemetrexed or a taxane agent better for combination with platinum therapy? Should bevacizumab be used, and is it beneficial when added to pemetrexed chemotherapy? When is maintenance therapy indicated, and which agent is best?
摘要
直至最近，晚期非小细胞肺癌 (NSCLC) 的一线治疗要求最少临床决策制定。符合化疗条件的患者接受铂类双药，但 5 年生存期率不理想。随着分子靶向药物和耐受性更佳的化疗药物（即贝伐珠单抗、厄洛替尼和培美曲塞）的到来，新治疗机会已经浮现。已经证明成功治疗 NSCLC 患者的一些策略是靶向血管内皮生长因子、初始疗法后对无病情进展的患者使用维持疗法以及定制对个体患者的癌组织结构特异的细胞毒药物。每种方案已经独立地显示改善总生存期，但是将源自许多复杂试验的数据整合成患者的“最佳”方案仍具有挑战性。本综述尝试解决临床医生在选择晚期 NSCLC（尤其是组织学非鳞癌）的一线治疗和维持治疗时面临的三个基础问题：培美曲塞或一种紫杉烷药物比联合铂类药物治疗更好吗? 应当使用贝伐珠单抗并且其增加至培美曲塞化疗时有益吗? 何时提示维持治疗并且哪种药物最好? The Oncologist 2015; 20:299–306
Keywords: Chemotherapy; Disease management; Lung cancer; Metastatic.
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