序贯、交替、巩固化疗对晚期非小细胞肺癌的价值

The value of sequential, alternating and consolidation chemotherapy in advanced non-small-cell lung cancer

含铂的两药联合化疗仍然是PS0-1分晚期非小细胞肺癌(NSCLC)患者的一线标准治疗方案,晚期NSCLC一线治疗的缓解率仅为20%～40%,中位生存时间为8～10个月.为了提高治疗的疗效,不同方案组合化疗成为研究的热点,主要包括序贯化疗、轮替化疗和巩固化疗.对于PS0～1分、能耐受毒副反应的患者,临床医师可以考虑含铂的联合化疗方案随后单药治疗.对于年龄较大、身体情况较差不能耐受含铂化疗的患者,临床医师可以考虑单药治疗随后用单药治疗的序贯给药方式.迄今为止没有一个临床试验可以证实交替化疗比标准化疗疗效好.在标准的4～6个周期一线化疗后,在能耐受毒副反应的情况下,巩固化疗可能为患者提高生存质量.

A platinum-based doublet with a third-generation agent represents the standard first-line treatment for advanced non-small cell lung cancer patients with good performance status (PS). Traditional chemotherapy provides response rates of 20 %-40 % and a median survival of 8-10 months. In an attempt to improve its outcome, alternative schedules have been proposed, namely sequential, alternating, and maintenance therapy. Sequential chemotherapy with a platinum-based doublet followed by a single agent is feasible in patients with good PS; The use of sequential single agents is an option for elderly and frail patients unsuitable for a platinum-based combination. Based on trials published so far, it is unlikely that an alternating chemotherapy strategy will be proved superior to standard chemotherapy in patients with good PS.Consolidation chemotherapy may provide additional benefit for patients achieving disease control after standard first-line chemotherapy.