晚期非小细胞肺癌的二线治疗进展

Advance of second-line chemotherapy in advanced non-small cell lung cancer

晚期非小细胞肺癌一线化疗后仅能有一个较短暂的疾病缓解期,绝大部分患者需要进行二线治疗。目前推荐的二线治疗药物主要是多西紫杉醇、培美曲赛和EGFR-TKIs。多西紫杉醇最先确立其二线治疗的地位。培美曲赛通过一项与多西紫杉醇进行随机对照的Ⅲ期研究批准用于晚期NSCLC二线治疗。虽然培美曲赛毒性很轻微,但进一步的临床研究并没有发现高剂量对患者生存有益。EGFR-TKIs靶向治疗是目前研究的热点。吉非替尼和厄洛替尼单药二线治疗具有较好的疗效。吉非替尼与传统化疗对照的研究表明,其疗效不差于多西紫杉醇,且毒性较化疗轻微。厄洛替尼与化疗对照的研究正在进行。其它一些药物不断出现,显示了其在二线治疗的作用,例如口服拓扑替肯和长春氟宁与多西紫杉醇均具有相似的疗效。

There is a temporal disease-free period after 1st line chemotherapy in advanced non-small cell lung cancer （NSCLC）, most of patients need 2nd line chemotherapy. The recommended drugs in the 2nd line were docetaxel, pemetrexed and epidermal growth factor receptor tyrosine kinase inhibitors （EGFR-TKIs）. Single docetaxel is the established therapy for second-line treatment of NSCLC.Pemetexem was validated its indication in the 2nd line in advanced NSCLC through a phase Ⅲ randomised clinical trial which was compared with docetaxel. Although there were little toxicity, the further research can＇t find the survival benefit in high dose pemetrexed. EGFR-TKIs target therapy is a hot spot now. Gefitinib and erlotinib monotherapy have a good efficacy in the 2nd line. The research of gefitinib versus traditional chemotherapy manifested that its efficacy was no less than docetaxel, and was less toxicitity . The comparison of erlotinib with chemotherapy is going on. There are more and more other drugs proved their effect in the 2nd line, such as the efficacy of oral toptecan and vinflunine were similar to docetaxel.