晚期非小细胞肺癌的维持治疗

目前晚期非小细胞肺癌（NSCLC）一线治疗标准是以铂类为基础的双药化疗.标准疗程化疗后当疾病处于控制状态时下一步处理存在着很大争议,维持治疗逐渐应用于晚期NSCLC的治疗中.晚期NSCLC维持治疗可分为继续维持治疗与换药维持治疗,目前多用于维持治疗的培美曲塞和厄洛替尼已被证实可提高总体生存率.     

晚期非小细胞肺癌维持治疗进展

晚期非小细胞肺癌(NSCLC)标准一线化疗方案的疗效已达到了一个平台期.研究证实化疗药物、分子靶向药物维持治疗可延长晚期NSCLC患者的生存期.免疫治疗成为晚期NSCLC的维持治疗,还需进一步研究证实.     

晚期非小细胞肺癌维持治疗的研究进展

目的:总结维持治疗在晚期非小细胞肺癌中的研究进展,探讨维持治疗的意义。方法:应用PubMed和CNKI期刊全文数据库检索系统,以"NSCLC maintenancetherapy及非小细胞肺癌,维持治疗"为关键词,共检索到2001-2011年相关文献284篇,纳入分析25篇。结果:维持治疗是近年来为延长晚期NSCLC患者生存期并提高其生存质量而出现的新的治疗观点,目前已有多项临床试验证实标准一线化疗结束使疾病获得控制后,继续给予维持治疗可以显著延长患者的无疾病进展生存期(progression-free survival,PFS),部分药物可以显著延长总生存(overall survival,OS),患者耐受良好。结论:维持治疗可以使晚期NSCLC患者获益,但是其最终疗效和患者的病理类型、EGFR突变状况、体力状况和对药物的耐受情况密切相关,结合患者的实际情况,进行个体化治疗,是NSCLC患者未来治疗的方向。     

晚期非小细胞肺癌维持治疗探讨

肺癌大多起病隐匿,发现时已属中晚期,根治性治疗较困难,大多需要后续长期治疗.本文主要通过分析我院不同时期晚期非小细胞肺癌(NSCLC)采取的包括细胞毒类药物、生物制剂、中医药等在内的不同维持治疗方法的疗效,探讨晚期NSCLC的维持治疗方案的个体差异,并给出一种维持治疗的个体化选择方案,使患者的生存时间得到延长,生活质量得到提高.     

晚期非小细胞肺癌的维持治疗进展

化疗在晚期非小细胞肺癌（NSCLC）治疗中占有重要的地位,但是现有化疗方案已经达到＂化疗疗效平台＂。为了保持现有的疗效,提高肿瘤缓解率和生存期,提出了维持治疗的概念。维持治疗是指患者在完成标准的几个化疗周期且疾病得到控制后再接受的治疗,架起一二线治疗间的桥梁,维持治疗已经逐渐被认可。全文从化疗药物、靶向药物及中医中药等方面综述晚期NSCLC的维持治疗新进展。     

Ⅲb＋Ⅳ期晚期肺癌53例治疗效果分析

肺癌是一种恶性程度极高且易复发、转移的恶性肿瘤。Rivera报道,在新诊断的肺癌中,非小细胞肺癌（non-small cell lung cancer,NSCLC）占80％～85％,而其中有1／3在初次确诊时已为局部晚期,不能手术的中晚期NSCLC约占全部NSCLC的3／4。针对晚期肺癌,临床根据患者病情发展的不同时期及不同转移部位,综合应用多学科治疗方法,以减轻患者痛苦,延长生命,维持较好的生存质量。     

中医药维持治疗晚期非小细胞肺癌的现状分析

近年来,中医药对晚期非小细胞肺癌（NSCLC）的维持治疗在国内多地开展。本文梳理了维持治疗的理论基础、主要内容和现状,并对近年中医药在这一领域的相关文献报道进行整理。通过对现有成果的归纳分析,得出中医药维持治疗晚期NSCLC既有改善临床症状、延长无进展生存期、提高生活质量等优势,同时存在研究规模小、高质量研究少、数据说服力不强等不足。期待更多高质量、规范化的临床研究能够开展。     

非小细胞肺癌分子靶向治疗药物的现状及进展

目前肺癌以高发病率、高死亡率居我国恶性肿瘤病死率的首位,严重威胁着人类的健康,其中非小细胞肺癌（non-small cell lung cancer ,NSCLC ）约占肺癌的80% ～90% 。遗憾的是大多数患者就诊时已为晚期,错失了外科手术的机会,故内科治疗成为NSCLC 晚期患者的主要治疗方法。近些年来分子靶向治疗药物取得了巨大的进展,为NSCLC 晚期患者提供了新的治疗手段。本文将就NSCLC 的分子靶向药物治疗作一介绍,希望能对临床上NSCLC 晚期患者的个体化治疗有所裨益。      

培美曲塞维持治疗晚期非小细胞肺癌的临床研究

目的:观察晚期非小细胞肺癌(NSCLC)培美曲塞维持化疗的疗效。方法:选择经一线培美曲塞+顺铂方案化疗4周期后获得疾病控制的晚期NSCLC患者32例,在完成4周期化疗后第21天开始应用培美曲塞维持化疗直至疾病进展。主要观察近期疗效、TTP及不良反应。结果:32例晚期NSCLC患者共完成维持化疗141周期,TTP为4.4个月。主要不良反应为白细胞减少、疲乏及皮疹,但均可忍受。结论:晚期NSCLC患者一线化疗稳定后应用培美曲塞维持化疗是安全的,可明显延长患者的TTP,不良反应可耐受。     

BIM在晚期非小细胞肺癌治疗中的作用

肺癌是全世界范围内发病率和死亡率最高的恶性肿瘤,其中非小细胞肺癌（non-small cell lung cancer,NSCLC）是肺癌中最常见的类型。随着对肺癌发病机制、生物学行为的深入研究及基因检测水平的提高,以表皮生长因子受体（epidermal growth fac? tor receptor,EGFR）和间变淋巴瘤激酶（anaplastic lymphoma kinase,ALK）为靶点药物的发现,在晚期NSCLC个体化治疗的发展中具有里程碑式的意义。BIM（Bcl-2 interaction mediator of cell death）是Bcl-2家族促凋亡蛋白中的一员,参与细胞凋亡的重要介质。近年来,有研究证实BIM的表达水平及多态性会影响晚期NSCLC靶向治疗及化疗的疗效。本文就BIM及其在晚期NSCLC靶向治疗及化疗中的作用进行综述。      

晚期非小细胞肺癌的中医维持治疗

晚期非小细胞肺癌（ＮＳＣＬＣ）维持治疗是肿瘤学专家在化疗疗效达到“瓶颈”后为延长患者生存时间所提出的一种新型治疗模式,主要包括化疗维持和靶向维持,目前维持治疗尚存在较多的争议,临床上尚未完全推行。本文通过论述中医药治疗晚期ＮＳＣＬＣ的现状及优势,分析中医药进行维持治疗的优势及可行性,并对维持治疗的发展进行探索,希望中医药在晚期ＮＳＣＬＣ维持治疗中能有新的突破和进展。     

晚期非小细胞肺癌维持治疗的新进展

 目前含铂两药化疗是晚期非小细胞肺癌（NSCLC）患者的一线治疗方案。然而,标准一线化疗方案的疗效已达到了一个平台,晚期NSCLC患者在一线治疗获得了客观缓解或疾病稳定后的维持治疗是目前研究的热点。培美曲塞成为晚期肺癌患者一线治疗达到缓解或稳定后的新的治疗手段,其耐受性好,提高了总体生存时间和无疾病进展时间,并且对于非鳞癌患者疗效显著。厄洛替尼（商品名：特罗凯）与一线化疗序贯治疗能显著延长患者无进展生存期,有研究表明标准治疗后的晚期NSCLC患者,无论病理类型、种族、性别、年龄、吸烟状态,应用厄洛替尼维持治疗均可临床获益且耐受性好。含铂两药一线化疗后使用吉非替尼（商品名：易瑞沙）维持治疗,可以给腺癌患者带来显著的临床获益。     

Maintaining clarity: Review of maintenance therapy in non-small cell lung cancer

The purpose of this article is to review the role of maintenance therapy in the treatment of advanced non-small cell lung cancer (NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options for advanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.     

Systemic chemotherapy for advanced non-small cell lung cancer: recent advances and future directions

Systemic therapy improves the survival and quality of life of patients with advanced stage non-small cell lung cancer (NSCLC). Several new therapeutic options have emerged for advanced NSCLC, incorporating novel cytotoxic agents (taxanes, gemcitabine, pemetrexed) and molecular-targeted agents (erlotinib, bevacizumab). Efforts to improve the outcome of first-line therapy for advanced and metastatic NSCLC have primarily focused on the addition of targeted agents to platinum-based two-drug regimens. Bevacizumab, an antibody against vascular endothelial growth factor, is the first drug to demonstrate superior outcomes when added to systemic chemotherapy in advanced disease. Evaluation of the role of maintenance therapy following four to six cycles of first-line combination chemotherapy is ongoing. Both cytotoxic agents and targeted agents are suitable for evaluation in the maintenance setting. Promising results have been noted with single-agent paclitaxel as maintenance therapy following four cycles of combination therapy with carboplatin and paclitaxel. Phase III studies are now under way to evaluate the roles of gemcitabine, pemetrexed, and erlotinib as maintenance therapies for patients who experience a response or disease stabilization after four cycles of combination chemotherapy. Whether this approach will be successful in extending the survival of a select group of patients remains to be seen.     

Maintenance strategies in stage IV non-small-cell lung cancer (NSCLC): in which patients,with which drugs?

Four to six cycles of platinum-based chemotherapy are currently recommended for the first-line treatment of advanced non-small-cell lung cancer (NSCLC). Several studies have assessed the benefit of maintenance therapy following platinum-based first-line therapy, to improve disease control, and thus, progression-free and overall survival with minimal toxicity and maintenance or improvement of quality of life of patients. We review here clinical trials evaluating continuation maintenance therapy or switch maintenance therapy in locally advanced or metastatic NSCLC, to highlight the achievements made and critical issues faced. Based on the available results and limitations of these trials, maintenance therapy should be considered a good treatment strategy for a limited subgroup of patients. Maintenance therapy should be personalised according to the characteristics of patients and their disease, taking into account the data available for the agents used in this setting.     

晚期非小细胞肺癌治疗策略

肺癌是临床最常见的恶性肿瘤之一,非小细胞肺癌约占肺癌的80%,由于肿瘤具有隐匿性特点,确诊时大约2/3患者已属晚期。随着医学的发展与新药的研发应用,晚期非小细胞肺癌的疗效有所提升,但仍不十分令人满意,临床中急需在一线、二线、维持以及中医药等综合治疗中,逐步优化治疗策略,使患者生存更加获益。     

The Role of Maintenance Treatment in Advanced Non–Small-Cell Lung Cancer: Reality or Early Second Line?

First-line platinum-based chemotherapy has reached a plateau of effectiveness for the treatment of patients with advanced non-small-cell lung cancer (NSCLC). In patients who reported a stable disease, no more than 4 cycles of chemotherapy are recommended while a maximum of 6 cycles is recommended in patients who are responding to therapy. A potential strategy with the aim of improving outcomes for NSCLC patients is to administer more therapy. This term includes different approaches: duration of therapy, sequential therapy, consolidation therapy, and maintenance therapy. Here, we attempt to define the different approaches that fall under the rubric of maintenance strategy, and discuss the results available to date.     

Maintenance or non-maintenance therapy in the treatment of advanced non-small cell lung cancer: that is the question

Lung cancer is the most common cancer worldwide with non-small cell lung cancer (NSCLC), including squamous carcinoma, adenocarcinoma and large cell carcinoma, accounting for about 85% of all lung cancer types with most of the patients presenting with advanced disease at the time of diagnosis. In this setting first-line platinum-based chemotherapy for no more than 4-6 cycles are recommended. After these cycles of treatment, non-progressing patients enter in the so called "watch and wait" period in which no further therapy is administered until there is disease progression. In order to improve the advanced NSCLC outcomes, the efficacy of further treatment in the "watch and wait" period was investigated. This is the "maintenance therapy". Recently, the results coming from randomized phase III trials investigating two new agents, pemetrexed and erlotinib, in this setting led to their registration for maintenance therapy. Here, we report and discuss these results.     

Maintenance and Consolidation Therapy in Patients with Unresectable Stage III/IV Non‐Small Cell Lung Cancer

Globally, lung cancer is the leading cause of cancer‐related mortality. Current chemotherapy combinations for the first‐line treatment of advanced disease (stage IIIB with malignant pleural effusion/stage IV) and chemoradiotherapy regimens for the treatment of unresectable locally advanced disease (stage IIIA and IIIB without malignant pleural effusion) appear to have reached an efficacy plateau. The addition of new compounds including targeted agents to standard first‐line cytotoxic doublets, administered concurrently and/or as maintenance therapy in patients who have not experienced disease progression after such treatment, has been shown to improve efficacy beyond this plateau in patients with advanced disease. However, to date, such approaches have been less successful in the treatment of patients with unresectable locally advanced stage III disease. The purpose of this review is to summarize the data from recent randomized phase III studies involving agents administered as maintenance or consolidation therapy in the treatment of unresectable stage III/IV non‐small cell lung cancer (NSCLC). A possible alternative approach to the use of cytotoxic or molecularly targeted agents in this setting is the administration of therapeutic anticancer vaccines, which are designed to stimulate a host immunological response against the tumor. Current data in relation to the potential of vaccine therapy for NSCLC are therefore also reviewed, with a particular focus on belagenpumatucel‐L and L‐BLP25 vaccines, which are currently undergoing phase III evaluation as maintenance therapies in patients with unresectable stage III/IV NSCLC who have tumor control following first‐line therapy.