2011年晚期非小细胞肺癌诊疗规范中药物应用解读

非小细胞肺癌发病率、死亡率的逐年攀升,使其成为肿瘤防治领域最受关注的疾病之一。针对晚期非小细胞肺癌的规范化治疗是提高患者生存时间、改善生活质量的关键点。本文将以2011年《美国国立综合癌症网络非小细胞肺癌临床实践指南》中晚期非小细胞肺癌诊疗规范内容为基础,解读具体药物及治疗方案的临床选择。     

IEP方案与MVP方案治疗非小细胞肺癌的疗效对比

目前治疗非小细胞肺癌的化疗方案较多,以含铂类的方案治疗非小细胞肺癌的疗效为人们认可.我们从2000年2月至2001年7月采用IEP方案治疗非小细胞肺癌33例,并与同期MVP方案治疗非小细胞肺癌36例对比,现总结报告如下:     

小细胞肺癌靶向治疗研究进展

小细胞肺癌是一种生长快、易转移的肺神经内分泌肿瘤,约占肺癌发病总数的15%。临床上治疗小细胞肺癌一般采用放化疗结合,在治疗初期通常响应良好,但病人很快产生耐药和复发。早期开发的靶向药物的临床测试均不太理想,迫切需要新的靶向药物和有效的治疗手段。近年来,随着对小细胞肺癌病理机制的深入了解和转化研究,开发了多种针对小细胞肺癌遗传变异的靶向药物,如激酶抑制剂、血管生成抑制剂、凋亡通路抑制剂、蛋白酶体抑制剂、表观遗传抑制剂、免疫检查点抑制剂等。部分靶向治疗正在进行临床试验,同时多种针对小细胞肺癌的新型治疗策略如免疫治疗和联合用药也值得关注。该文总结小细胞肺癌的分子机制和靶向药物的研究进展,以及在此基础上已完成、正在开展的临床研究和临床前研究的现状,同时展望未来可能的小细胞肺癌新型治疗策略。     

IAP方案治疗中、晚期非小细胞肺癌58例报告

目的IAP方案治疗中、晚期非小细胞肺癌的近期疗效及毒、副反应的观察。方法58例中、晚期非小细胞肺癌,其中初治35例,复治23例。结果IAP方案治疗非小细胞肺癌总有效率为50％,初治病例有效率为57．1％,复治病例有效率为39．1％。结论IAP方案治疗中、晚期非小细胞肺癌疗效较佳,用药安全,可做为一线及复治患者二线方案用药。     

不同化疗方案治疗晚期非小细胞肺癌的疗效研究

目的分析探讨不同化疗方案治疗晚期非小细胞肺癌的临床疗效和不良反应,寻求最佳治疗方案。方法收集洛阳市中心医院肿瘤科初治Ⅲ～Ⅳ期晚期非小细胞肺癌患者共70例,按随机法分为单用药组和联合用药组,每组各35例,分别采用单用药化疗方案和联合用药化疗方案进行治疗,于不同化疗方案4周后对其临床疗效进行分析比较。结果 70例患者治疗后均可评价,单用药组化疗方案有效率为31.4%,联合用药组化疗方案有效率为45.7%,两组比较差异具有统计学意义(P<0.05);联合用药组在恶心、呕吐发生率,白细胞下降率,血小板下降发生率较单用药组,明显下降,差异具有统计学意义差异(P<0.05)。结论联合用药化疗方案治疗晚期非小细胞肺癌临床疗效肯定,不良反应可耐受,可供临床化疗选择。     

金龙胶囊联合化疗治疗晚期非小细胞肺癌的临床观察

目的 评价金龙胶囊联合化疗治疗晚期非小细胞肺癌的疗效、毒副反应及对生活质量、免疫功能的影响.方法 85例非小细胞肺癌患者被分为治疗组和对照组,其中治疗组接受NP方案化疗,同时口服金龙胶囊;对照组仅接受同样方案化疗.结果 治疗组有效率高于对照组,白细胞降低程度明显低于对照组.结论 金龙胶囊联合化疗治疗非小细胞肺癌具有增效减毒及提高免疫功能的作用,可作为化疗的辅助治疗药物.     

盐酸埃克替尼靶向治疗晚期非小细胞肺癌的不良反应观察和护理

目的观察国家一类新药盐酸埃克替尼靶向治疗晚期非小细胞肺癌的不良反应,探讨临床护理方法。方法针对30例给予单药盐酸埃克替尼靶向治疗达4个月的晚期非小细胞肺癌患者,严密观察用药后反应,给予对症护理,并加强用药指导及心理护理。结果 30例应用盐酸埃克替尼治疗的非小细胞肺癌患者出现如下不良反应:皮疹8例(26.7%),腹泻4例(13.3%),恶心、呕吐5例(16.7%),轻度肝功能损害2例(6.7%),用药期间给予对症护理,均未因不良反应而中断治疗。结论盐酸埃克替尼治疗晚期非小细胞肺癌期间,加强不良反应的观察和护理,重视心理护理及用药指导,有助于保证用药安全性和提高治疗依从性。     

干预前后非小细胞肺癌辅助性用药情况调查与分析

目的:了解临床药师干预前后我院非小细胞肺癌辅助治疗性用药情况,为探讨临床药师参与制订治疗方案及肿瘤多学科综合会诊的合理性提供依据。方法 :对我院2008—2012年病历进行查阅、分析,比较和评价综合规范前后非小细胞肺癌辅助性用药合理性情况。结果:临床药师参与临床后,用药合理性明显提高,降低了不合理的支出,减少了药品不良反应的发生。结论:临床药师应参与非小细胞肺癌的临床治疗工作,从而可增强临床用药合理性。     

小细胞肺癌的临床病理分析

目的探折小细胞肺癌的临床病理,为科学诊疗该类疾病提供可靠的临床依据。方法选取我院2009年7月至2013年7月间收治的100例小细胞肺癌病患,系统探讨提高生存率的各项治疗、放疗、化疗方法,对其预后的影响要素加以分析。结果处于广泛期的小细胞肺癌治疗方案以全身化疗为主,选用卡铂作为化疗方案;局限期的治疗运用EP方案治疗3～6周期,搞好胸部放射;治疗之后,肺部肿瘤得以彻底缓解者应施行全颅放疗。以上疗法均收获了较为满意的临床效果,符合该疾病的临床病理学。结论对小细胞肺癌临床病理的科学分析是做好疾病治疗工作的重要基础。     

血清P53抗体检测在非小细胞肺癌诊断中的应用

非小细胞肺癌目前主要以外科治疗为主,但是约有80%的患者在就诊时已经失去手术时机[1].如何提高肺癌患者的早期诊断水平、治疗水平是重要的研究课题.     

Opportunities and obstacles of targeted therapy and immunotherapy in small cell lung cancer

Abstract

Small cell lung cancer (SCLC) is an aggressive malignant tumour which accounts for approximately 13–15% of all newly diagnosed lung cancer cases. To date, platinum-based chemotherapy are still the first-line treatments for SCLC. However, chemotherapy resistance and systemic toxicity limit the long-term clinical outcome of first-line treatment in SCLC. Recent years, targeted therapy and immunotherapy have made great breakthrough in cancer therapy, and researchers aim to exploit both as a single agent or in combination with chemotherapy to improve the survival of SCLC patients, but limited effectiveness and the adverse events remain the major obstacles in the treatment of SCLC. To overcome these challenges for SCLC therapies, prevention and early diagnosis for this refractory disease is very important. At the same time, we should reveal more information about the pathogenesis of SCLC and the mechanism of drug resistance. Finally, new treatment strategies should also be taken into considerations, such as repurposing drug, optimising of targets, combination therapy strategies or prognostic biomarkers to enhance therapeutic effects and decrease the adverse events rates in SCLC patients. This article will review the molecular biology characteristics of SCLC and discuss the opportunities and obstacles of the current therapy for SCLC patients.     

Optimal drugs for second-line treatment of patients with small-cell lung cancer

Introduction: Despite the high response rate to chemotherapy, there have been few advances in the treatment of small-cell lung cancer (SCLC) in the last decades. The state-of-the-art second-line therapy and future research developments in relapsed SCLC are reviewed.

Areas covered: There are no optimal drugs for second-line treatment of recurrent SCLC but only agents registered for this use. Topotecan remains the standard-of-care for the treatment of second-line platinum-sensitive SCLC patients worldwide, while amrubicin is another option, but registered only in Japan. To date, no targeted agents reporting interesting results in second-line SCLC treatment are available. The next-generation DNA sequencing should discover somatic gene alterations and their roles in SCLC to help in selecting patients who could benefit from a targeted agent. Two immunotherapeutics, ipilimumab and nivolumab, have shown promising preliminary results and are being investigated in ongoing trials.

Expert opinion: Second-line treatment is not an option for most SCLC patients. Given the evidence up to now, the potentials for immuno-oncology in SCLC are high. The hope is that these expectations are met, and that all drugs being developed will offer new and improved treatment options for SCLC patients.     

肺癌合并上腔静脉综合征29例分析

目的 分析肺癌合并上腔静脉综合征（SVCS）的临床特点及治疗方法。方法 29例患者临床资料回顾性分析。结果 24例单纯化疗的患者中，临床症状缓解率为87.5%，肿瘤的客观有效率为62.5%。其中小细胞肺癌的客观有效率为100％。结论 化疗可以作为肺癌合并SVCS患者，尤其小细胞肺癌患者首选的治疗方法。     

Advances in pharmacotherapy of small cell lung cancer

Introduction: Small cell lung cancer (SCLC) is an aggressive malignancy characterized by early metastatic dissemination and responsiveness to initial therapy. The incidence of SCLC has been declining over the past two decades. Limited-stage SCLC is a potentially curable disease with long-term survival of ～ 20% when treated with platinum-based chemotherapy plus concurrent thoracic radiation and prophylactic cranial irradiation. For patients with extensive-stage SCLC, survival can be increased with combination platinum-based chemotherapy, but the disease remains incurable.

Areas covered: This review looks at the current advances in pharmacotherapy for SCLC.

Expert opinion: Many chemotherapeutic strategies and newer cytotoxic agents have been evaluated in SCLC, and some had promising activity in early clinical trials. However, none have demonstrated consistent improvements in outcome over standard platinum-based treatment. Similarly, although many potential molecular targets have been identified in preclinical studies of SCLC, molecularly targeted therapy has yet to demonstrate any substantial activity in clinical trials. Nonetheless, future advances in this disease will undoubtedly depend on improvements in our understanding of the molecular mechanisms that drive the proliferation and survival of SCLC cells.     

Medical treatment of small cell lung cancer: state of the art and new development

Introduction: Small cell lung cancer (SCLC) is a rapidly progressive disease that accounts for approximately 15% of all lung cancers. Chemotherapy remains the cornerstone of treatment of SCLC, but in the last two decades, its progress has reached a plateau. Although a significant sensitivity to chemotherapy and radiotherapy is a feature of SCLC, an early development of drug resistance unavoidable occurs during the course of the disease. Second-line treatment for relapsed patients remains a very challenging setting, with a limited clinical benefit.

Areas covered: A thorough analysis of various therapeutic strategies reported in literature for SCLC treatment was performed. This review includes novel therapeutic approaches such as maintenance or consolidation treatments, new chemotherapy agents and targeted therapy.

Expert opinion: Against this background, there is a desperate need for the development of novel active drugs. Among these, amrubicin has also shown more favourable antitumor activity, and is the most promising at present. Concerning targeted agents, these have failed to demonstrate effectiveness for SCLC and a better understanding of the molecular mechanisms is clearly needed. In the future, further investigations are required to clarify the role of novel anti-angiogenic or pro-apoptotic agents and hedgehog pathway inhibitors.     

CEA、NSE、CYFRA21-1联合检测在肺癌诊断中的价值

目的 探讨血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)和神经特异性烯醇化酶(NSE)对肺癌诊断的价值.方法 采取血清标本 42例,其中腺癌12 例、鳞癌 21例、小细胞癌9 例,肺部良性病变31 例,采用电发光技术检测.结果 CEA、CYFRA21-1和NSE在肺癌组的敏感性分别为 47.61%、4...     

小细胞肺癌中RECK基因的表达及与VEGF和MVD的关系

目的 探讨RECK基因与血管内皮生长因子(VEGF)表达、微血管密度(MVD)在小细胞肺癌(SCLC)的表达和相关性,及其与临床病理特征的联系.方法 采用免疫组化SP法检测43例肺癌组织和10例癌旁正常肺组织中RECK和VEGF、MVD的表达水平.结果 SCLC癌组织中RECK蛋白表达低于癌旁正常组织(P值为0.003),VEGF蛋白表达和MVD值高于癌旁正常组织(P值分别为0.011和0.001).三个指标在临床病理特征分析中数据差异未见统计学意义.RECK与VEGF表达无相关,RECK与MVD呈现负相关,且当VEGF表达高时两者负相关更加显著.结论 RECK基因与SCLC的侵袭和转移可能有一定关系.RECK、VEGF、MVD与患者的临床病理特征未见明显相关性.     

骨桥蛋白和粘附蛋白CD44v6在肺癌组织的表达及临床意义

目的 探讨骨桥蛋白OPN和粘附蛋白CD44v6在肺小细胞癌和肺鳞状细胞癌进展中所起的作用及其对患者预后的影响.方法 应用免疫组织化学法检测134例肺癌组织标本中OPN和CD44v6的表达情况,比较分析肺小细胞癌患者和肺鳞状细胞癌患者的3年生存率.结果 OPN和CD44v6在肺小细胞癌中的表达均明显低于在肺鳞状细胞癌中的表达,差异有统计学意义(P＜0.01);在肺鳞状细胞癌中,OPN和CD44v6的表达呈正相关(r=0.395,P＜0.01);在肺鳞状细胞癌中仅CD44v6 的表达差异有统计学意义(P＜0.05).两种肺癌患者3年生存率差异有统计学意义(P＜0.05).结论 提示CD44v6可作为判断肺鳞状细胞癌预后的独立指标,而OPN不可作为其预后的独立指标,但二者可以联合作为判断肺鳞状细胞癌预后的参考指标.     

小细胞肺癌的CT表现与诊断

目的：探讨小细胞肺癌(SCLC)的CT表现与诊断。方法：回顾性分析了经手术病理证实的63例SCLC的CT表现。结果：肺内肿块、肺门与纵隔广泛性淋巴结肿大，而肺不张少见是SCLC的CT表现特点。结论：小细胞肺癌的CT表现有一定的特征性，CT扫描是诊断SCLC的有效检查方法。     

Chemotherapy strategies in the treatment of small cell lung cancer

Lung cancer is the most prevalent, yet most preventable malignancy worldwide. Given the tendency of small cell lung cancer (SCLC) to early relapse and its subsequent resistance to treatment, there is an urgent need to optimize standard treatment strategies and develop new treatments. Over the last decade, several strategies have been adopted and advances in the molecular biology of lung cancer have identified a number of targets for future therapy. In this article, we review chemotherapy strategies that have been evaluated in the management of patients with SCLC.