射频消融联合分子靶向药物(EGFR-TKI)治疗老年非小细胞肺癌的临床疗效

目的 探究消融联合化疗和靶向药物治疗老年非小细胞肺癌的临床疗效.方法 选取108例非小细胞肺癌老年患者为研究对象,采用随机数表法将其分为观察组和对照组,各54例.对照组患者给予化疗和靶向药物治疗,观察组患者在对照组患者的基础上联合肿瘤消融治疗.对比2组患者的临床疗效、生活质量和不良反应发生情况.结果 观察组的临床总有效率为68.5%,明显高于对照组患者的37.1%,差异具有统计学意义(P<0.05).生活质量各项评分的比较中观察组均显著优于对照组,差异具有统计学意义(P<0.05).观察组疼痛、发热的发生率均显著高于对照组(P<0.05),但腹泻和皮疹的发生率差异均无统计学意义(P>0.05).结论 靶向药物和消融联合化疗治疗老年非小细胞肺癌能够更好地抑制肿瘤的生长,提高临床疗效和改善患者的生活质量,可以在临床上进一步推广和使用.     

非小细胞肺癌脑转移治疗的研究进展

约30%~50%的非小细胞肺癌患者在疾病过程中发生脑转移。随着治疗手段的不断发展,患者的生存期得到明显改善。目前的治疗方法主要有手术、放疗、化疗和靶向药物治疗。虽然治疗方法众多,但如何针对不同患者制定最佳治疗方案,仍需要不断深入研究和总结。全文就近几年非小细胞肺癌脑转移治疗的研究进展作一综述。     

肺癌靶向治疗新进展及展望

近年来,靶向药物治疗已全面改变了肺癌的诊疗模式,并显著地改善了肺癌患者的生存期和生活质量。药物的更新迭代、靶向治疗模式的优化、耐药机制的探索、新靶点新药物的研发,不断地丰富肺癌靶向治疗的内容。针对驱动基因阳性肺癌的靶向治疗最新进展和未来方向进行综述。     

老年晚期非小细胞肺癌研究进展

 老年晚期非小细胞肺癌（NSCLC）的治疗目前尚无统一标准,但一般状况较好的老年患者,单纯放疗或化疗已逐渐成为治疗的主要措施。同步放化疗的综合治疗也能使部分老年患者获益,值得进一步的临床研究。靶向治疗疗效确切,不良反应小,为老年晚期NSCLC的治疗提供了新的治疗模式,但经济负担较重,一般家庭不能接受,故靶向药物及靶向药物与传统抗肿瘤治疗模式的结合尚不能广泛开展。     

老年晚期非小细胞肺癌化疗进展

超过47%非小细胞肺癌(NSCLC)患者在诊断时年龄大于70岁,由于老年患者常常合并其他疾病,所以与年轻人相比对化疗耐受性差.尽管化疗在年轻群体中能够得到很多临床证据,但不能盲目的不经选择的应用于老年NSCLC中.目前有大量的关于老年非小细胞肺癌患者的化疗和靶向治疗的前瞻性研究数据.在老年非小细胞肺癌中,基于Ⅱ期和Ⅲ期临床试验,单药化疗主要为第三代化疗药物(长春瑞滨,吉西他滨,紫杉醇),认为是所有患者的常规治疗方案,Ⅱ期临床试验同时也显示出以铂类为基础联合方案的可行性和有效性.同样在相关的Ⅱ期临床中也显示了靶向治疗表皮生长因子酪氨酸激酶抑制剂(厄洛替尼和吉非替尼)及抗血管生成药物(贝伐单抗)作为老年患者一线治疗的可行性.本文对老年晚期非小细胞肺癌化疗新进展进行综述.     

化疗序贯EGFR-TKIs治疗晚期非小细胞肺癌的机制及疗效

随着肿瘤分子生物学研究的发展,表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)在晚期非小细胞肺癌治疗中占有重要地位,特别针对于EGFR突变型患者.但基于分子靶向药物并未明显改善患者的总生存时间及出现获得性耐药问题,如何将传统化疗药物与靶向药物有机结合延长晚期患者的总生存时间受到广泛关注.化疗序贯EGFR-TKIs模式被证实为其中一项颇有前景的治疗策略.本文将结合相关研究对化疗序贯EGFR-TKIs治疗晚期非小细胞肺癌(NSCLC)的机制及疗效进行综述.     

非小细胞肺癌孤立性骨转移的治疗

非小细胞肺癌（NSCLC）骨转移的治疗方法有手术、化疗、放疗等。近年来分子靶向治疗如地诺单抗成为NSCLC骨转移新的治疗方法。尽管治疗手段众多,但是NSCLC骨转移患者预后仍未得到明显改善。对于孤立性骨转移患者,积极的治疗可改善患者的生存及预后。     

老年人肺癌治疗概况

简述了老年人肺癌的发生情况、老年肺癌患者的生理、病理特点及治疗情况。包括老年肺癌患者手术的术式和注意事项;放疗的适用方法;化疗的药物及剂量选择及靶向治疗和中医药治疗的概况等。对老年肺癌患者,延长生存期、提高生活质量是治疗的目的,在治疗中应遵循个体化原则,按照患者的病情和体质选择治疗方案。     

贝伐单抗治疗原发肺癌新进展

在2007年ASCO会议上,有关肺癌靶向治疗联合化疗的各临床试验结果分别揭晓.贝伐单抗(BEV)作为一种抑制血管生成的靶向治疗药物已用于临床,它与肺癌传统治疗(化疗/放疗)及其他靶向药物的高联合疗效及低毒性反应令人鼓舞.研究者正在进行扩大研究样本及统计总体生存期的临床试验,希望这种药物能使进展期肺癌患者的预后得到改善.     

中医药维持治疗晚期非小细胞肺癌的可行性探讨

晚期非小细胞肺癌维持治疗越来越受肯定,现以化疗或靶向治疗模式为主,但化疗药物的毒性蓄积,甚至过度治疗等问题却成为维持化疗的瓶颈,靶向药物的价格昂贵也给患者维持带来不便,中医药治疗晚期肺癌在改善临床症状、提高生活质量及延长生存期方面彰显优势.全文就中医药维持治疗晚期肺癌的可行性作一分析.     

Treatment of elderly patients or patients who are performance status 2 (PS2) with advanced Non-Small Cell Lung Cancer without epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations – Still a daily challenge

Cytotoxic chemotherapy remains the core treatment strategy for patients with advanced non-small cell lung cancer (NSCLC) with tumours that do not have actionable molecular alterations, such as epidermal growth factor receptor (EGFR)-sensitising mutations, anaplastic lymphoma kinase (ALK) translocations or ROS1 translocations. Age and performance status (PS) are two pivotal factors to guide treatment decisions regarding the use of chemotherapy in lung cancer patients. Lung cancer is predominantly a disease of the elderly, with more than two-thirds of patients aged ≥65 years, the current definition of ‘elderly’. The prevalence of poor PS, as estimated by patients themselves, can be as high as 50%. Both the elderly and PS2 patients are underrepresented in clinical trials. Therefore, optimising treatment strategy for the subgroup of elderly or PS2 patients with advanced NSCLC remains challenging as a result of a paucity of clinical trial data. The current review focusses on the elderly or PS2 patients without actionable oncogenic drivers and attempts to summarise current available data on recent treatments trials including angiogenesis inhibitors and immune-checkpoint inhibitors.     

Epidermal growth factor receptor tyrosine kinase inhibitors in elderly or poor performance status patients with advanced non-small cell lung cancer

Elderly and poor performance status advanced non-small cell lung cancer (NSCLC) patients often tolerate chemotherapy poorly. Special approaches are needed for these patient populations. Tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR), erlotinib and gefitinib, are active agents in the treatment of advanced NSCLC. Several phase II trials have been conducted utilizing EGFR TKIs in elderly or poor performance status patients with advanced NSCLC. This review will summarize the results of erlotinib or gefitinib in these subsets of patients with advanced NSCLC.     

Recent topics in chemotherapy for elderly patients with lung cancer

With the prolongation of life expectancy in Japan, lung cancer is increasing not only in the elderly but also in poor-risk patients who can not undergo standard chemotherapy. Because survival benefits from chemotherapy are clearly expected in patients with small-cell lung cancer (SCLC), standard chemotherapy should be established for the elderly as well as for poor-risk patients with SCLC. We recently reported that the combination of AUC-based carboplatin and a standard dose of intravenous etoposide was an active and relatively nontoxic regimen for elderly patients with SCLC (J Clin Oncol 17: 3540-3545, 1999). Had chemotherapy with concurrent chest irradiation been used for patients with limited disease (LD), better survival might have been achieved in this study. However, Pignon et al. reported that combined chemoradiotherapy in elderly patients with LD-SCLC is a possible poor prognostic factor in their meta-analysis. A recent randomized controlled clinical trial has shown that vinorelbine monotherapy contributed to longer survival in elderly patients with advanced non-small-cell lung cancer (NSCLC), compared to best supportive care. Several retrospective studies have shown that cisplatin can be safely and effectively administered to elderly patients who are eligible for protocol treatment. However, there have been no randomized trials indicating that cisplatin-based combination chemotherapy improves survival in elderly patients with advanced NSCLC, compared to single-agent chemotherapy. Similarly, the role of combined chemoradiotherapy remains controversial in elderly patients with locally advanced NSCLC. Thus, standard therapies proven to be beneficial to non-elderly patients with lung cancer have not always been proven to be beneficial to elderly patients. In order to solve these difficult problems, phase III studies are warranted in elderly or poor-risk patients with lung cancer. Moreover, new agents with relatively low toxicities recently approved in Japan should be applied in clinical trials for the elderly or poor-risk patients with lung cancer.     

晚期非小细胞肺癌抗血管生成治疗联合免疫检查点抑制剂的研究进展

近年来,转移性或局部晚期非小细胞肺癌的治疗取得了较大的进展,特别是在一线治疗或治疗后出现进展的患者。通过联合治疗提高疗效已成为该领域的主要研究方向,对于没有驱动基因突变或对靶向治疗无效的患者,这种探索尤为迫切。有证据表明促血管生成因子具有免疫抑制活性,这使得研究人员开始评估抗血管生成药物联合免疫检查点抑制剂治疗晚期非小细胞肺癌的潜在协同作用。本文就抗血管生成药物联合免疫检查点抑制剂治疗晚期非小细胞肺癌的理论基础及临床研究进行综述。     

Practice pearls in the management of lung cancer in the elderly

Lung cancer is a disease that afflicts the elderly. It is a leading cause of cancer mortality worldwide. Treatment of lung cancer which was predominantly combination chemotherapy was initially thought to be too toxic for older patients with cancer due to their frail state. However a number of recent studies have shown that this is not necessarily true and many elderly can actually tolerate combination chemotherapy and derive just as much benefit from it as younger patients with lung cancer do. More recently it has been found that a significant proportion of lung cancer patients have tumors that harbor mutations that are targetable by molecularly targeted therapy (MTT). These targeted therapies have a much better tolerated side effect profile, hence have been used in elderly patient with lung cancer with great success. A new generation of drugs called immune checkpoint inhibitors have now come into the fray with exciting results in the second line treatment of lung cancer with a low side effect profile. A key element in deciding whether an elderly patient with lung cancer can tolerate treatment involves a detailed assessment using the comprehensive geriatric assessment (CGA). A number of CGA and clinical factors have also been found to be able to predict chemotherapy associated toxicity. This review of lung cancer in the elderly was part of a lecture on “Practice pearls in the management of lung cancer in the elderly” presented at the SIOG Annual Meeting in Prague in November 2015.     

BAI及BAE术治疗老年中晚期肺癌的疗效观察

目的 观察支气管动脉灌注化疗(BAI)及化疗栓塞术(BAE)治疗老年中晚期肺癌患者的疗效.方法采用BAI及BAE术治疗老年中晚期肺癌患者,观察其近期疗效及毒副反应.结果32例患者中CR 2例,PR 15例,SD 7例,PD 8例,有效率为53.12%.结论采用BAI及BAE治疗老年中晚期肺癌疗效确切,且毒副反应能耐受.     

培美曲塞二线治疗老年晚期非小细胞肺癌的临床观察

目的：探讨培美曲塞二线治疗老年晚期非小细胞肺癌的疗效及不良反应。方法：老年晚期非小细胞肺癌患者34例,采用培美曲塞500 mg/m2,静脉滴注,第1天;21d为1周期,至少2周期后评价疗效。结果：有效率（RR）为14.7%,中位TTP 3.2个月,中位生存期7.9个月。主要毒副反应为骨髓抑制及消化道反应。结论：培美曲塞二线治疗老年晚期非小细胞肺癌的近期疗效较好,且患者耐受性好,值得临床推广。     

晚期肺鳞癌的治疗

肺癌是全世界肿瘤死亡的首要原因,肺鳞癌（squamous cell lung cancer, SQCLC）作为肺癌的一种常见的病理类型,全世界每年约40余万人因其致死。其常规治疗方法主要包括手术治疗、化学治疗和分子靶向治疗。但是大多数患者确诊的时候已经是晚期,失去了手术的机会。尽管分子靶向治疗在肺腺癌的治疗中具有里程碑式的作用,但是对肺鳞癌而言,尚无特异性的分子靶标药物,因此,对于晚期肺鳞癌的标准治疗仍是含铂双药方案。而大多数患者经历了一线、二线治疗失败后都面临无药可用的状态。本文旨在对晚期肺鳞癌的常规治疗进行系统性的综述,探讨晚期肺鳞癌的治疗方案以及发展方向。     

Chemotherapy in elderly patients with advanced non-small cell lung cancer

Because of increasing life expectancy and of higher risk of cancer with ageing, lung cancer in elderly is a frequent disease. For a long time nihilism influenced treatment decisions in elderly patients with advanced non-small cell lung cancer. Since the beginning of the last decade single agent chemotherapy has been accepted as standard of care, vinorelbine and gemcitabine being the most frequently used drugs in Europe and US, docetaxel in Japan.Platinum-based doublets have been shown to be superior to monotherapy in young and fit patients with advanced non-small cell lung cancer. Although there were some indications from subgroup analyses of clinical trials not specifically dedicated to elderly patients that a platinum-based doublet might also benefit to older patients, there was no definitive proof of concept until ASCO meeting 2010. At this meeting results of a phase 3 trial showed that PS 0-2 patients, aged 70-89 years drove a significant benefit from a treatment with carboplatin associated to weekly paclitaxel compared to a monotherapy. Thus, the paradigm of treatment in elderly patients should perhaps be modified from a single agent to doublet chemotherapy. Whether other platinum-based doublets would provide the same benefit as the specific one studied remains to be evaluated.     

厄洛替尼治疗老年晚期非小细胞肺癌的临床观察

背景与目的 非小细胞肺癌(NSCLC)约占肺癌的80%,其中70%以上为晚期患者.本文评价单药厄洛替尼治疗老年晚期非小细胞的客观疗效及毒副反应.方法 观察29例老年晚期NSCLC,口服厄洛替尼150 mg/d,记录临床疗效及毒副反应,共观察3个月,统计分析结果 .结果 29例患者均可评价疗效,总有效率为20.69%(6/29),其中CR 1例,PR 5例,SD 9例,PD14例.Ⅲ期与Ⅳ期患者有效率比较差异没有统计学意义(P=0.337).毒副反应主要为1-2级毒性反应,包括皮疹(37.93%)、腹泻(17.24%)和呕吐(6.9%).3例患者因严重毒性反应终止厄洛替尼治疗,其中1例患者口服21 d后出现典型肺纤维化.结论 单药厄洛替尼治疗老年NSCLC有较高的临床有效率,患者耐受性尚可,值得临床进一步研究.