现行晚期非小细胞肺癌治疗策略

肿瘤分子标志物的应用对肺癌化疗药物的选择及预测治疗效果有重要意义。对于具有良好行为状态（performance status,PS）评分的患者,以铂类为基础的双药联合治疗方案可延长生存期、改善生活质量、减少肿瘤相关症状。对于PS评分差的或高龄患者推荐单药化疗。二线治疗的选择包括：多西他赛、培美曲塞、吉非替尼和厄洛替尼。其中,培美曲塞对于非鳞癌患者可获益,吉非替尼则应用于EGFR突变患者。尽管治疗方法和可选择的药物不断发展,晚期非小细胞肺癌患者生存期仍有限,新的治疗方法和临床研究都有待进一步探索。

A systematic review of the treatment strategies for advanced non-small cell lung cancer

Lung cancer is the world＇s leading reasons of cancer caused death.The majority of patients bear non-small cell lung cancer（NSCLC）.And most of them have already locally advanced or distant metastasis when clinical diagnose.The most common histological type is adenocarcinoma,followed by squamous cell carcinoma,large cell carcinoma and undifferentiated carcinoma,et al.For patients of good performance status（PS） scores,platinum-based double-agent regimen could prolong survival period,improve quality of life and reduce tumor-related symptoms.Without clinical benefit,the addition of a third cytotoxic drug could only increase toxicity.It＇s tumor molecular markers that show great significance on chemotherapy drug options and treatment efficacy prediction.Patients will receive better survival benefits if we combines platinum-based double-agent regimen with molecular targeted drug,such as bevacizumab.Such patients must meet non-squamous cell carcinoma,PS score ≤ 1,no brain metastases,no hemoptysis,no uncontrolled hypertension and no need of anticoagulant therapy.Low PS score patients,as chemotherapy brings little clinical benefits,are currently recommended single-agent chemotherapy.It＇s also the standard chemotherapy of most elderly patients（≥ 70 years old）,who are thought to be receiving clinical benefits.Elderly patients with good PS scores,who could accept platinum-based chemotherapy without untolerable side-effects,will receive survival benefits similar to young people.Recently,non-smoking patients are divided into a special population.They share some certain clinical,molecular characteristics and obtain benefits from epidermal growth factor receptor tyrosine kinase inhibitors（EGFR TKI）.Once progressing after first-line treatment,the patients have several second-line therapy options,including docetaxel,pemetrexed,gefitinib and erlotinib.Pemetrexed is for non-squamous cell carcinoma patients,and gefitinib should be used in patients with EGFR mutations.Although the alternative drugs and treatment methods develop all the time,survival period in patients with advanced NSCLC is still limited.Clinical researches of new treatment methods and drugs have to be explored further.