Lung cancer is the most common malignant tumor in the world. According to statistics released by WHO in 1985, there were 896 thousand new ca
Lung cancer is the most common malignant tumor in the world. According to statistics released by WHO in 1985, there were 896 thousand new cases of lung cancer, accounting for about 11.8% of all cancers. Found that nearly 20 years of follow-up, new cases of lung cancer each year at a rate of about 0.5% in growth, has become a serious harm to people's health and life of the common Bofei small cell lung cancer (NonSmallCellLungCancer, CLC) is a small cell in addition to all types of lung cancer, accounting for 75%~80% of all lung cancer. The treatment of lung cancer is mainly treated by surgery. About 30%~40% of CLC patients had distant metastases at diagnosis, and only C (BestSuortiveCare) had an average survival time of 4~5 months for patients with advanced or metastatic disease, if not treated with antineoplastic therapy.
The treatment of advanced non-small cell lung cancer in recent years develops quite rapidly and the emergence of a number of new anticancer drugs such as Changchun vinorelbine, paclitaxel, docetaxel, gemcitabine and irinotecan, since 1994s, has greatly changed the past chemotherapy low efficacy, side effects of the shortcomings. Since 2003 to epidermal growth factor receptor tyrosine kinase inhibitor (EGFRTKI) and vascular endothelial growth factor (VEGF) inhibitor molecular target as the representative of the treatment to provide a new treatment for advanced non-small cell lung cancer. This article reviews the recent advances in the treatment of advanced non-small cell lung cancer.
Advances in chemotherapy of advanced non-small cell lung cancer
At present, there are a number of large randomized controlled studies show that the new platinum based chemotherapy (third generation scheme) is better than that of other platinum containing solution (second generation scheme), efficiency between 30%~40%, one year survival rate is about 40%. Therefore, platinum containing regimens, continuous treatment of 4~6 courses as a first-line treatment of advanced CLC. In 2005, JosephTreat, Kosmidis, AMueller, S.Novello and other scholars put forward new views on the status of platinum containing regimens and the way of administration in the American Society of Clinical Oncology (ASCO).
Ound; ¨ Ò raquooundcopy; comparison of platinum and platinum based regimens
Platinum, especially cisplatin, has been the main drug in the treatment of non-small cell lung cancer. But the non hematologic toxicity of cisplatin such as nausea, vomiting, ear, kidney, long-term neurotoxicity are heavier, hematologic toxicity such as neutropenia, anemia is also common, hindering clinical widely used, even the patient because of adverse reaction of fear and give up treatment. The purpose of the treatment of advanced cancer is not only to prolong survival, relieve symptoms, but also to improve the quality of life. How to balance the relationship between efficacy and side effects of a clinical problem that must be solved, with the third generation of drug treatment of lung cancer, non platinum solution because of its high efficiency, mild side effects and become the focus of clinical research.
D&rsquo, Addario et al. Carried out a Meta analysis of platinum containing regimens compared with non platinum based regimens:
Platinum was more effective than non platinum regimens (both single drug and two drug third generation scheme), and survival, analysis showed that platinum is superior to non platinum for all patients, but two of the three generation combined drug non platinum and platinum two plan drugs for survival are similar. JosephTreat and other scholars at the 2005 ASCO meeting for the first time reported the results of large clinical trials - Alpha test. 982 patients were enrolled in this study and randomly divided into A, B, C group three. A, C two groups were divided into the group of 326 and 328 patients were treated with platinum (A group: Gemcitabine1000mg/m2d1, D8; Carboplatin5.5AUCd1; q21). Group C: Paclitaxel225mg/m2d1; Carboplatin6.0AUCd1; q21. B group of 328 patients received non platinum treatment: Gemcitabine1000mg/m2d1, D8, Paclitaxel200mg/m2d1; q21. There was no statistically significant difference between the three groups in terms of efficiency, time to progression, median survival, and the 1 - and 2 year survival rates (Figure 1). In the aspect of side effects, the A group had more thrombocytopenia and anemia, while the alopecia and neurotoxicity were more obvious in B group and C group. This large sample of clinical studies has shown that platinum containing regimens compared with non platinum regimens have similar efficacy.
Figure 1 Comparison of platinum and non platinum
At the same time, there are other relatively small clinical studies at the 05 annual meeting to support the results of the Alpha study. For example, Kosmidis et al reported 512 cases of patients were randomly divided into combined group Paclitaxel Gemcitabine combined with Carboplatin group and Gemcitabine (Figure 2); the author also reported 82 cases of CLC patients were randomly divided into combined group Vinorelbine Gemcitabine combined with Cilatin group and Gemcitabine. The above research results showed that the curative effect and survival is similar in terms of non platinum and platinum, while the side reactions with the use of drugs vary slightly, but compared with the platinum hematologic toxicity is still relatively weak, the quality of life has improved.
Figure 2GC and GP program comparison of clinical research
To sum up, whether the non platinum program in advanced non-small cell lung cancer chemotherapy can completely replace the platinum drugs, there are still no consistent opinion, there are a number of clinical studies have shown that a non platinum for clinical benefit with the traditional platinum, and less toxicity for some poor, elderly one of the patients, chemotherapy toxicity is large, non platinum chemotherapy is currently the clinical alternatives.
(two) comparison of combination and sequential administration
The combination of 4~6 regimen is the first-line treatment of advanced non-small cell lung cancer, but some patients in the treatment of a variety of serious side effects, a small number of patients died. At the 2005 ASCO annual meeting, Mueller and so on were used to explore the comparison between the combination and sequential therapy. 327 cases of newly diagnosed CLC patients were divided into two groups, A group using conventional Gemcitabine1000mg/m2, D1, D8, Docetaxel75mg/m2, D8, once a week, a total of 6 courses of treatment. B group single drug Gemcitabine (doseop) every 3 weeks, a total of 3 courses, and then Docetaxel (doseop) a 3 week course, shared 3 (if the progress of single drug Gemcitabine immediately replaced by Docetaxel). There was no significant difference between the two groups in the overall survival, TTP, and the effective rate, but the clinical hematological toxicity in the A group was higher than that in the B group (with more cases requiring blood transfusion and more days of antibiotics). The study of surface using sequential treatment was significantly lower than the cost of joint programs and prompt treatment for the development of palliative care in patients with advanced CLC from the pursuit of effective rate to the pursuit of quality of life and cost of treatment in the direction of the trend, but the combined therapy is better than the traditional sequential treatment but also the need for larger studies to verify.
Ound; ¨ arathoroundcopy; maintenance therapy after first-line therapy
Novello and other scholars reported their research on the mode of drug delivery at the annual meeting. The study design is the first two cycles of standard Gemzar patients (1250mg/m2, D1, D8) and Cilatin (75mg/m2, D2) treatment, then for CR or PR or SD were randomly divided into two groups, A group continue to repeat the use of GP for three cycles, B group single drug Gemcitabine (1250mg/m2, D1, D8. 3 cycles). A total of 250 patients were randomly divided into A group and B group (n = 125). The specific cases were shown in table 1. The results showed that the 5 cycle GP treatment group showed a significant survival advantage, but there was no significant difference in TTP between the two groups. After 2 cycles of chemotherapy, the remission rate of the patients in the two groups increased by 15% and 8%, respectively, but A group was significantly higher than that in group B. The trial showed that patients were in good condition
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