非小细胞肺癌化疗现状

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1、非小细胞肺癌化疗现状：艰难前行中的一丝曙光？1非小细胞肺癌化疗是全世界医生面前的难题：（1）肿瘤细胞克隆具多样性，生物行为复杂，倍增时间不一，难以用一种或几种方案覆盖全部。（2）瘤细胞对药物具较强抗拒性，各种药物均难达到根治。（3）化疗药物毒副作用较强，降低患者生活质量、缩短存活时间（化疗还是支持治疗更好？）。探索：提高治疗效果、减少不良反应、提高生活质量、延长生存时间。曾用药物：ADM,CTX,VCR,MMC等，因疗效差、毒性大已少采用。二线新药：TAX,GEM,NVB等，尝试组成新的有效方案。2循证医学和Meta－分析Meta分析III期临床试验随机III期临床试验II期临床试验个

2、例报道体内/体外试验I期临床试验国际公认的大样本随机对照试验结果是证明某种疗法的有效性和安全性最可靠的依据（金标准）3No.ofevents/no.ofpatientsenteredTrialSupportivecarepluschemotherapySupportivecareObserved–expecteddeathsVarianceLong-termalkylatingagents:Oxford120/12162/6716.4043.80Quebec20/2018/18–4.387.99Subtotal140/14180/8512.0251.79Vincaalkaloid

3、s/etoposide:Gwent296/11167/75–5.1538.00Subtotal96/11167/75–5.1538.00Cisplatin-based:RLW835184/8680/81–8.0639.94NCICCTG95/9751/53–11.2828.24Southampton17/1715/151.167.55NRH44/4440/432.9318.72UCLA31/3230/31–4.8314.53Ancona163/6365/65–5.7230.95AOI-Udine52/5250/50–14.9818.77CEP-8523/2521/24–10.526.6

4、1Subtotal409/416352/362–51.31165.31TOTAL645/668499/522–44.44255.090.51.01.52.0SupportivecarepluschemotherapybetterSupportivecare(control)better化疗与BSC治疗非小细胞肺癌比较:Meta-分析结果BritishMedicalJournal11:19954化疗与BSC治疗非小细胞肺癌比较:Meta-分析结果BritishMedicalJournal11:1995风险比P值%绝对受益1年生存率(15%)中位生存期(4月)长效烷化剂1.260.0

5、95-6%-1月长春花碱or依托泊甙0.870.44%含铂方案0.73<0.00110%1.5月5ClinicalPracticeGuidelinesCTprolongssurvivalCTshouldbePlatinum-basedCTshouldbeinitiatedearlyCTshouldnotexceed6-8cyclesPlatin-basedCTisrecommendedforPS0-1patients晚期NSCLC一线化疗方案的选择:JCO15,8,2996-3018,19976Stratification:Stage:IIIBvsIVPS:0–1vs2WtLoss:

6、5%vs5%CNSMets:novsyesArmA:Cisplatin+PaclitaxelPaclitaxel:135mg/m2/24hDay1Cisplatin:75mg/m2Day2q3wkArmD:Carboplatin+PaclitaxelPaclitaxel:225mg/m2/3hDay1Carboplatin:AUC6Day1ArmC:Cisplatin+DocetaxelDocetaxel:75mg/m2Day1Cisplatin:75mg/m2Day1ArmB:Cisplatin+GemcitabineGemcitabine:1000mg/m2Days1,8,15

7、Cisplatin:100mg/m2Day1q4wkq3wkq3wkSchillerJH,etal.ProcASCO36thAnnualMeeting.2000;19:abstr2.SchillerJH,etal.NEnglJMed.2002;346:92-98.RANDOMIZE晚期NSCLC一线化疗方案的选择:ECOG1594:StudyDesign7Paclitaxel+CisplatinGemcitabine+CisplatinDoce