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題名 | 非小細胞肺癌的維持性治療=Maintenance Therapy in Non-Small Cell Lung Cancer |
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作者姓名(中文) | 簡采汝; 林哲斌; |
作者姓名(外文) | Chien, Tsai-ju; Lin, Che-pin; |
書刊名 | 臺灣癌症醫學雜誌 |
卷期 | 26:2 2010.04[民99.04] |
頁次 | 頁45-54 |
分類號 | 415.468 |
語文 | chi |
關鍵詞 | 非小細胞肺癌; 維持性治療; 標靶治療; Non small cell lung cancer; Maintenance therapy; Targeted therapy; |
中文摘要 | 維持治療是一個比較新的概念在非小細胞肺癌治療。根據NCCN 治療指引認為在進 展性非小細胞癌經一線化療後,可有持續維持性治療(Continuation maintenance)及轉換 性維持治療(Switch maintenance)兩種。近年來大型臨床研究結果顯示在4-6 次的含鉑 (platinum based)化學治療後給予維持性治療可延長這些進展性非小細胞癌患者的無進 展存活率(PFS)。 Pemetrexed(商品名:愛寧達)是FDA 已通過用於非小細胞癌的維持治療,2009 Lancet 對其相對於最佳支持療法之優勢已作發表。而第二線使用Taxotere(歐洲紫杉醇)之好處 亦有報導。分子標靶藥物近年的蓬勃,包括口服類酪胺酸脢抑制劑(tyrosine kinase inhibitors): Gefitinib 及Erlotinib 有大型臨床試驗(IPASS for Gefitinib; SATURN, ALTAS for Erlotinib)支持其於非小細胞肺癌二線治療之療效,後者(Erlotinib)在FDA 已通過為維持治療之選擇。非口服製劑之標靶選擇之兩大類:抗血管內皮生長抗體(Anti-VEGF. ex. Bevacizumab; Trail: ECOG 4599, AVAiL)及抗表皮生長因子受體之抗體(Anti-EGFR ex. Cetuximab; Trail: FLEX)在此一議題上均有無病存活率之優勢。本文將回顧以上用於進展 性非小細胞癌的維持性及二線治療的相關數篇大型研究,冀對目前臨床上非小細胞肺癌 之維持性治療有一整體輪廓。 |
英文摘要 | Maintenance therapy is defined as continuation of therapy after disease response to induction or first line treatment. It has been applied to patients with advanced stage non-small cell lung cancer (NSCLC) in the past few years. Recent trials have shown a benefit of maintenance therapy after 4 to 6 cycles of chemotherapy. These trials have shown improved progression-free survival in non-small cell lung cancer patients receiving second-line therapeutic agents. Pemetrexed (FDA approved for NSCLC maintenance therapy) and Taxotere have recently been shown to improve median progression-free survival in the maintenance setting. Molecular targeted therapies (e.g., anti-VEGF and anti-EGFR agents) also have the potential to be effective in maintaining tumor regression after an initial response to chemotherapy. The addition of molecular targeted agents such as bevacizumab (in Avail trial) and cetuximab (in FLEX trial) to combination chemotherapy in the frontline setting has been associated with modest improvement. Erlotinib (SATURN and ALTAS trials) has also been shown to improve progression-free survival in patients receiving second- or third-line treatment for stage IIIB/IV NSCLC. In this article we will review recent data on maintenance therapy with chemotherapeutic and targeted agents in advanced NSCLC. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。