Shifting the paradigm for maintenance therapy for non-small cell lung cancer

Abstract

Systemic chemotherapy has been the standard treatment for advanced I metastatic non-small-cell lung cancer, particularly in those who do not harbour an epidermal growth factor receptor mutation. In the last decade, there was no established evidence to justify the use of more than 4 to 6 cycles of chemotherapy. However, the use of maintenance systemic chemotherapy and more recently targeted therapy for those who do not show evidence of benefit after standard chemotherapy have been demonstrated to delay progression and more importantly prolong survival. Use of pemetrexed after standard non-pemetrexed chemotherapy has brought an improvement in median survival by 2.8 months. The use of more easily administered erlotinib as maintenance therapy after chemotherapy has been shown to improve the median survival by 1.0 month. Use of bevacizumab, an anti-vascular endothelial growth factor receptor monoclonal antibody, combined with standard chemotherapy to start with also appears to be safe and efficacious. This article elaborates on the rationale, use, and future directions of maintenance therapy after standard chemotherapy for advanced I metastatic non-small-cell lung cancer. © 2010 Hong Kong College of Radiologists. 全身化療已成為晚期或轉移性非小細胞肺癌的標準治療，尤期是那些沒有表皮生長因子受體突變的 病人。過去十年都沒有確實證據支持進行多於四至六個周期的化療。可是已有證據顯示全身性維持 化療以及近期的標靶治療，可以為那些未受惠於標準化療的病人延緩病情惡化，更重要的是可以延 長他們的生存期。病人接受完非培美曲塞的標準化療後再服用培美曲塞（pemetrexed）可以把生存期 中位數增加2.8個月。化療後以簡單易用的埃羅替尼（erlotinib）作維持治療亦可把生存期中位數增加 1.0個月。VEGF抗體貝伐單抗（bevacizumab）結合標準化療似乎同樣安全有效。對於晚期或轉移性 非小細胞肺癌的病人接受完標準治療後所進行的維持治療，本文闡述其理念、用途及未來的發展方 向。