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      姚波医生,非小细胞肺癌晚期或转移性疾病的全身治疗2017V4

    • 全网发布:2021-05-02 07:15:02 发表者: x2admin

    SYSTEMIC THERAPY FOR ADVANCED OR METASTATIC DISEASE 早期或者转移性疾病的满身医治

    ADVANCED DISEASE: 早期疾病山东省肿瘤病院呼吸外科张品良

    * The drug regimen with the highest likelihood of benefit with toxicity deemed acceptable to both the physician and the patient should be given as initial therapy for advanced lung cancer. 该当赐与最能够受害的、毒性对于医患单方均可承受的药物计划作为早期肺癌的初始医治。

    * Stage, weight loss, performance status, and gender predict survival. 分期、体重加重、普通状况和性别猜测生活。

    * Platinum-based chemotherapy prolongs survival, improves symptom control, and yields superior quality of life compared to best supportive care. 与最好撑持医治比拟,以铂类为根底的化疗延伸生活期、进步病症把持率并可取得更好的糊口品质。

    * Histology of NSCLC is important in the selection of systemic therapy. 正在满身医治的挑选方面非小细胞肺癌的构造学是紧张的。

    * New agent/platinum combinations have generated a plateau in overall response rate (≈ 25%–35%), time to progression (4–6 mo), median survival (8–10 mo), 1-year survival rate (30%–40%), and 2-year survival rate (10%–15%) in it patients. 患者承受新药/铂二联的疗效有个平台:总无效率(≈25%–35%)、至停顿工夫(4–6个月)、中位生活期(8–10个月)、1年生活率(30%–40%)、2年生活率(10%–15%)。

    * Unit patients of any age (performance status 3–4) do not benefit from cytotoxic treatment, except erlotinib, afatinib, or gefitinib for EGFR mutation-positive and crizotinib for ALK-positive tumors of nonsquamous NSCLC or NSCLC NOS. PS 3–四、任何春秋段的患者均不克不及从细胞毒性医治中获益,除厄洛替尼、阿法替尼或者吉非替尼用于医治EGFR渐变阴性以及克唑替尼用于医治ALK阴性的非鳞非小细胞肺癌或者非小细胞肺癌非特指患者。

    First-line Therapy 一线医治

    * There is superior efficacy and reduced toxicity for cisplatin/pemetrexed in patients with nonsquamous histology, in comparison to cisplatin/gemcitabine. 正在构造学非鳞癌患者中,与顺铂/吉西他滨比拟,顺铂/培美曲塞有良好的疗效以及较低的毒性。

    * There is superior efficacy for cisplatin/gemcitabine in patients with squamous histology, in comparison to cisplatin/pemetrexed. 正在构造学鳞癌患者中,与顺铂/培美曲塞比拟,顺铂/吉西他滨有良好的疗效。

    * Two drug regimens are preferred; a third cytotoxic drug increases response rate but not survival. Single-agent therapy may be appropriate in select patients. 首选两药计划;第3个细胞毒药物添加无效率,但没有改进生活。正在挑选性的患者中单药医治能够是公道的。

    * Response assessment after 2 cycles, then every 2–4 cycles with CT of known sites of disease with or without contrast or when clinically indicated. 两周期后评价疗效,而后每一2-4周期或者有临床指征时对于已经知部位强化或者平扫CT反省。

    Maintenance Therapy 保持医治

    * Continuation maintenance refers to the use of at least one of the agents given in first line, beyond 4–6 cycles, in the absence of disease progression. Switch maintenance refers to the initiation of a different agent, not included as part of the first-line regimen, in the absence of disease progression, after 4–6 cycles of initial therapy. 持续保持医治是指正在4至6周期后疾病无停顿者,运用至多一种一线赐与的药物。转换保持医治是指正在4-6周期初始医治后疾病无停顿者,启动一线计划中没有包括的另外一个差别的药物。

    Subsequent Therapy 后续医治

    * Response assessment with CT of known sites of disease with or without contrast every 6–12 weeks. 每一6-12周对于已经知病变部位强化或者平扫CT反省评价疗效。

    See First-line Systemic Therapy Options for Adenocarcinoma, Large cell, NSCLC NOS on NSCL-F (2 of 4) 见NSCL-F(2/4)腺癌、大细胞癌、非特指非小细胞肺癌的一线满身医治计划。

    See First-line Systemic Therapy Options for Squamous Cell Carcinoma on NSCL-F (3 of 4)见NSCL-F(3/4)鳞状细胞癌的一线满身医治计划

    SYSTEMIC THERAPY FOR ADVANCED OR METASTATIC DISEASE+ 早期或者转移性疾病的满身医治

    First-line Systemic Therapy Options 一线满身医治计划

    Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-1)腺癌、大细胞肺癌、非小细胞肺癌非特指(PS 0-1)

    * Bevacizumab/carboplatin/paclitaxel (category 1),*,**,*** 贝伐单抗/卡铂/紫杉醇(1类)

    * Bevacizumab/carboplatin/pemetrexed,*,**,*** 贝伐单抗/卡铂/培美曲塞

    * Bevacizumab/cisplatin/pemetrexed*,**,*** 贝伐单抗/顺铂/培美曲塞

    * Carboplatin/albumin-bound paclitaxel (category 1) 卡铂/白卵白分离型紫杉醇(1类)

    * Carboplatin/docetaxel (category 1)卡铂/多西他赛(1类)

    * Carboplatin/etoposide (category 1) 卡铂/依靠泊苷(1类)

    * Carboplatin/gemcitabine (category 1) 卡铂/吉西他滨(1类)

    * Carboplatin/paclitaxel (category 1) 卡铂/紫杉醇(1类)

    * Carboplatin/pemetrexed (category 1) 卡铂/培美曲塞(1类)

    * Cisplatin/docetaxel (category 1) 顺铂/多西他赛(1类)

    * Cisplatin/etoposide (category 1) 顺铂/依靠泊苷(1类)

    * Cisplatin/gemcitabine (category 1) 顺铂/吉西他滨(1类)

    * Cisplatin/paclitaxel (category 1) 顺铂/紫杉醇(1类)

    * Cisplatin/pemetrexed (category 1) 顺铂/培美曲塞(1类)

    * Gemcitabine/docetaxel (category 1) 吉西他滨/多西他赛(1类)

    * Gemcitabine/vinorelbine (category 1) 吉西他滨/长春瑞滨(1类)

    Adenocarcinoma, Large Cell, NSCLC NOS (PS 2)腺癌,大细胞肺癌,非小细胞肺癌非特指(PS 2)

    * Albumin-bound paclitaxel 白卵白分离型紫杉醇

    * Carboplatin/albumin-bound paclitaxel 卡铂/白卵白分离型紫杉醇

    * Carboplatin/docetaxel 卡铂/多西他赛

    * Carboplatin/etoposide 卡铂/依靠泊苷

    * Carboplatin/gemcitabine 卡铂/吉西他滨

    * Carboplatin/paclitaxel 卡铂/紫杉醇

    * Carboplatin/pemetrexed卡铂/培美曲塞

    * Docetaxel 多西他赛

    * Gemcitabine 吉西他滨

    * Gemcitabine/docetaxel 吉西他滨/多西他赛

    * Gemcitabine/vinorelbine 吉西他滨/长春瑞滨

    * Paclitaxel 紫杉醇

    * Pemetrexed 培美曲塞

    +Albumin-bound paclitaxel may be substituted for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. 正在承受紫杉醇或者多西他赛的患者中,虽然预处置用药仍有过敏反响者,或者规范预处置用药(即地塞米松、H2受体停滞剂、H1受体停滞剂)忌讳者,白卵白分离型紫杉醇能够代替紫杉醇或者多西他赛。

    *Bevacizumab should be given until progression. 该当赐与贝伐单抗直至疾病停顿。

    **Any regimen with a high risk of thrombocytopenia and the potential risk of bleeding should be used with caution in combination with bevacizumab. 任何具备血小板增加高危以及潜伏出血危害的计划,结合贝伐单抗时均应慎重。

    ***Criteria for treatment with bevacizumab: non-squamous NSCLC, and no recent history of hemoptysis. Bevacizumab should not be given as a single agent, unless as maintenance if initially used with chemotherapy.结合贝伐单抗是规范医治:非鳞非小细胞肺癌而且近期无咯血史。贝伐单抗不该单药赐与,除了非最后结合化疗运用而后作为保持。

    SYSTEMIC THERAPY FOR ADVANCED OR METASTATIC DISEASE+早期或者转移性疾病的满身医治

    First-line Systemic Therapy Options 一线满身医治计划

    Adenocarcinoma, Large Cell, NSCLC NOS (PS 0-1) 腺癌、大细胞肺癌、非小细胞肺癌非特指(PS 0-1)

    * Bevacizumab/carboplatin/paclitaxel (category 1),*,**,*** 贝伐单抗/卡铂/紫杉醇(1类)

    * Bevacizumab/carboplatin/pemetrexed,*,**,*** 贝伐单抗/卡铂/培美曲塞

    * Bevacizumab/cisplatin/pemetrexed*,**,*** 贝伐单抗/顺铂/培美曲塞

    * Carboplatin/albumin-bound paclitaxel (category 1) 卡铂/白卵白分离型紫杉醇(1类)

    * Carboplatin/docetaxel (category 1) 卡铂/多西他赛(1类)

    * Carboplatin/etoposide (category 1) 卡铂/依靠泊苷(1类)

    * Carboplatin/gemcitabine (category 1) 卡铂/吉西他滨(1类)

    * Carboplatin/paclitaxel (category 1) 卡铂/紫杉醇(1类)

    * Carboplatin/pemetrexed (category 1) 卡铂/培美曲塞(1类)

    * Cisplatin/docetaxel (category 1) 顺铂/多西他赛(1类)

    * Cisplatin/etoposide (category 1)顺铂/依靠泊苷(1类)

    * Cisplatin/gemcitabine (category 1) 顺铂/吉西他滨(1类)

    * Cisplatin/paclitaxel (category 1) 顺铂/紫杉醇(1类)

    * Cisplatin/pemetrexed (category 1) 顺铂/培美曲塞(1类)

    * Gemcitabine/docetaxel (category 1) 吉西他滨/多西他赛(1类)

    * Gemcitabine/vinorelbine (category 1) 吉西他滨/长春瑞滨(1类)

    Adenocarcinoma, Large Cell, NSCLC NOS (PS 2) 腺癌,大细胞肺癌,非小细胞肺癌非特指(PS 2)

    * Albumin-bound paclitaxel 白卵白分离型紫杉醇

    * Carboplatin/albumin-bound paclitaxel 卡铂/白卵白分离型紫杉醇

    * Carboplatin/docetaxel 卡铂/多西他赛

    * Carboplatin/etoposide 卡铂/依靠泊苷

    * Carboplatin/gemcitabine 卡铂/吉西他滨

    * Carboplatin/paclitaxel 卡铂/紫杉醇

    * Carboplatin/pemetrexed 卡铂/培美曲塞

    * Docetaxel 多西他赛

    * Gemcitabine 吉西他滨

    * Gemcitabine/docetaxel 吉西他滨/多西他赛

    * Gemcitabine/vinorelbine 吉西他滨/长春瑞滨

    * Paclitaxel 紫杉醇

    * Pemetrexed 培美曲塞

    +Albumin-bound paclitaxel may be substituted for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. 正在承受紫杉醇或者多西他赛的患者中,虽然预处置用药仍有过敏反响者,或者规范预处置用药(即地塞米松、H2受体停滞剂、H1受体停滞剂)忌讳者,白卵白分离型紫杉醇能够代替紫杉醇或者多西他赛。

    *Bevacizumab should be given until progression. 该当赐与贝伐单抗直至疾病停顿。

    **Any regimen with a high risk of thrombocytopenia and the potential risk of bleeding should be used with caution in combination with bevacizumab. 任何具备血小板增加高危以及潜伏出血危害的计划,结合贝伐单抗时均应慎重。

    ***Criteria for treatment with bevacizumab: non-squamous NSCLC, and no recent history of hemoptysis. Bevacizumab should not be given as a single agent, unless as maintenance if initially used with chemotherapy.结合贝伐单抗是规范医治:非鳞非小细胞肺癌而且近期无咯血史。贝伐单抗不该单药赐与,除了非最后结合化疗运用而后作为保持。

    First-line Systemic Therapy Options 一线满身医治计划

    Squamous Cell Carcinoma (PS 0-1) 鳞状细胞癌(PS 0-1)

    * Carboplatin/albumin-bound paclitaxel (category 1) 卡铂/白卵白分离型紫杉醇(1类)

    * Carboplatin/docetaxel (category 1) 卡铂/多西他赛(1类)

    * Carboplatin/gemcitabine (category 1) 卡铂/吉西他滨(1类)

    * Carboplatin/paclitaxel (category 1) 卡铂/紫杉醇(1类)

    * Cisplatin/docetaxel (category 1)顺铂/多西他赛(1类)

    * Cisplatin/etoposide (category 1)顺铂/依靠泊苷(1类)

    * Cisplatin/gemcitabine (category 1) 顺铂/吉西他滨(1类)

    * Cisplatin/paclitaxel (category 1) 顺铂/紫杉醇(1类)

    * Gemcitabine/docetaxel (category 1) 吉西他滨/多西他赛(1类)

    * Gemcitabine/vinorelbine (category 1)吉西他滨/长春瑞滨(1类)

    Squamous Cell Carcinoma (PS 2) 鳞状细胞癌(PS 2)

    * Albumin-bound paclitaxel 白卵白分离型紫杉醇

    * Carboplatin/albumin-bound paclitaxel 卡铂/白卵白分离型紫杉醇

    * Carboplatin/docetaxel 卡铂/多西他赛

    * Carboplatin/etoposide 卡铂/依靠泊苷

    * Carboplatin/gemcitabine 卡铂/吉西他滨

    * Carboplatin/paclitaxel 卡铂/紫杉醇

    * Docetaxel 多西他赛

    * Gemcitabine 吉西他滨

    * Gemcitabine/docetaxel 吉西他滨/多西他赛

    * Gemcitabine/vinorelbine 吉西他滨/长春瑞滨

    * Paclitaxel 紫杉醇

    +Albumin-bound paclitaxel may be substituted for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (ie, dexamethasone, H2 blockers, H1 blockers) are contraindicated. 正在承受紫杉醇或者多西他赛的患者中,虽然预处置用药仍有过敏反响者,或者规范预处置用药(即地塞米松、H2受体停滞剂、H1受体停滞剂)忌讳者,白卵白分离型紫杉醇能够代替紫杉醇或者多西他赛。

    ++Cisplatin/gemcitabine/necitumumab in the first-line setting and erlotinib or afatinib in the second-line setting are not used at NCCN institutions for these indications related to the efficacy and safety of these agents compared to the efficacy and safety of other available agents.正在NCCN机构中关于这些顺应症,基于这些药物的疗效与平安性以及其余可用药物的疗效与平安性比拟较,顺铂/吉西他滨/奈昔妥珠单抗不必于一线、厄洛替尼或者阿法替尼不必于二线。

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