小细胞肺癌(SCLC)复发患者的治疗方法

SCLC复发后标准治疗方法包括:

很多SCLC患者在复发时仍可接受进一步治疗。

化疗

虽然有研究显示二线化疗可缩小肿瘤,但缓解期通常较短,中位生存时间很少超过12个月,二线治疗后中位生存时间通常短于6个月[1]。对一线化疗的反应能够预测对后续二线治疗的反应。

如其他化疗敏感的肿瘤(例如霍奇金淋巴瘤和卵巢上皮癌等),接受二线化疗的患者主要可分为两类:敏感和耐药患者。敏感患者一线治疗后从治疗完成开始计算的缓解时间大于90天。这些患者经二线治疗获益最大。化疗敏感的患者中约有50%对相同方案仍有反应,但可能出现累积毒性反应[2]。化疗耐药患者为一线治疗后未缓解或初次治疗后90天内复发的患者[3]。 拓扑替康、伊立替康与吉西他滨等药物的多项II期临床研究发现对药物的治疗反应很大程度上取决于肿瘤为敏感性、耐药性还是难治性[4][5][6][7][8]。[ 证据等级:3iiiDii​]

拓扑替康是SCLC复发后的标准化疗。敏感性肿瘤患者可能对很多药物有良好反应,包括拓扑替康、伊立替康、紫杉烷、长春瑞滨、紫杉醇或吉西他滨等[4][5][6][7][8][9][10][11]。[ 证据等级:3iiiDii​]联合治疗的缓解率通常优于单药治疗[12][13]。但很多研究并未区别报道患者是敏感型、耐药型还是难治型。

姑息治疗

有中枢神经系统(CNS)复发的患者通常加用化疗和(或)放疗可缓解症状。一项回顾性综述发现CNS复发后增加化疗的患者中43%对二线化疗有良好反应[16]。 绝大多数放疗患者在放疗后达到客观缓解[17]

总结中信息不可作为保险报销决策的依据。关于保险覆盖的更多信息见Cancer.gov网站上应对癌症:经济、保险和法律信息页面。支气管内梗阻性病变或支气管外肿瘤压迫的患者中,一些患者通过经支气管镜激光治疗(仅适用于支气管内病变)和(或)近距离放射治疗后可成功缓解症状[18]。对于恶性肿瘤气道梗阻患者,可在局麻下经气管镜放入膨胀式金属内支架以缓解症状、改善肺功能[19]

初次化疗失败后的进展性胸内肿瘤患者可通过外部放疗达到显著的肿瘤缓解、症状缓解并实现短期局部控制。仅有极少数患者在挽救性放疗后可长期生存[20]

处于临床评估阶段的治疗方法

处于临床评估阶段的SCLC复发患者的治疗方法包括新药I、II期临床试验。

目前开展的临床试验

现招募 小细胞肺癌复发​患者的美国临床研究请参见美国NCI癌症临床研究列表,可根据部位、药物、干预或其他标准进行筛选。

NCI网站提供关于临床试验的基本信息。

参考文献

1. Davies AM, Evans WK, Mackay JA, et al.: Treatment of recurrent small cell lung cancer. Hematol Oncol Clin North Am 18 (2): 387-416, 2004.[PUBMED Abstract]

2. Postmus PE, Berendsen HH, van Zandwijk N, et al.: Retreatment with the induction regimen in small cell lung cancer relapsing after an initial response to short term chemotherapy. Eur J Cancer Clin Oncol 23 (9): 1409-11, 1987.[PUBMED Abstract]

3. Giaccone G, Donadio M, Bonardi G, et al.: Teniposide in the treatment of small-cell lung cancer: the influence of prior chemotherapy. J Clin Oncol 6 (8): 1264-70, 1988.[PUBMED Abstract]

4. Sandler AB: Irinotecan in small-cell lung cancer: the US experience. Oncology (Williston Park) 15 (1 Suppl 1): 11-2, 2001.[PUBMED Abstract]

5. van der Lee I, Smit EF, van Putten JW, et al.: Single-agent gemcitabine in patients with resistant small-cell lung cancer. Ann Oncol 12 (4): 557-61, 2001.[PUBMED Abstract]

6. Masuda N, Fukuoka M, Kusunoki Y, et al.: CPT-11: a new derivative of camptothecin for the treatment of refractory or relapsed small-cell lung cancer. J Clin Oncol 10 (8): 1225-9, 1992.[PUBMED Abstract]

7. Perez-Soler R, Glisson BS, Lee JS, et al.: Treatment of patients with small-cell lung cancer refractory to etoposide and cisplatin with the topoisomerase I poison topotecan. J Clin Oncol 14 (10): 2785-90, 1996.[PUBMED Abstract]

8. Masters GA, Declerck L, Blanke C, et al.: Phase II trial of gemcitabine in refractory or relapsed small-cell lung cancer: Eastern Cooperative Oncology Group Trial 1597. J Clin Oncol 21 (8): 1550-5, 2003.[PUBMED Abstract]

9. Eckardt JR, von Pawel J, Pujol JL, et al.: Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J Clin Oncol 25 (15): 2086-92, 2007.[PUBMED Abstract]

10. Ardizzoni A, Hansen H, Dombernowsky P, et al.: Topotecan, a new active drug in the second-line treatment of small-cell lung cancer: a phase II study in patients with refractory and sensitive disease. The European Organization for Research and Treatment of Cancer Early Clinical Studies Group and New Drug Development Office, and the Lung Cancer Cooperative Group. J Clin Oncol 15 (5): 2090-6, 1997.[PUBMED Abstract]

11. Furuse K, Kubota K, Kawahara M, et al.: Phase II study of vinorelbine in heavily previously treated small cell lung cancer. Japan Lung Cancer Vinorelbine Study Group. Oncology 53 (2): 169-72, 1996 Mar-Apr.[PUBMED Abstract]

12. Smit EF, Fokkema E, Biesma B, et al.: A phase II study of paclitaxel in heavily pretreated patients with small-cell lung cancer. Br J Cancer 77 (2): 347-51, 1998.[PUBMED Abstract]

13. Rocha-Lima CM, Herndon JE 2nd, Lee ME, et al.: Phase II trial of irinotecan/gemcitabine as second-line therapy for relapsed and refractory small-cell lung cancer: Cancer and Leukemia Group B Study 39902. Ann Oncol 18 (2): 331-7, 2007.[PUBMED Abstract]

14. von Pawel J, Schiller JH, Shepherd FA, et al.: Topotecan versus cyclophosphamide, doxorubicin, and vincristine for the treatment of recurrent small-cell lung cancer. J Clin Oncol 17 (2): 658-67, 1999.[PUBMED Abstract]

15. O'Brien ME, Ciuleanu TE, Tsekov H, et al.: Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol 24 (34): 5441-7, 2006.[PUBMED Abstract]

16. Kristensen CA, Kristjansen PE, Hansen HH: Systemic chemotherapy of brain metastases from small-cell lung cancer: a review. J Clin Oncol 10 (9): 1498-502, 1992.[PUBMED Abstract]

17. Carmichael J, Crane JM, Bunn PA, et al.: Results of therapeutic cranial irradiation in small cell lung cancer. Int J Radiat Oncol Biol Phys 14 (3): 455-9, 1988.[PUBMED Abstract]

18. Miller JI Jr, Phillips TW: Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thorac Surg 50 (2): 190-5; discussion 195-6, 1990.[PUBMED Abstract]

19. Wilson GE, Walshaw MJ, Hind CR: Treatment of large airway obstruction in lung cancer using expandable metal stents inserted under direct vision via the fibreoptic bronchoscope. Thorax 51 (3): 248-52, 1996.[PUBMED Abstract]

20. Ochs JJ, Tester WJ, Cohen MH, et al.: "Salvage" radiation therapy for intrathoracic small cell carcinoma of the lung progressing on combination chemotherapy. Cancer Treat Rep 67 (12): 1123-6, 1983.[PUBMED Abstract]

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