Recent Advances in Systemic Therapy for Non-Small Cell Lung Cancer in Elderly Patients

老年人非小細胞肺癌的近年進展

陳育民(Yuh-Min Chen)

《台灣癌症醫學雜誌》 29卷2期 (2013/06) Pp. 63-72

https://doi.org/10.6323/JoCRP.2013.29.2.1

摘要

目的：回顧更新初次診斷老年非小細胞肺癌的全身性治療。方法：我們由medline與國際醫學會議摘要回顧有關第一線化療或標靶治療的研究，也包括我們自己的研究，著重於老年人的治療或是有提供年齡分組的臨床研究，以更新老年人全身性治療的資訊。結果：如同年輕病患，非小細胞肺癌病患應檢查是否有EGFR活化突變或是ALK重排。如果年老患者有EGFR突變，可先使用EGFR-TKI，如果有ALK重排，可使用crizotinib，而如果是EGFR與ALK原生型或未明的年老患者，可接受單一藥物化療，含鉑或不含鉑的二種藥物化療。體力適合的年老病患化療的腫瘤反應率與存活期不會比年輕病患差。如果是手術後第二或第三期病患，也可以接受輔助性化療。結論：年齡因素不能排除年老患者全身性治療。標靶與化療均可以使用於適合的年老非小細胞肺癌病患。

關鍵字

老年人 ； 非小細胞肺癌 ； 化療 ； 標靶治療

並列摘要

Objective: Our aim was to review and provide updated information about recent advances in systemic therapy for treatment-naïve elderly patients with non-small cell lung cancer (NSCLC).Methods: We reviewed clinical trials, including those we conducted ourselves, of first-line chemotherapy regimens and targeted agents involved with recent advances in systemic treatment options for elderly patients. Such chemotherapy regimens and agents were identified using Medline and through review of relevant presentations at international conferences, which addressed the elderly in particular or provided subgroup information by age.Results: Similar to the approach taken in younger patients, NSCLC patients of all ages should be assessed to ascertain the presence of either tumor epidermal growth factor receptor (EGFR)-active mutation or anaplastic lymphoma kinase (ALK) rearrangement. For patients with EGFR active mutations, an EGFR-tyrosine kinase inhibitor (TKI) could be given as first-line treatment, and crizotinib for patients with an ALK rearrangement. Patients with a wild-type or unknown EGFR and ALK mutation status can be treated with either a single agent, or platinum-based or non-platinum-based doublets. The response rates and median survival times of fit elderly NSCLC patients receiving appropriate chemotherapy, including single-agent, or combination treatment, were no worse than those of younger patients. Physically fit elderly patients may receive platinum-based adjuvant chemotherapy after surgical treatment, if the pathological staging was stage II or III.Conclusions: Advanced age alone should not preclude systemic therapy. Either targeted therapy or chemotherapy should be considered for selected elderly patients with NSCLC who are sufficiently fit.

並列關鍵字

elderly ； non-small cell lung cancer ； chemotherapy ； targeted therapy