非小细胞肺癌NCCN指南2017第4版讨论:贝伐单抗

非小细胞肺癌NCCN指南2017第4版讨论:靶向治疗

Bevacizumab 贝伐单抗

In 2006, the FDA approved bevacizumab for patients with unresectable, locally advanced, recurrent, or metastatic non-squamous NSCLC. The ECOG recommends bevacizumab in combination with paclitaxel/carboplatin for select patients with advanced non-squamous NSCLC based on the results of phase 2 to 3 clinical trials (ECOG 4599). To receive treatment with bevacizumab and chemotherapy, patients must meet the following criteria: non-squamous NSCLC and no recent history of hemoptysis. Any regimen with a high risk for thrombocytopenia—and, therefore, possible bleeding—should be used with caution when combined with bevacizumab. Bevacizumab in combination with chemotherapy (ie, carboplatin/paclitaxel, carboplatin/pemetrexed, cisplatin/pemetrexed) is one of the recommended options for patients with a PS 0 to 1 and non-squamous NSCLC or NSCLC NOS and negative or unknown test results for ALK or ROS1 rearrangements, sensitizing EGFR mutations, or PD-L1 expression (see Sensitizing EGFR Mutation Positive/First-Line Therapy or ALK Positive/First-Line Therapy in the NCCN Guidelines for NSCLC). Bevacizumab is not recommended for patients with squamous cell NSCLC. 2006年，FDA批准贝伐单抗用于治疗不能切除的、局部晚期、复发或转移性非鳞NSCLC。基于2-3期临床试验（ECOG 4599）的结果，对于选择性晚期非鳞NSCLC患者ECOG推荐贝伐单抗联合紫杉醇/卡铂。接受贝伐单抗和化疗治疗的患者必须满足以下条件：非鳞NSCLC并且近期无咯血史。因此，任何可能出血的高危血小板减少症方案，当联合贝伐单抗时均应慎重。对于PS 0-1、非鳞NSCLC或NSCLC NOS、ALK和ROS1重排检测结果阴性或未知、敏感EGFR突变或PD-L1表达的患者，贝伐单抗联合化疗（即卡铂/紫杉醇、卡铂/培美曲塞、顺铂/培美曲塞）是推荐的一个选择（见NSCLC NCCN指南中的敏感EGFR突变阳性/一线治疗或ALK阳性/一线治疗）。对于肺鳞癌患者不推荐使用贝伐单抗。