非小细胞肺癌维持治疗NCCN指南2016v4

NSCLC NCCN2016V4 Discussion
讨论

Maintenance Therapy
维持治疗

In patients with advanced NSCLC, maintenance therapy is another option for those with responsive or stable disease after first-line systemic therapy (see the NCCN Guidelines for Non-Small Cell Lung Cancer).
在晚期NSCLC患者中，一线全身治疗后有效或疾病稳定者，维持治疗是另一种选择（见非小细胞肺癌NCCN指南）。

For patients with non-squamous NSCLC who are negative for ALK rearrangements or sensitizing EGFR mutations, continuation maintenance therapy includes bevacizumab (category 1), pemetrexed (category 1), bevacizumab/pemetrexed, or gemcitabine (category 2B) (see the NCCN Guidelines for Non-Small Cell Lung Cancer).
对于ALK重排或敏感EGFR突变阴性的非鳞NSCLC患者，继续维持治疗包括贝伐单抗（1类）、培美曲塞（1类）、贝伐单抗/培美曲塞或吉西他滨（2B类）（见非小细胞肺癌NCCN指南）。

Switch maintenance therapy for these patients includes pemetrexed or erlotinib (both are category 2B).
对于这些患者的转换维持治疗包括培美曲塞或厄洛替尼（均为2B类）。

A phase 3 randomized trial (n = 663) assessed the effect of best supportive care with (or without) switch maintenance pemetrexed in patients with advanced NSCLC who had received platinum-based chemotherapy but had not progressed.

一项3期随机试验（n = 663）评估了最佳支持治疗加（或不加）培美曲塞转换维持治疗已接受铂类联合化疗但未进展的晚期NSCLC患者的效果。

In patients with non-squamous NSCLC, overall survival was increased with pemetrexed when compared with placebo (15.5 vs. 10.3 months, P = .002).

在非鳞NSCLC患者中，与安慰剂相比培美曲塞延长总生存期（10.3对15.5个月，P = 002）。

Close observation is another option.
密切观察是另一种选择。

Maintenance therapy is discussed in greater detail earlier in this Discussion (see Combined Modality Therapy: Maintenance Therapy).
在本讨论中更详细的讨论早期维持治疗（见综合疗法：维持治疗）。

For patients with squamous cell carcinoma, gemcitabine (category 2B) is recommended as continuation maintenance therapy (see the NCCN Guidelines for Non-Small Cell Lung Cancer).
对于鳞状细胞癌患者，吉西他滨（2B类）被推荐为继续维持治疗（见非小细胞肺癌NCCN指南）。

Switch maintenance therapy for these patients includes docetaxel (category 2B).
这些患者的转换维持治疗包括多西他赛（2B类）。

Close observation is a category 2A option.
密切观察是2A类选择。

As previously mentioned, a phase 3 randomized trial compared using maintenance therapy with either gemcitabine or erlotinib after first-line therapy with cisplatin-gemcitabine.
如前所述，一项3期随机试验比较了在顺铂-吉西他滨一线治疗后使用吉西他滨或厄洛替尼维持治疗。

Continuation maintenance therapy with single-agent gemcitabine increased PFS to a greater extent (3.8 months) than switch maintenance therapy with erlotinib (2.9 months) when compared with observation (1.9 months).
PFS与观察相比（1.9个月），单药吉西他滨继续维持治疗（3.8个月）比用厄洛替尼转换维持治疗（2.9个月）改善程度更大。

However, the benefits of maintenance therapy were very slight; therefore, the recommendation is only category 2B for maintenance therapy with gemcitabine.
但是，维持治疗获益非常少；因此，用吉西他滨维持治疗只是2B类推荐。

A phase 3 trial assessed switch maintenance therapy with docetaxel given either immediately after chemotherapy or delayed until progression.
一项3期试验评估了在化疗后立即或延迟至进展给予多西他赛转换维持治疗。

However, switch maintenance therapy with docetaxel is a category 2B recommendation in the NCCN Guidelines, because many patients in the delayed chemotherapy arm did not receive docetaxel.
然而，多西他赛转换维持治疗在NCCN指南中是2B类推荐，因为延迟化疗组很多患者未接受多西他赛。