Small-cell lung cancer

小细胞肺癌
  • 文章类型: Meta-Analysis
    背景:粒细胞集落刺激因子(G-CSF)通常用于接受骨髓抑制化疗的癌症患者,特别是当发热性中性粒细胞减少症(FN)的发生率超过20%时。虽然G-CSF的初级预防已被证明可有效预防癌症患者的FN,关于其疗效的证据有限,肺癌。我们的系统评价重点是G-CSF一级预防在肺癌中的疗效。
    方法:我们使用PubMed提取了对非小细胞肺癌(NSCLC)和小细胞肺癌(SCLC)的研究,IchushiWeb,和Cochrane图书馆数据库。两名评审员评估了每种类型肺癌的提取研究,并对预先计划的结果进行了定量和荟萃分析。包括总生存率,FN发生率,感染相关死亡率,生活质量,肌肉骨骼疼痛.
    结果:提取了有限数量的研究:2项关于NSCLC,6项关于SCLC。由于NSCLC数据不足,未进行荟萃分析。两项病例对照研究探讨了G-CSF初级预防在NSCLC患者(多西他赛和雷莫西单抗治疗)中的疗效,并表明G-CSF的FN频率较低。对于SCLC,五项研究的荟萃分析显示FN发病率没有显着降低,比值比为0.38(95%置信区间0.03-5.56,P=0.48)。由于数据可用性低,无法评估除FN发生率以外的其他结果。
    结论:关于G-CSF预防肺癌的数据有限。在接受多西他赛和雷莫西单抗联合治疗的日本NSCLC患者中,可能弱推荐使用G-CSF进行初级预防。
    BACKGROUND: Granulocyte colony-stimulating factor (G-CSF) is commonly administered to cancer patients undergoing myelosuppressive chemotherapy, especially when incidence rate of febrile neutropenia (FN) surpasses 20%. While primary prophylaxis with G-CSF has been proven effective in preventing FN in patients with cancer, there is limited evidence regarding its efficacy in specifically, lung cancer. Our systematic review focused on the efficacy of G-CSF primary prophylaxis in lung cancer.
    METHODS: We extracted studies on non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) using the PubMed, Ichushi Web, and Cochrane Library databases. Two reviewers assessed the extracted studies for each type of lung cancer and conducted quantitative and meta-analyses of preplanned outcomes, including overall survival, FN incidence, infection-related mortality, quality of life, and musculoskeletal pain.
    RESULTS: A limited number of studies were extracted: two on NSCLC and six on SCLC. A meta-analysis was not conducted owing to insufficient data on NSCLC. Two case-control studies explored the efficacy of primary prophylaxis with G-CSF in patients with NSCLC (on docetaxel and ramucirumab therapy) and indicated a lower FN frequency with G-CSF. For SCLC, meta-analysis of five studies showed no significant reduction in FN incidence, with an odds ratio of 0.38 (95% confidence interval 0.03-5.56, P = 0.48). Outcomes other than FN incidence could not be evaluated due to low data availability.
    CONCLUSIONS: Limited data are available on G-CSF prophylaxis in lung cancer. Primary prophylaxis with G-CSF may be weakly recommended in Japanese patients with NSCLC undergoing docetaxel and ramucirumab combination therapy.
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  • 文章类型: Journal Article
    背景:免疫治疗是治疗广泛小细胞肺癌(ES-SCLC)的转折点。虽然,许多问题仍在辩论中。
    方法:一组在管理ES-SCLC患者方面具有专业知识的意大利医学和放射肿瘤学家制定了一份陈述清单,分为六个感兴趣的领域。德尔菲法用于评估对定义的陈述列表的共识。
    结果:32项声明被列入由德尔福小组投票的最终名单,26日就协议达成共识。多学科团队的迅速参与是提供综合治疗策略的优先事项。一线推荐的治疗方法是免疫疗法与铂类化疗和依托泊苷联合四个周期,然后进行维持免疫疗法。
    结论:在等待临床试验和现实世界研究的新数据时,这些建议可以成为在日常实践中指导ES-SCLC患者管理的有用工具.
    BACKGROUND: Immunotherapy represented a turning point for treating extensive small-cell lung cancer (ES-SCLC). Although, many issues remain debated.
    METHODS: A group of Italian medical and radiation oncologists with expertise in managing patients with ES-SCLC developed a list of statements divided in six areas of interest. The Delphi method was used to assess the consensus on the defined list of statements.
    RESULTS: 32 statements were included in the final list to be voted by the Delphi panel, and 26 reached a consensus on the agreement. A prompt involvement of a multidisciplinary team is a priority to provide an integrated treatment strategy. First-line recommended treatment is immunotherapy in combination with platinum-based chemotherapy and etoposide for four cycles followed by maintenance immunotherapy.
    CONCLUSIONS: While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool to guide the management of ES-SCLC patients in daily practice.
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  • 文章类型: Journal Article
    小细胞肺癌(SCLC)是一种高度侵袭性的恶性肿瘤,约占肺癌的15%。只有三分之一的患者被诊断为局限期(LS)。手术切除可以在早期治愈,其次是铂-依托泊苷辅助治疗,尽管只有少数SCLC患者符合手术资格.同步放化疗是不可手术切除的LS-SCLC的标准护理,然后对无进展的患者进行预防性颅骨照射(PCI)。对于广泛阶段(ES)-SCLC,铂和依托泊苷的组合历来是治疗的支柱。最近,程序性死亡-配体1抑制剂联合化疗的疗效已成为ES-SCLC新的一线治疗标准.关于SCLC生物学的新兴知识,包括基因组特征和分子亚型,和新的治疗方法将可能导致SCLC患者护理的进步。
    Small-cell lung cancer (SCLC) is a highly aggressive malignancy comprising approximately 15% of lung cancers. Only one-third of patients are diagnosed at limited-stage (LS). Surgical resection can be curative in early stages, followed by platinum-etoposide adjuvant therapy, although only a minority of patients with SCLC qualify for surgery. Concurrent chemo-radiotherapy is the standard of care for LS-SCLC that is not surgically resectable, followed by prophylactic cranial irradiation (PCI) for patients without progression. For extensive-stage (ES)-SCLC, a combination of platinum and etoposide has historically been a mainstay of treatment. Recently, the efficacy of programmed death-ligand 1 inhibitors combined with chemotherapy has become the new front-line standard of care for ES-SCLC. Emerging knowledge regarding SCLC biology, including genomic characterization and molecular subtyping, and new treatment approaches will potentially lead to advances in SCLC patient care.
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  • 文章类型: Practice Guideline
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  • 文章类型: Journal Article
    UNASSIGNED: This study compared real-world treatment patterns of patients with extensive disease small-cell lung cancer (ED-SCLC) across regions and by platinum resistance/platinum sensitivity (PR/PS) and established if these patterns were in line with published guidelines.
    UNASSIGNED: The data source was the Oncology Monitor, a global database using retrospective medical chart reviews of oncology patients treated with anticancer drugs. All patients diagnosed with ED-SCLC from January 2014 through December 2016 in the US, and in France, Germany, Italy, Spain, and the UK (European Union; EU5), and Japan were included.
    UNASSIGNED: Of 5,849 treated patients, 73.4%, 19.8% and 6.8% received first, second, or third/later lines (1L, 2L, 3L) of therapy, respectively. The most frequent 1L treatment, platinum + etoposide, was significantly more common in the US (87.0%) than in the EU5 (82.1%) or Japan (73.3%) (P<0.05). Platinum + irinotecan was a common 1L treatment in Japan (22.7%) but not in the US (2.0%) or EU5 (0.5%, P<0.0001). Topotecan was the most common 2L treatment in the US and EU5, but amrubicin was the most common in Japan. Among PR patients, 27.3%, 10.8%, and 36.4% received a platinum-based 2L therapy in the US, EU5, and Japan, respectively. Among PS patients, approximately half were not re-challenged with a 2L platinum-based therapy across all regions.
    UNASSIGNED: In contrast to treatment guidelines, a significant proportion of real-world PR patients were re-challenged with a 2L platinum-based therapy, while conversely, many PS patients did not receive platinum-based therapies in 2L. This study highlights a lack of a consistent paradigm for 2L ED-SCLC treatment, limited therapeutic options, and an unmet need among SCLC patients.
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