Kombinace systematických terapií s radiací u nemalobuněčného karcinomu plic

English version

Autoři: K. Adamowicz; E. Goszczynska‑ matysiak
Působiště autorů: Department of Oncology, Regional Oncology Center of Gdansk, Poland
Vyšlo v časopise: Klin Onkol 2015; 28(5): 321-331
Kategorie: Přehledy
doi: https://doi.org/10.14735/amko2015321

Souhrn

Radioterapie je hlavní léčebnou modalitou při léčbě III. stadia nemalobuněčného plicního karcinomu. Na počátku 90. let 20. století byla zavedena kombinovaná léčba s chemoterapií. V roce 1995 prokázala metaanalýza zlepšené výsledky léčby při sekvenčním použití chemoterapie a radioterapie založené na cisplatině v porovnání se samotnou radioterapií. Následné randomizované studie a dvě metaanalýzy prokázaly, že současně používaná radiochemoterapie převyšuje sekvenční používání obou metod v celkovém přežití i lokální kontrole onemocnění. Přesto zůstává v rámci výsledků léčby a profilu toxicity nezodpovězeno několik otázek, včetně optimálního režimu chemoterapie a dávky a techniky radioterapie. Cílená léčba představuje novou třídu léčiv, která reagují se specifickými molekulárními cíli (typicky proteiny), které hrají klíčovou roli v růstu nádoru a progresi. Některé kombinace se jeví jako příliš toxické, jako třeba protilátka proti vaskulárnímu epiteliálnímu růstovému faktoru – bevacizumab. Možnost přidání inhibitoru receptoru epidermálního růstového inhibičního faktoru cetuximabu byla nedávno popsána u pacientů s nemalobuněčným karcinomem plic. Jsou zapotřebí vyvinout strategie, jak bezpečně začlenit nová antiangiogenní agens do kombinované terapie u rakoviny plic. Rychlý rozvoj molekulární onkologie snad přispěje k lepšímu výběru pacientů pro jednotlivé strategie a k optimalizaci léčby. K dalšímu zlepšení výsledků léčby může dále vést zvýšení dávek radioterapie, aplikované v souladu s nejnovějšími technikami a v kombinaci s novými biologickými látkami.

Klíčová slova:
karcinom plic – chemoterapie – radioterapie – farmakoterapie

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Obdrženo:
27. 7. 2015

Přijato:
14. 9. 2015

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