ゲムシタビン＋ビノレルビンとゲムシタビン＋ドセタキセル

摘要

目的．進行非小細胞肺癌に対する非プラチナ併用化学療法の意義を検討する．方法．論文報告されたゲムシタビン＋ビノレルビンおよびゲムシタビン＋ドセタキセルの第Ⅲ相試験を中心に効果，毒性について検討した．結果．ゲムシタビン＋ビノレルビンはシスプラチンを含む併用化学療法に比較し，毒性はより軽度であるものの，幻global QoLに差は無く，無増悪生存期間はシスプラチン群が有意に良好であった．ゲムシタビン＋ドセタキセルはシスプラチン＋ドセタキセルに比較して，奏効率，生存期間に差は無く，より消化器毒性が軽度であった．結論．非プラチナ製剤同士の2剤併用化学療法は非小細胞肺癌に対する有効なレジメンであるが，シスプラチンを含むレジメンに比較して，抗腫瘍効果がやや劣る可能性がある．消化器毒性がより軽度であり，特にシスプラチンの毒性が問題になる症例に対する選択肢の一つとなり得る．Purpose. To evaluate the role of non-platinum, gemcitabine-based combination chemotherapy for patients with advanced non-small-cell lung cancer (NSCLC). Method. Clinical trials of gemcitabine plus vinorelbine and gemcitabine plus docetaxel which were published in peer-review journals were reviewed in terms of efficacy and toxicity. Results. A phase Ⅲ trial comparing gemcitabine plus vinorelbine with cisplatin-based regimens demonstrated a non-significant slight survival disadvantage with gemcitabine plus vinorelbine.Global QoL is not improved with gemcitabine plus vinorelbine, although it is less toxic than cisplatin-based regimens.A randomized trial comparing docetaxel plus gemcitabine with cispaltin plus docetaxel demonstrated similar response rate, time to tumor progression, overall survival, and two-year survival rate. Conclusion. Gemcitabine-based two drug combination is active in patients with advanced NSCLC with less gastrointestinal toxicity than standard cisplatin-based chemotherapy. Non-platinum gemcitabine-based chemotherapy could be a treatment option in patients with advanced NSCLC.