晚期非小细胞肺癌一线化疗后仅能有一个较短暂的疾病缓解期,绝大部分患者需要进行二线治疗。目前推荐的二线治疗药物主要是多西紫杉醇、培美曲赛和EGFR-TKIs。多西紫杉醇最先确立其二线治疗的地位。培美曲赛通过一项与多西紫杉醇进行随机对照的Ⅲ期研究批准用于晚期NSCLC二线治疗。虽然培美曲赛毒性很轻微,但进一步的临床研究并没有发现高剂量对患者生存有益。EGFR-TKIs靶向治疗是目前研究的热点。吉非替尼和厄洛替尼单药二线治疗具有较好的疗效。吉非替尼与传统化疗对照的研究表明,其疗效不差于多西紫杉醇,且毒性较化疗轻微。厄洛替尼与化疗对照的研究正在进行。其它一些药物不断出现,显示了其在二线治疗的作用,例如口服拓扑替肯和长春氟宁与多西紫杉醇均具有相似的疗效。 After first-line chemotherapy for advanced non-small cell lung cancer, there is only a short-lived period of remission, and most patients need second-line treatment. The currently recommended second-line treatment drugs are docetaxel, pemetrexed and EGFR-TKIs. Docetaxel was the first to establish its second-line treatment status. Pemetrexed was approved for a second-line treatment of advanced NSCLC through a phase III study randomized to docetaxel. Although the toxicity of Pemetrexed is very slight, further clinical studies have not found that high doses are beneficial to the survival of patients. Targeted therapy for EGFR-TKIs is currently the focus of research. Gefitinib and erlotinib monotherapy have a good effect. The study of gefitinib versus traditional chemotherapy showed that the efficacy was not worse than docetaxel, and the toxicity was milder than chemotherapy. Studies of erlotinib versus chemotherapy are ongoing. The continued emergence of other drugs has shown its role in second-line treatment, such as oral topotecan and vinflunine with docetaxel have similar efficacy.