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“美国非小细胞肺癌NCCN指南，该指南旨在给患者提供治疗信息，帮助患者从“0”到“1”认识肺癌，找到适合的治疗方案。本指南有些建议也许不适合你，你的医生可能会根据你的情况和其他因素制定不一样的治疗方案。”

本公众号将非小细胞肺癌NCCN指南重新整理拆分，将以中英文在公众号连载的方式发布，本指南不能做任何商业用途，转载请联系本公众号。

译者：朱志华、梅伟健

Part7 治疗指南：转移性癌

第7部分是治疗转移性肺癌治疗方案的指南。这种癌症已经扩散到遥远的地方。治疗的目的是减少症状，控制癌症，延长生命。支持性护理对你的健康也很重要。

Part 7 is a guide to the treatment options for metastatic lung cancer. This cancer has spread to distant sites. The treatment aim is to reduce symptoms, control the cancer, and extend life. Supportive care is also important for your well-being.

综述

本部分是治疗转移性肺癌的指南。这些癌症包括IV期，也包括远处转移的的分期较早的肿瘤。

This section is a guide to treatment for metastatic lung cancer. These cancers include stage IV. They also include earlier stages that have spread to distant sites.

M1a意味着癌症已经扩散到胸腔内的其他器官。M1b的得分意味着癌症已经扩散到胸部以外的部位。

A score of M1a means the cancer has spread to distant sites within the chest. A score of M1b means the cancer has spread to sites beyond the chest.

1、支持性护理

与治疗团队尽早开始支持性护理。支持性护理已被证明可以延长和改善转移性肺癌患者的生活。

Talk with your treatment team about starting supportive care early. Supportive care has been shown to extend and enhance life for people with metastatic lung cancer.

2、功能评分

医生使用许多因素来制定治疗计划。一个重要的因素是你的健康。如果你的健康状况不佳，一些治疗方法可能对你没有好处。

Doctors use many factors to plan treatment for metastases. One important factor is your health. If your health is poor, some treatments may not be good for you.

功能得分是对你的活动能力的评价。它被医生用来衡量一般健康状态。ECOG(Eastern Cooperative Oncology Group)绩效量表是一个常见的评分系统。它的范围是0～4分。

A performance score is a rating of your ability to do activities. It is used by doctors as a measure of general health. The ECOG (Eastern Cooperative Oncology Group) Performance Scale is a common scoring system. It consists of four scores.

➢得分为0意味着你有完整的活动能力。

A score of 0 means you are fully active.

➢1分意味着你可以做所有的自我保健活动，但不能做艰苦的体力劳动。

A score of 1 means you are able to do all self-care activities but are unable to do hard physical work.

➢2分意味着你能够做所有的自我保健活动，大部分时间可以离开床活动，但不能做任何工作。

A score of 2 means you are able to do all selfcare activities and spend most of waking time out of bed but are unable to do any work.

➢3分就意味着你不能做所有自我照顾活动和任何工作，大部分时间必须睡在床上。

A score of 3 means you are unable to do all self-care activities and any work and spend most of waking time in bed.

➢4分意味着你完全失去活动能力。

A score of 4 means you are fully disabled.

3、局限的区域

如果转移是局限的，你可以接受局部治疗。你也应该有相当不错的健康状况。局部治疗包括手术、放射治疗和放化疗。在某些情况下，局部治疗可以提供最好的癌症控制效果。

You may be able to receive local treatment if metastases are limited. You should also be in fairly good health other than cancer. Local treatments include surgery, radiation therapy, and chemoradiation. In certain cases, local treatments may provide the best chance for a cancer control.

对于M1a，如果癌症扩散是局限的，局部治疗可以使用。一个例子是在非原发性肺内的一个肿瘤。M1a还包括癌细胞扩散到胸膜及胸液。如果需要，胸膜腔的胸液可以被抽干，或将两层胸膜闭合。

You may be able to receive local treatment if metastases are limited. You should also be in fairly good health other than cancer. Local treatments include surgery, radiation therapy, and chemoradiation. In certain cases, local treatments may provide the best chance for a cancer control.

极少数M1b疾病只蔓延到胸外的一个站点。这些部位包括大脑和肾上腺。在这种情况下，可以接受局部治疗。然而，如果有N3疾病，则不建议局部治疗。N3疾病包括癌扩散到锁骨或颈部附近的淋巴结。

Very rarely does M1b disease spread to only one site beyond the chest. Such sites include the brain and adrenal gland. In these cases, local treatment may be received. However, local treatment isn’t suggested if there is N3 disease. N3 disease includes cancer spread to lymph nodes near the collarbone or in the neck.

4、广泛的区域

这是局部治疗并不是一个好选择。这些癌症包括那些扩散到胸部内外多个部位的癌症。在这种情况下，治疗取决于肺癌和生物标志物的类型。

Most often, local treatment is not a good option for metastatic lung cancer. Such cancers include those that have spread to more than one site within and beyond the chest. In these cases, treatment depends on the type of lung cancer and biomarkers.

Part7.1 EGFR突变过表达

指南21列出了对于EGFR突变过表达的治疗方案。这些选项可能会帮助你，不管你的表现状态如何。

Guide 21 lists treatments options for overactive EGFR mutations. These options may help you no matter your performance status.

1、一线治疗

你的选择可能是埃罗替尼、阿法替尼、吉非替尼或奥斯替尼。这些治疗都是有针对性的治疗。当你在进行一线化疗时，可能会发现这种突变。在这种情况下，你可以尽早停止化疗，并开始有针对性的治疗。否则，你可能会在完成化疗后开始有针对性的治疗。

Your options may be erlotinib, afatinib, gefitinib, or osimertinib. These treatments are targeted therapies. This mutation may be found while you are on first-line chemotherapy. In this case, you may stop chemotherapy early and start targeted therapy. Otherwise, you may start targeted therapy as a maintenance treatment after completing chemotherapy.

2、二线治疗

在一线治疗过程中癌症可能恶化。如果对埃罗替尼 (erlotinib)、阿法替尼(afatinib)或吉非替尼(gefitinib)耐药，则建议进行T790M测试。结果将有助于计划治疗。

The cancer may worsen while on first-line treatment. If it worsens on erlotinib, afatinib, or gefitinib, T790M testing is advised. Results will help to plan treatment.

如果癌症没有恶化，你可以选择坚持你的治疗方法。局部治疗可加到一线治疗中。当转移发生在大脑或肾上腺等受控制的区域内时，有时会用到局部治疗。

If the cancer doesn’t worsen much, one option may be to stay on your first-line treatment. Local treatment may be added to first-line treatment. It is sometimes used when the metastasis is within a confined area, such as the brain or adrenal gland.

如果你需要转换治疗方案，奥斯替尼可能会被使用。如果之前并未使用，或者出现T790M突变，它会非常有效。

If you need to switch treatment, osimertinib may be received. It is given if not received before and a T790M mutation is present.

以铂为基础的化疗可能是另一个选择。这时必须没有发现T790M突变或在使用奥斯替尼期间癌症恶化。如果有多种转移性肿瘤引起症状，通常使用化疗。阅读指南26，学习腺癌，大细胞，和未知的类型的更多的选择。阅读《指南》27，了解鳞状细胞癌的更多选择。

Platinum-based chemotherapy may be another option. The T790M mutation must not be present or the cancer worsened while on osimertinib. Chemotherapy is often used if there are multiple metastatic tumors causing symptoms. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types. Read Guide 27 to learn more options for Squamous cell carcinoma.

Part7.2 ALK基因重排

指南22列出了AL6基因重排的治疗方法。这些方法可能会帮助你，不管你的表现状态如何。

Guide 22 lists treatment options for ALK gene rearrangements. These options may help you no matter your performance status.

1、一线治疗

你可以有三个选择。NCCN专家的首选方案是阿雷替尼alectinib。其他选择是克唑替尼crizotinib或色瑞替尼ceritinib。这些治疗都是有针对性的治疗。在你做一线化疗时可能会发现ALK突变。在这种情况下，您可以停止化疗，开始有针对性的治疗。否则，你可能会在完成化疗后开始有针对性的治疗。

You may have three options. The preferred option of NCCN experts is alectinib. Other options are crizotinib or ceritinib. These treatments are targeted therapies.

The ALK mutation may be found while you are on first-line chemotherapy. In this case, you may stop chemotherapy early and start targeted therapy. Otherwise, you may start targeted therapy as a maintenance treatment after completing chemotherapy.

2、二线治疗

在你做一线治疗时癌症可能恶化。如果癌症没有恶化，可以选择坚持一线治疗。可以添加局部治疗。它有时被用于可控制区域的转移。这些区域包括大脑或肾上腺。

The cancer may worsen while on first-line treatment. If the cancer doesn’t worsen much, one option may be to stay on first-line treatment. Local treatment may be added. It is sometimes used when the metastasis is within a confined area. Examples of these areas are the brain or adrenal gland.

如果需要转换方案治疗,在使用克唑替尼crizotinib之后，你还可以选择色瑞替尼ceritinib 、阿雷替尼alectinib或brigatinib。在这种情况下，也可以增加局部治疗。

If you need to switch treatment, ceritinib, alectinib, or brigatinib are options after taking crizotinib. Local treatment may be added in this case, too.

以铂为基础的化疗可能是另一个选择。如果有多种转移性肿瘤引起症状，则经常使用。阅读指导26学习腺癌，大细胞，和未知的类型的更多的选择。阅读《指南》27，了解鳞状细胞癌的更多选择。

Platinum-based chemotherapy may be another option. It is often used if there are multiple metastatic tumors causing symptoms. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types. Read Guide 27 to learn more options for Squamous cell carcinoma.