Small cell lung cancer (SCLC) comprises approximately 13% of all lung cancers. In limited stage (LS)-SCLC, combined-modality therapy represents the standard of care. Therapy should be approached curatively in fit patients with a good performance status because 5-year survival rates approach 26% in aggressively treated patients. In contrast, cure is not possible in extensive stage (ES)-SCLC with median 2-year survival rates with current therapy remaining at less than 10%. Pemetrexed (Alimta; Eli Lilly and Co, Indianapolis, IN) is a novel, multi-targeted antifolate that inhibits several folate-dependent enzymes involved in purine and pyrimidine synthesis, and is active as a single-agent or in combination with a platinum in both non-small cell lung cancer and malignant pleural mesothelioma. Pemetrexed/platinum combinations appear active in ES-SCLC based on objective response rates observed in a randomized phase II trial. However, no survival data is yet available from this trial. The toxicity profile of both cisplatin and carboplatin in combination with pemetrexed was extremely favorable, as was the ability to deliver full doses of each of the component drugs. Given the limited options available for patients in the relapsed setting, the activity of single-agent pemetrexed is interesting. Also, preliminary data indicates that full doses of carboplatin/pemetrexed can be administered with thoracic radiation therapy, supporting a future clinical trial initiative in LS-SCLC.

中文翻译：

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培美曲塞（Alimta）用于小细胞肺癌。

小细胞肺癌（SCLC）约占所有肺癌的13％。在有限期（LS）-SCLC中，联合治疗代表了护理标准。对于表现良好的健康患者，应进行治疗，因为积极治疗的患者的5年生存率接近26％。相反，在广泛期（ES）-SCLC中，中位2年生存率目前的治疗率还不到10％，不可能治愈。Pemetrexed（Alimta; Eli Lilly and Co，Indianapolis，IN）是一种新型的多靶点抗叶酸药，可抑制参与嘌呤和嘧啶合成的几种叶酸依赖性酶，并在单独使用或与铂结合时具有活性非小细胞肺癌和恶性胸膜间皮瘤均如此。根据在II期随机试验中观察到的客观缓解率，培美曲塞/铂类组合在ES-SCLC中似乎很活跃。但是，该试验尚无生存数据。顺铂和卡铂与培美曲塞联用的毒性特征都非常好，而且能够递送全部剂量的每种成分药物。鉴于在复发情况下患者可用的选择有限，因此培美曲塞单药的活性很有趣。同样，初步数据表明，全剂量的卡铂/培美曲塞可以通过胸腔放疗进行给药，从而支持了LS-SCLC的未来临床试验计划。顺铂和卡铂与培美曲塞联用的毒性特征都非常好，同时也能递送全部剂量的每种成分药物。由于在复发情况下患者可用的选择有限，因此培美曲塞单药的活性很有趣。同样，初步数据表明，全剂量的卡铂/培美曲塞可以通过胸腔放疗进行给药，从而支持了LS-SCLC中未来的临床试验计划。顺铂和卡铂与培美曲塞联用的毒性特征都非常好，同时也能递送全部剂量的每种成分药物。由于在复发情况下患者可用的选择有限，因此培美曲塞单药的活性很有趣。同样，初步数据表明，全剂量的卡铂/培美曲塞可以通过胸腔放疗进行给药，从而支持了LS-SCLC中未来的临床试验计划。