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(r)Tj
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(Key words:)Tj
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(Figura 1. Meta-anlisis de combinaciones con cisplatino vs car-)Tj
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(\(Figs. 2 y 3\). )Tj
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(nuevo considerada en diferentes estudios. Paclitaxel)Tj
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[(semanal tras quimioterapia con Carbo/P)91.6(AC no ha)]TJ
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(18)Tj
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(. Otros estu-)Tj
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(tados en el Congreso de ASCO-2005)Tj
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(19)Tj
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(\), Estudio)Tj
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(administra Pemetrexed vs mejor cuidado de soporte,)Tj
T*
0.0014 Tc
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[(y el Estudio EOR)59.8(TC 08021 que tras quimioterapia)]TJ
T*
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0 Tw
(randomiza a gefitinib vs placebo.)Tj
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0.005 Tc
0.0538 Tw
(En cuanto a las terapias dirigidas, hay que desta-)Tj
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(car los recientes hallazgos sobre mutaciones del gen)Tj
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T*
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0.074 Tw
(nomas, no fumadores, mujeres y asiticos \(10-20%)Tj
T*
0.0323 Tw
(en poblacin caucasiana\))Tj
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0.0324 Tw
(20, 21)Tj
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0.0323 Tw
(. Cuando estas existen,)Tj
-11.7719 -1.1818 TD
0.0294 Tc
0.1005 Tw
(se consiguen con los inhibidores EGFR-TK res-)Tj
T*
0.023 Tc
0.1069 Tw
[(puestas muy satisfactorias y lar)17.8(ga supervivencia.)]TJ
T*
0.0255 Tc
0.1045 Tw
(Parece necesario realizar una seleccin clnica y)Tj
T*
0.0049 Tc
0.0673 Tw
[(molecular para el uso de inhibidores EGFR-TK los)]TJ
T*
0.0661 Tw
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T*
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0.1165 Tw
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T*
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T*
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0 Tw
(T)Tj
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0.005 Tc
0.1204 Tw
[(ACT 1 y 2, TRIBUTE, T)79.9(ALENT\))]TJ
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0 Tw
(22-25)Tj
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0.1204 Tw
(. Las muta-)Tj
-16.2988 -1.1818 TD
0.1035 Tw
[(ciones EGFR son el mejor factor predictivo en es-)]TJ
T*
0.0137 Tc
0.1163 Tw
(tos momentos para el tratamiento con inhibidores)Tj
T*
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0.0237 Tw
[(EGFR-TK, pero este no es del todo perfecto porque)]TJ
T*
0.0176 Tw
[(hay respuestas sin mutaciones y mutaciones sin res-)]TJ
T*
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0.1084 Tw
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T*
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0.121 Tw
(resultados en el anlisis retrospectivo de mutacio-)Tj
T*
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[(nes de estudios conocidos \(TIBUTE, T)79.8(ALENT)73.9(, IN-)]TJ
T*
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(T)Tj
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[(ACT)73.9(, IDEAL, S0126, BR21\) en el Congreso de)]TJ
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T*
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(blicados en los que en algunos tambin se definen)Tj
T*
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(otros marcadores predictivos de eficacia: FISH/IHQ)Tj
T*
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[(de EGFR, IHQ de pAKT)73.9(, mutaciones K-ras)]TJ
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0 Tw
(26-30)Tj
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[(\(T)69.7(a-)]TJ
-19.45 -1.1818 TD
0.0512 Tc
0.0788 Tw
(bla I\). Adems, probablemente las mutaciones)Tj
T*
0.0049 Tc
0.0308 Tw
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T*
0.0079 Tc
0.122 Tw
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T*
0.005 Tc
0.096 Tw
(cia en pacientes mutados que recibieron o no inhi-)Tj
T*
0.1029 Tw
(bidores EGFR-TK\), y porque los resultados de su-)Tj
T*
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0.1094 Tw
(pervivencia en pacientes sin mutaciones que res-)Tj
T*
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0.0001 Tw
(ponden son menos satisfactorios. )Tj
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0.0447 Tw
(Por otro lado, han sido detectadas mutaciones ad-)Tj
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-0.0001 Tc
0.0296 Tw
[(quiridas en EGFR \(exn 20\) en pacientes resistentes)]TJ
T*
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0.1135 Tw
[(a inhibidores EGFR-TK, aunque seguramente exis-)]TJ
T*
0.0468 Tw
(tan tambin a otros niveles. Se valorara entonces la)Tj
T*
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0.1147 Tw
(posibilidad de administracin de 2 lnea de trata-)Tj
T*
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(Figura 2. Meta-anlisis de combinaciones con o sin platino: To-)Tj
1.0753 -1.1948 TD
-0.0001 Tc
0 Tw
(dos los estudios.)Tj
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(Figura 3. Meta-anlisis de combinaciones con o sin platino: Es-)Tj
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(tudios sin platino con frmacos de 3 generacin)Tj
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(con inhibidores EGFR, conocemos los resultados ya)Tj
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(, y hay otros en marcha. En la actuali-)Tj
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(dad, las lneas de investigacin se orientan hacia el)Tj
T*
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T*
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T*
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(mutaciones o tras su resistencia: lapatinib, ZD6474,)Tj
T*
0.0048 Tw
(CI 1033...; y se considera la posibilidad de combina-)Tj
T*
0 Tw
[(cin con otras terapias dirigidas, QT)74(...)]TJ
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-0.0001 Tc
0.0172 Tw
[(Cetuximab ha sido ensayado en diferentes fases II)]TJ
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0.0076 Tc
0.1174 Tw
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T*
-0.0001 Tc
0.0502 Tw
[(CAS, fase II randomizado de CDDP/VNR )-300.3(cetuxi-)]TJ
T*
0 Tc
0.0538 Tw
[(mab con resultados de eficacia satisfactorios para la)]TJ
T*
0.0786 Tw
(asociacin del Ac monoclonal anti EGFR)Tj
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0 Tw
(33)Tj
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-0.0001 Tc
0.0787 Tw
(\(est ya)Tj
-17.9557 -1.1818 TD
0 Tw
(en marcha el estudio fase III\). )Tj
0.9767 -1.1818 TD
0 Tc
0.006 Tw
[(Otro Ac monoclonal es bevacizumab \(anti VEGF\))]TJ
-0.9767 -1.1818 TD
0.1157 Tw
(que ha sido tambin ensayado en un fase II rando-)Tj
T*
0.0231 Tc
0.1019 Tw
[(mizado con Carbo/P)91.7(AC, con resultados de mejor)]TJ
T*
0 Tc
0.1197 Tw
(respuesta y tiempo a la progresin con tendencia a)Tj
T*
0.0299 Tw
(mejor supervivencia pero con episodios de sangrado)Tj
T*
0 Tw
(tumoral)Tj
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(34)Tj
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(. El grupo ECOG ha llevado a cabo el fase)Tj
-3.7101 -1.1818 TD
0.0596 Tw
[(III de Carbo/P)91.8(AC )-309.7(bevacizumab \(E4599\) con dife-)]TJ
T*
0.0232 Tc
0.1018 Tw
(rencias significativa de supervivencia, aunque se)Tj
T*
0 Tc
0.1249 Tw
(han seleccionado en este estudio pacientes con no-)Tj
T*
0.0211 Tw
[(carcinoma escamoso, sin historia de HT)79.9(A ni hemop-)]TJ
T*
0.0009 Tc
0.1241 Tw
(tisis severa, y la toxicidad es superior con mejores)Tj
T*
-0.0001 Tc
0.1095 Tw
(resultados en varones. Es el primer estudio fase III)Tj
T*
0 Tc
0.0377 Tw
(de quimioterapia asociada a una terapia dirigida que)Tj
T*
0.0072 Tc
0.1178 Tw
(demuestra mejores resultados para la combinacin)Tj
T*
0.075 Tc
0.0955 Tw
(\(supervivencia mediana 12.5 m. vs 10.2 m.,)Tj
T*
-0.0001 Tc
0 Tw
(P<0.007\))Tj
6.6 0 0 6.6 67.4995 76.6143 Tm
0 Tc
(35)Tj
11 0 0 11 74.0995 72.9843 Tm
0.0278 Tw
[(. Sin embar)17.8(go, de momento slo dispone-)]TJ
-4.3026 -1.1818 TD
0.0096 Tw
(mos de este estudio, en pacientes muy seleccionados)Tj
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0.0232 Tw
(y con mayor toxicidad, por lo que es difcil conside-)Tj
-0.0245 -1.1818 TD
0.0046 Tc
0.1204 Tw
(rar este tratamiento todava como standard. Se en-)Tj
T*
0.006 Tc
0.119 Tw
(cuentra en marcha el estudio fase III BO1770 con)Tj
T*
-0.0001 Tc
0.0001 Tw
[(CDDP/GEM )-250.1(bevacizumab.)]TJ
0.9767 -1.1818 TD
0.0286 Tc
0.0963 Tw
[(Para pacientes con Her)19.7(-2/neu 3+, trastuzumab)]TJ
-0.9767 -1.1818 TD
0 Tc
0.076 Tw
(consigue buenos resultados asociado a dobletes con)Tj
T*
0 Tw
(platino en algn estudio)Tj
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(36)Tj
11 0 0 11 396.8423 371.9843 Tm
(. )Tj
-9.2046 -1.1818 TD
-0.0001 Tc
0.0442 Tw
(Han sido negativos los estudios fase III con el re-)Tj
-0.9767 -1.1818 TD
0.0172 Tc
0.1077 Tw
[(tinoide bexaroteno combinados con Carbo/P)91.9(AC y)]TJ
T*
-0.0001 Tc
0 Tw
(CDDP/VNR respectivamente \(SPIRIT I y II\))Tj
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0 Tc
(37, 38)Tj
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(.)Tj
-18.5439 -1.1818 TD
0.0299 Tc
0.1051 Tw
(Son de inters las investigaciones de biologa)Tj
-0.9767 -1.1818 TD
0.01 Tc
0.1246 Tw
(molecular orientadas a seleccionar a los pacientes)Tj
T*
0.1075 Tw
(que vayan a responder a las diferentes terapias en)Tj
T*
0.0382 Tw
[(relacin con distintos marcadores moleculares. En-)]TJ
T*
0.0167 Tc
0.1183 Tw
(tre ellas se encuentran los estudios farmacogen-)Tj
T*
0.0099 Tc
0.0311 Tw
[(micos destacando el estudio GIL)91.6(T)0( del Grupo Espa-)]TJ
T*
0.0132 Tc
0.1218 Tw
(ol de Cncer de Pulmn que es el 1 en marcha)Tj
T*
0.01 Tc
0.0206 Tw
(que de forma prospectiva y randomizada, segn ni-)Tj
T*
0.0274 Tc
0.1076 Tw
(veles de ERCC1 bajos o altos a nivel del tumor)Tj
T*
0.0099 Tc
0.0372 Tw
[(\(gen de reparacin del DNA como marcador mole-)]TJ
T*
0.1121 Tw
(cular\), determina la administracin de un rgimen)Tj
T*
0.0763 Tw
(con o sin cisplatino. Se han presentado en el Con-)Tj
T*
0.092 Tw
(greso de ASCO 2005 resultados preliminares con-)Tj
T*
0.0301 Tc
0.1048 Tw
(firmndose una de las hiptesis de este estudio:)Tj
T*
0.01 Tc
0.0196 Tw
[(respuesta significativamente mejor para niveles ba-)]TJ
T*
0.0235 Tc
0.1115 Tw
(jos de expresin de ERCC1 y quimioterapia con)Tj
T*
0.01 Tc
0 Tw
(platino)Tj
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(39)Tj
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(\(Fig. 4\).)Tj
-2.7426 -1.1818 TD
0.0161 Tc
0.1139 Tw
(Otras lneas de investigacin a nivel molecular)Tj
-0.9767 -1.1818 TD
0.0172 Tc
0.1128 Tw
(incluyen metilaciones, sobreexpresiones de genes)Tj
T*
0.005 Tc
0.1091 Tw
(como TS, RRM1, BRCA1, mutaciones en diferen-)Tj
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(tes genes... En este sentido, dentro del Grupo Espa-)Tj
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[(Respuesta)-6141(Supervivencia)]TJ
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-0.0001 Tc
[(Estudio)-6199.1(Farmaco)-4525.4(Mutaciones)-2876.7(si Mutaciones)-3516.7(med. si Mutaciones \(m.\))-2947.4(Diferencias)]TJ
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[(INTACT)-5589.2(Gefitinib)-5622.2(10.2%)-5792.3(72%)-9861.8(?)-8556.8(Mejor?)]TJ
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[(IDEAL)-6256.2(Gefitinib)-5997.2(18%)-6167.3(46%)-9861.8(?)-9778.5(?)]TJ
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[(S0126)-6698.6(Erlotinib)-6052.2(18%)-6167.3(23%)-9861.8(?)-9778.5(?)]TJ
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[(BR21)-6920.4(Erlotinib)-6052.1(23%)-6167.2(15%)-9861.7(?)-9361.4(N)0.5(S)]TJ
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(26)Tj
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[(Gefitinib)-5622.2(18.9%)-5792.3(64%)-9583.7(30)-8037.4(P<0.001)]TJ
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(Cappuzzo)Tj
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(27)Tj
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[(Gefitinib)-5997.2(17%)-6167.3(54%)-9583.7(20)-8287.4(P=0.09)]TJ
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(29)Tj
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-0.0001 Tc
[(Gefitinib)-5997.2(12%)-6167.3(60%)-9583.7(13)-8287.4(P=0.02)]TJ
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(Tarn)Tj
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(30)Tj
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[(Gefitinib)-5997.2(28%)-6167.3(94%)-9583.7(18)-8287.4(P=0.04)]TJ
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0.0109 Tc
0.1191 Tw
(expresin de BRCA1 determinados en biopsia tu-)Tj
T*
0.0049 Tc
0 Tw
(moral \(Fig. 5\).)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 284.8106 682.0326 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(T)Tj
0.593 0 TD
-0.0001 Tc
(ratamiento en 2 lnea)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 295.5539 657.9843 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(T)Tj
0.5759 0 TD
0.0855 Tw
(ras quimioterapia basada en platino y buen per-)Tj
-1.5526 -1.1818 TD
0.0736 Tw
(formance status, docetaxel se ha considerado el tra-)Tj
T*
0.0201 Tw
(tamiento standard durante los ltimos aos \(estudios)Tj
T*
0 Tw
(T)Tj
0.5503 0 TD
0.0192 Tc
0.1057 Tw
[(AX 317, T)79.8(AX 320\))]TJ
6.6 0 0 6.6 383.0107 622.6143 Tm
0 Tw
(40-41)Tj
11 0 0 11 399.0431 618.9843 Tm
0.1057 Tw
[(. Sin embar)17.8(go, posterior-)]TJ
-10.3848 -1.1818 TD
0.0069 Tc
0.1181 Tw
(mente, otros frmacos han demostrado eficacia si-)Tj
T*
0.0024 Tc
0.1226 Tw
(milar: pemetrexed \(comparado con docetaxel en el)Tj
T*
0.0029 Tc
0.122 Tw
(estudio fase III JMEI, con tolerancia hematolgica)Tj
T*
-0.0001 Tc
0.0747 Tw
(ms favorable\))Tj
6.6 0 0 6.6 351.2834 570.6143 Tm
0 Tc
0 Tw
(42)Tj
11 0 0 11 357.8834 566.9843 Tm
0.0747 Tw
[(, gemcitabina, CPT)91.8(-1)36.9(1, dobletes sin)]TJ
-6.643 -1.1818 TD
0 Tw
(platino...)Tj
0.9767 -1.1818 TD
0.0054 Tc
0.1196 Tw
(Las recomendaciones de ESMO 2005 para la 2)Tj
-0.9767 -1.1818 TD
0.0069 Tc
0.1181 Tw
(lnea son que docetaxel y pemetrexed mejoran los)Tj
T*
0 Tc
0.0219 Tw
(sntomas relacionados con la enfermedad y la super-)Tj
T*
0 Tw
(vivencia en pacientes seleccionados)Tj
6.6 0 0 6.6 442.702 505.6143 Tm
(4)Tj
11 0 0 11 446.002 501.9843 Tm
(.)Tj
-13.6771 -1.1818 TD
-0.0001 Tc
0.0327 Tw
(Los inhibidores EGFR-TK en estudios fase II han)Tj
-0.9767 -1.1818 TD
0.0043 Tc
0.1207 Tw
(demostrado actividad similar a docetaxel: gefitinib)Tj
T*
-0.0001 Tc
0.0823 Tw
(en estudios IDEAL 1 y 2)Tj
6.6 0 0 6.6 398.9995 466.6143 Tm
0 Tc
(43, 44)Tj
11 0 0 11 416.0426 462.9843 Tm
0.0822 Tw
(, y para erlotinib en el)Tj
-11.9302 -1.1818 TD
0.0118 Tc
0.1131 Tw
(estudio de Prez-Soler)Tj
6.6 0 0 6.6 389.1139 453.6143 Tm
0 Tw
(45)Tj
11 0 0 11 395.8701 449.9843 Tm
0.1132 Tw
(, destacando la asociacin)Tj
-10.0963 -1.1818 TD
0 Tc
0.093 Tw
(de erlotinib con bevacizumab que consigue una su-)Tj
T*
0.0546 Tc
0.0704 Tw
[(pervivencia mediana de 12.6 m. y a 1 ao del)]TJ
T*
0.0025 Tc
0 Tw
(51.8%)Tj
6.6 0 0 6.6 313.3603 414.6143 Tm
(46)Tj
11 0 0 11 319.9939 410.9843 Tm
0.1225 Tw
(. En cuanto a estudios fase III, erlotinib es)Tj
-3.1985 -1.1818 TD
0 Tc
0.0703 Tw
(superior a cuidados de soporte en el BR.21)Tj
6.6 0 0 6.6 478.9954 401.6143 Tm
0 Tw
(47)Tj
11 0 0 11 485.5955 397.9843 Tm
0.0703 Tw
(; y hay)Tj
-18.2532 -1.1818 TD
0.1186 Tw
(otros para gefitinib: frente a cuidados de soporte =)Tj
T*
0.0714 Tw
(estudio ISEL \(no demuestra mejor supervivencia)Tj
6.6 0 0 6.6 504.07 375.6143 Tm
0 Tw
(48)Tj
11 0 0 11 510.6701 371.9843 Tm
-0.0002 Tc
(\),)Tj
-20.5327 -1.1818 TD
0 Tc
0.1157 Tw
(y frente a docetaxel = estudio INTEREST \(todava)Tj
T*
0.0814 Tw
(en marcha\). Gefitinib ha sido comparado con doce-)Tj
T*
0.0207 Tc
0.1043 Tw
[(taxel en un estudio fase II randomizado \(Estudio)]TJ
T*
-0.0001 Tc
0.0672 Tw
[(SIGN\) demostrando misma eficacia con mejor tole-)]TJ
T*
0.0713 Tc
0 Tw
(rancia)Tj
6.6 0 0 6.6 316.3798 310.6143 Tm
(49)Tj
11 0 0 11 323.921 306.9843 Tm
0.0537 Tw
(. ZD6474 es un inhibidor de EGFR y)Tj
-3.5555 -1.1818 TD
0.0076 Tc
0.1174 Tw
(VEGFR que se est valorando en la actualidad en)Tj
T*
-0.0001 Tc
0.1039 Tw
[(distintos ensayos destacando los resultados frente a)]TJ
T*
0 Tc
0 Tw
[(gefitinib \(mejor tiempo a la progresin, P=0.01)36.9(1\))]TJ
6.6 0 0 6.6 501.3758 271.6143 Tm
(50)Tj
11 0 0 11 507.9759 267.9843 Tm
(.)Tj
-19.3111 -1.1818 TD
-0.0075 Tc
0.0424 Tw
(Bortezomib ha sido ensayado en un estudio fase II)Tj
-0.9767 -1.1818 TD
0.0147 Tc
0.1028 Tw
[(randomizado )-367.6(docetaxel cuyos resultados son de)]TJ
T*
-0.0075 Tc
0.0009 Tw
(buena tolerancia con respuesta de 9% vs 8%, y super-)Tj
T*
0.0138 Tc
0.1037 Tw
(vivencia mediana 7.8 vs 7.4 m. \(P=no significati-)Tj
T*
-0.0076 Tc
0 Tw
(va\))Tj
6.6 0 0 6.6 298.6058 206.6143 Tm
-0.0075 Tc
(51)Tj
11 0 0 11 305.1069 202.9843 Tm
0 Tc
(.)Tj
-0.8685 -1.1818 TD
0.0184 Tc
0.1066 Tw
(Cetuximab en monoquimioterapia consigue su-)Tj
-0.9767 -1.1818 TD
0 Tc
0.0133 Tw
(pervivencia a 1 ao de 41%)Tj
6.6 0 0 6.6 407.402 180.6143 Tm
0 Tw
(52)Tj
11 0 0 11 414.0021 176.9843 Tm
0.0133 Tw
(. Combinado con doce-)Tj
-11.7447 -1.1818 TD
0 Tw
(taxel las respuestas alcanzan 28%)Tj
6.6 0 0 6.6 433.2301 167.6143 Tm
(53)Tj
11 0 0 11 439.8301 163.9843 Tm
(.)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 284.8106 124.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(Performance status 2)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 295.5539 98.9843 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.0986 Tw
(Recientemente se ha alcanzado un Consenso Eu-)Tj
-0.9767 -1.1818 TD
0.0086 Tw
(ropeo para el tratamiento de este subgrupo: se indica)Tj
T*
0.0298 Tw
(el uso de agentes en monoquimioterapia \(gemcitabi-)Tj
T*
0.0345 Tw
(na, vinorelbina, taxanos, dependiendo la eleccin de)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.74 719.95 m
517.08 719.95 l
S
0 0 0 0 k
26.73 788 490.35 -56 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
10 0 0 10 382.1097 734.168 Tm
0 0 0 1 k
/GS1 gs
0 Tc
-0.0001 Tw
(Oncologa, 2005; 28 \(7\):311-320)Tj
ET
0 0 0 0 k
493.07 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 507.0804 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(15)Tj
ET
0 0 0 0 k
26.73 691.61 232.27 -138.61 re
f
0 0 0 0.6 k
26.98 691.36 21.59 -123.16 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F4 1 Tf
9 0 0 9 34.526 681.2535 Tm
0 0 0 0 k
/GS1 gs
0 Tc
0 Tw
(R)Tj
0 -1.1948 TD
(A)Tj
T*
(N)Tj
T*
(D)Tj
-0.028 -1.1948 TD
(O)Tj
-0.0275 -1.1948 TD
(M)Tj
0.2775 -1.1948 TD
(I)Tj
-0.1665 -1.1948 TD
(Z)Tj
-0.0281 -1.1948 TD
(E)Tj
-0.3888 -2.3896 TD
-0.0002 Tc
(1:2)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.98 691.36 21.59 -123.16 re
44.273 573.72 m
S
0 0 0 0.4 k
57.25 636.08 62.1 -12.45 re
f
BT
8 0 0 8 60.9684 627.8164 Tm
0 0 0 1 k
(N-461 patients)Tj
ET
57.25 636.08 62.1 -12.45 re
115.631 627.816 m
S
0 0 0 0.2 k
178.51 669.11 76.2 -13.67 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F5 1 Tf
8 0 0 8 183.9383 660.2386 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(docetaxel/cisplatin)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
178.51 669.11 76.2 -13.67 re
249.285 660.239 m
S
0 0 0 0.2 k
178.35 629.96 76.2 -24.95 re
f
BT
8 0 0 8 183.7733 620.8182 Tm
0 0 0 1 k
(docetaxel/cisplatin)Tj
-0.4424 -1.3442 TD
(\(low ERCC1 mRNA\))Tj
ET
178.35 629.96 76.2 -24.95 re
252.659 610.065 m
S
0 0 0 0.2 k
178.51 593.2 80.24 -24.95 re
f
BT
8 0 0 8 185.9586 584.0609 Tm
0 0 0 1 k
(docetaxel/cisplatin)Tj
-0.6373 -1.3442 TD
(\(high ERCC1 mRNA\))Tj
ET
178.51 593.2 80.24 -24.95 re
256.404 573.307 m
S
0.5 w
48.97 629.911 m
69.742 657.042 l
S
74.307 663.004 m
70.669 654.14 l
69.867 656.794 l
69.47 657.098 l
66.699 657.18 l
f*
0.5 w
64.787 610.06 m
48.983 629.252 l
S
69.554 604.27 m
61.744 609.822 l
64.517 609.994 l
64.903 610.312 l
65.604 613 l
f*
0.5 w
144.25 661.51 m
167.6 661.51 l
S
175.1 661.51 m
165.85 659.01 l
167.47 661.26 l
167.47 661.76 l
165.85 664.01 l
f*
0 0 0 0.2 k
76.1 672.56 72.75 -19.34 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F4 1 Tf
8 0 0 8 82.4854 660.85 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(CONTROL ARM)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
76.1 672.56 72.75 -19.34 re
142.465 660.85 m
S
0.5 w
160.489 602.457 m
168.786 610.392 l
S
174.206 615.576 m
169.249 607.376 l
168.872 610.128 l
168.526 610.49 l
165.793 610.989 l
f*
0.5 w
160.49 594.72 m
169.16 587.134 l
S
174.805 582.195 m
166.197 586.405 l
168.905 587.025 l
169.235 587.401 l
169.489 590.168 l
f*
0 0 0 0.2 k
71.54 610.57 92.17 -24.04 re
f
BT
8 0 0 8 76.0739 601.8857 Tm
0 0 0 1 k
(EXPERIMENTAL ARM)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F5 1 Tf
8 0 0 8 90.0729 591.1324 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(\(ERCC1 levels\))Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
71.54 610.57 92.17 -24.04 re
145.174 591.132 m
S
0 0 0 0 k
26.73 547.59 232.27 -37.4 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
9 0 0 9 26.7332 541.4382 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.1232 Tw
(Figura 4. Estudio GILT del Grupo Espaol de Cncer de Pul-)Tj
1.0753 -1.1948 TD
0 Tw
(mn.)Tj
ET
0 0 0 0 k
26.73 362.79 232.27 -281.14 re
f
Q
q
1 i
26.73 362.79 232.27 -281.14 re
W* n
0 0 0 1 k
/GS1 gs
q
232.7916 0 0 274.9893 26.5 81.4106 cm
/Im4 Do
Q
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.73 77.14 232.27 -20.49 re
f
BT
/F1 1 Tf
9 0 0 9 26.7332 70.9896 Tm
0 0 0 1 k
0 Tc
0.0435 Tw
[(Figura 5. Estudio SLABD y SLAT del Grupo Espaol de Cn-)]TJ
1.0753 -1.1948 TD
0 Tw
(cer de Pulmn.)Tj
ET
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1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
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0 822 m
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BT
/F1 1 Tf
11 0 0 11 27.0402 449.9843 Tm
0 0 0 1 k
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0 Tc
0.022 Tw
(su toxicidad y la comorbilidad del paciente\), aunque)Tj
-0.0245 -1.1818 TD
0.0121 Tc
0.1129 Tw
(dobletes basados en carboplatino o dosis bajas de)Tj
T*
0 Tc
0.0645 Tw
(platino con un frmaco de 3 generacin pueden re-)Tj
T*
0.0014 Tc
0.1236 Tw
[(presentar una alternativa)]TJ
6.6 0 0 6.6 137.9974 414.6143 Tm
0.0015 Tc
0 Tw
(54)Tj
11 0 0 11 144.6172 410.9843 Tm
0.1235 Tw
(. Este Consenso coincide)Tj
-10.7133 -1.1818 TD
0 Tc
0 Tw
(con las recomendaciones de ASCO 2004)Tj
6.6 0 0 6.6 206.6806 401.6143 Tm
(3)Tj
11 0 0 11 209.9806 397.9843 Tm
(. )Tj
-15.6788 -1.1818 TD
-0.0001 Tc
0.0228 Tw
(Son necesarios estudios randomizados especficos)Tj
-0.9767 -1.1818 TD
0 Tc
0.0087 Tw
(para este grupo de pacientes comparando las dos op-)Tj
T*
0.0024 Tw
(ciones ya comentadas, considerando tambin nuevos)Tj
T*
0.0217 Tw
(agentes biolgicos. Adems, resulta de inters la va-)Tj
T*
0.0063 Tc
0.1186 Tw
(loracin de los resultados de los estudios conside-)Tj
T*
0.0078 Tc
0.1172 Tw
(rando las razones que condicionan el performance)Tj
T*
0 Tc
0 Tw
[(status 2: comorbilidades, car)17.8(ga tumoral o ambas. )]TJ
0.9767 -1.1818 TD
0.0044 Tw
(Es prioritario la mejora de los cuidados de soporte)Tj
-0.9767 -1.1818 TD
0.0009 Tc
0.1241 Tw
(contemplando tambin como objetivos de los estu-)Tj
T*
0 Tc
0.0536 Tw
(dios la mejora sintomtica, el beneficio clnico y la)Tj
T*
0 Tw
(calidad de vida. )Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 26.7705 215.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(Ancianos)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.5138 189.9843 Tm
0 0 0 1 k
/GS1 gs
0.0037 Tc
0.1212 Tw
(En diferentes subanlisis retrospectivos de gran-)Tj
-0.9767 -1.1818 TD
0 Tc
0.077 Tw
(des estudios en los que se administraba quimiotera-)Tj
T*
0.0675 Tw
(pia basada en platino, no se han objetivado diferen-)Tj
T*
0.0504 Tw
(cias segn la edad para pacientes con buenas condi-)Tj
T*
0.1194 Tw
(ciones fsicas, aunque s algo ms de toxicidad. Se)Tj
T*
0.0214 Tc
0.1036 Tw
(precisan estudios randomizados de quimioterapia)Tj
T*
0 Tc
0 Tw
(basada en platino en pacientes no seleccionados. )Tj
0.9767 -1.1818 TD
-0.0001 Tc
0.0273 Tw
[(En el Estudio EL)91.7(VIS)]TJ
6.6 0 0 6.6 130.5743 102.6143 Tm
0 Tc
0 Tw
(55)Tj
11 0 0 11 137.1744 98.9843 Tm
0.0272 Tw
(, VNR en monoquimiotera-)Tj
-10.0367 -1.1818 TD
-0.0001 Tc
0.0364 Tw
[(pia demostr ser superior a mejor cuidado de sopor-)]TJ
T*
0.0361 Tc
0.0889 Tw
(te. En el Estudio MILES)Tj
6.6 0 0 6.6 148.2653 76.6143 Tm
0 Tw
(56)Tj
11 0 0 11 159.4671 72.9843 Tm
0.0889 Tw
(no se demuestra que)Tj
-12.0633 -1.1818 TD
0.0037 Tc
0.1212 Tw
(GEM/VNR sea superior a GEM VNR en mono-)Tj
23.4861 35.4545 TD
0 Tc
0.125 Tw
[(quimioterapia. Sin embar)17.8(go, en el Estudio SICOG,)]TJ
-0.0245 -1.1818 TD
-0.0001 Tc
0.0825 Tw
(GEM/VNR si es superior a VNR)Tj
6.6 0 0 6.6 434.4808 440.6143 Tm
0 Tc
0 Tw
(57)Tj
11 0 0 11 441.0809 436.9843 Tm
0.0824 Tw
(. En el Congreso)Tj
-14.203 -1.1818 TD
-0.0001 Tc
0.1088 Tw
[(ASCO 2005 se conocen resultados del estudio fase)]TJ
T*
0 Tc
0.1038 Tw
[(III japons WJT)17.8(OG9904 que en 1 lnea demuestra)]TJ
T*
-0.0001 Tc
0.0258 Tw
(que Docetaxel es superior a VNR \(respuestas 22.7%)Tj
T*
0.0381 Tc
0.0869 Tw
(vs 9.9%, supervivencia mediana 13.9 vs 9,9 m,)Tj
T*
-0.0001 Tc
0 Tw
(P=0.03\))Tj
6.6 0 0 6.6 320.0769 375.6143 Tm
0 Tc
(58)Tj
11 0 0 11 329.427 371.9843 Tm
-0.0001 Tc
[(\(T)69.7(abla II\).)]TJ
-3.076 -1.1818 TD
0.0134 Tc
0.1116 Tw
(Las recomendaciones del reciente Panel de Ex-)Tj
-0.9767 -1.1818 TD
0.0178 Tc
0.1072 Tw
(pertos Internacional para el tratamiento de ancia-)Tj
T*
-0.0001 Tc
0 Tw
(nos)Tj
6.6 0 0 6.6 300.126 336.6143 Tm
0 Tc
(59 )Tj
11 0 0 11 308.6563 332.9843 Tm
0.0424 Tw
(establece que la valoracin geritrica exhausti-)Tj
-2.1644 -1.1818 TD
0.0112 Tc
0.1138 Tw
(va es necesaria para definir mejor el pronstico y)Tj
T*
0 Tc
0.0102 Tw
(predecir la tolerancia al tratamiento. En pacientes no)Tj
T*
0.0532 Tw
(seleccionados, el tratamiento se basar en monoqui-)Tj
T*
0.0816 Tw
(mioterapia con un frmaco de 3 generacin \(VNR,)Tj
T*
0.0173 Tw
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T*
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T*
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[(, y previsto un fase II rando-)]TJ
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0.9767 -1.1818 TD
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-0.9767 -1.1818 TD
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T*
0.0023 Tc
0.1227 Tw
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T*
0 Tc
0.1089 Tw
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T*
0.1092 Tw
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T*
0.1128 Tw
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T*
0.0224 Tw
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T*
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T*
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T*
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[(En el Cncer de Pulmn No Microctico A)74(vanza-)]TJ
-0.9767 -1.1818 TD
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T*
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T*
0 Tc
0.0058 Tw
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T*
0.0336 Tw
[(cer)54.9(. No existe un rgimen de quimioterapia standard)]TJ
T*
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T*
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T*
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T*
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T*
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T*
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[(Las nuevas T)69.7(erapias Dirigidas son prometedoras)]TJ
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T*
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T*
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T*
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T*
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0.1074 Tw
(mos avanzando, conseguimos lentamente mejorar)Tj
T*
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T*
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T*
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T*
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T*
(C/ San Juan Bosco, 15)Tj
T*
(E-50009 Zaragoza)Tj
T*
(E-mail: onch-isla@hcu-lblesa.es)Tj
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T*
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[(2.)-703.3(Hotta K, Matsuo K, Ueoka H, et al. Addition of platinum)]TJ
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T*
0.1204 Tw
(small cell lung cancer: a literature based meta-analysis of)Tj
T*
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0.0515 Tw
[(3.)-703.4(Pfister D, Johnson D, Azzoli C, et al. American Society of)]TJ
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T*
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(Cell Lung Cancer Guideline: Update 2003. J Clin Oncol)Tj
T*
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(2004;22:330-353.)Tj
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0.0133 Tw
[(4.)-703.3(ESMO Minimum Clinical Recommendations for diagnosis,)]TJ
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0.0929 Tw
(treatment and follow-up of non-small cell lung cancer)Tj
T*
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0.1246 Tw
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T*
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0.1163 Tw
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T*
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(JAMA 2004;292:470-84.)Tj
-1.4533 -1.4376 TD
0.0017 Tc
0.1232 Tw
[(6.)-701.6(Lilenbaum RC, Herdon JE, List MA. Single-agent versus)]TJ
1.4533 -1.1986 TD
0.0303 Tc
0.0947 Tw
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T*
0.0055 Tc
0.1195 Tw
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T*
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(9730\). J Clin Oncol 2005;23:190-6.)Tj
-1.4533 -1.4376 TD
0.0028 Tc
0.1222 Tw
[(7.)-700.5(Schiller J, Harrrington D, Belani C, et al. Comparison of)]TJ
1.4533 -1.1986 TD
0.0057 Tc
0.1193 Tw
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T*
0 Tc
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-1.4533 -1.4376 TD
(8.)Tj
1.4533 0 TD
0.022 Tc
0.1029 Tw
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0.0127 Tc
0.1123 Tw
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T*
0.0041 Tc
0.1209 Tw
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T*
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0.0696 Tw
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T*
0 Tw
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-1.4533 -1.4376 TD
-0.0001 Tc
0.0039 Tw
[(9.)-703.4(Scagliotti G, De Marinis, F, Rinaldi, M, et al. Phase III ran-)]TJ
1.4533 -1.1986 TD
0 Tc
0.1229 Tw
(domized trial comparing three platinum-based doublets in)Tj
T*
0.0053 Tc
0.1197 Tw
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T*
0 Tc
0 Tw
(20:4285-91.)Tj
-1.9117 -1.4376 TD
0.0429 Tw
[(10.)-661.7(Kelly K, Crowley J, Bunn, PA Jr, et al. Randomized phase)]TJ
1.9117 -1.1986 TD
0.0131 Tc
0.1119 Tw
(III trial of paclitaxel plus carboplatin versus vinorelbine)Tj
T*
0.0119 Tc
0.1131 Tw
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T*
0.0021 Tc
0.1229 Tw
(non-small-cell lung cancer: a Southwest Oncology Group)Tj
T*
0 Tc
0 Tw
(Trial. J Clin Oncol 2001; 19:3210-8.)Tj
-1.9117 -1.4376 TD
-0.0001 Tc
0.046 Tw
[(11.)-661.8(Socinsky MA, Schell MJ, Peterman A, et al. Phase III trial)]TJ
1.9117 -1.1986 TD
0 Tc
0.0459 Tw
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T*
0.0493 Tw
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T*
0.0749 Tc
0.1512 Tw
(IIIB/IV non-small-cell lung cancer. J Clin Oncol)Tj
T*
0 Tc
0 Tw
(2002;20:1335-43.)Tj
-1.9117 -1.4376 TD
0.002 Tc
0.123 Tw
[(12.)-659.7(Le Chevalier T, Scagliotti G, Natale R, et al. Efficacy of)]TJ
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