重组人血管内皮抑制素联合化疗治疗４６例晚期非小细胞肺癌的临床观察

目的：观察重组人血管内皮抑制素（恩度）联合常规化疗方案治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的疗效和毒副反应。方法：经病理学检查证实的４６例初治ⅢＢ和Ⅳ期ＮＳＣＬＣ患者，包括鳞癌１７例，腺癌２３例，其他类型６例，均采用恩度联合常规化疗，其中联合ＴＰ方案１２例，联合ＧＰ方案１５例，联合ＮＰ方案１９例。恩度剂量为１５ｍｇ／次，加入生理盐水５００ｍｌ中静滴３～４小时，第１～１４天连续给药。ＴＰ方案：紫杉醇（ＰＴＸ）１７５ｍｇ／ｍ^２第１天，顺铂（ＣＤＤＰ）２５ｍｇ／ｍ^２第１～３天；ＧＰ方案：吉西他滨（ＧＥＭ）１ ０００ｍｇ／ｍ^２第ｌ、８天，ＣＤＤＰ２５ｍｇ／ｍ^２第１～３天；ＮＰ方案：长春瑞滨（ＮＶＢ）２５ｍｇ／ｍ^２第１、８天，ＣＤＤＰ２５ｍｇ／ｍ^２第１～３天。均２１天为１周期。所有患者至少完成２个周期，根据ＷＨＯ疗效评定及毒副反应分级标准，观察其近期疗效、１年生存率、肿瘤进展时间（ＴＴＰ）及毒副反应。结果：４６例初治晚期ＮＳＣＬＣ，获ＣＲ２例（４.３５％），ＰＲ１７例（３６.９６％），ＳＤ１４例（３０.４３％），ＰＤ１３例（２８.２６％），客观反应率（ＲＲ）为４１.３１％，疾病控制率（ＤＣＲ）７１.７４％。中位ＴＴＰ为５.１个月，１年生存率为３８.２％。治疗相关毒副反应主要为食欲不振，疲乏，轻度的心脏毒副反应，包括心悸、胸闷、血压升高等，全组无心律失常及出血发生。骨髓抑制、Ⅰ ～Ⅱ度胃肠道及外周神经毒性均可耐受。结论：恩度联合常规化疗方案治疗晚期ＮＳＣＬＣ的近期客观疗效较高，安全性好，但远期疗效仍需进一步观察。

Clinical study of chemotherapy combined with endostar in the treatment of 46 advanced non-small cell lung cancer

Objective：To observe the efficacy and safety of rh-endostatin injection（endostar） combined with TP or GP or NP regimen in patients with advanced non-small cell lung cancer（NSCLC）.Methods：Forty-six histologically confirmed stage ⅢB and Ⅳ NSCLC patients were enrolled in the group,including 17 cases with squamous cell carcinoma,23 cases with adenocarcinoma and 6 cases with other type of carcinoma.There were 12 patients administrated with endostar plus TP regimen（endostar 15mg/d solved in 500ml of normal saline was slowly dropped from day 1 to 14; paelitaxel 175mg/m2 day 1, cisplatin 25mg/m2 day 1 to 3, repeated 21 days） ; 15 patients were administrated with endostar plus GP regimen （endostar 15mg/d solved in 500ml of normal saline was slowly dropped from day 1 to 14,gemcitabine 1 000mg/m2 day 1 and 8, cisplatin 25mg/m2 dayl to 3, repeated 21 days） ; 19 patients were administrated with endostar plus NP regimen（ endostar 15mg/d solved in 500ml of normal saline was slowly dropped from day 1 to 14 ,vinorelbine 25mg/m2 day l and 8, cisplatin 25mg/m2 dayl to 3 ,repeated 21 days）. All patients shoud completed 2 cycles at least. The primary point were the therapeutic effects, one-year survival rate, the median time to progress and adverse reactions. Results： Among 46 cases,there were 2 cases CR（4. 35% ） , 17 cases PR（36.96% ）, 14 cases SD（30. 43% ） and 13 cases PD（28. 26% ）. ORR was 41.31%, DCR was 71.74% , mTTP was 5. 1 months and one-year survival was 38. 3%. The most common adverse effects were nausea and Vomiting, bone marrow suppression and fatigue. The G3-G4 toxicities including neutropenia 8 caces（ 17. 39% ）, thrombocytopenia 3 cases（6. 52% ）. Two cases occurrenced Gj and G2 blood pressure set-up and 2 cases occurrenced cardiopalmus. Arrhythmia and hemorrhage had no occurrence. Conclusion： Endostar combined chemotherapy were effective and safe in treatment of advanced NSCLC.These results deserved further investigations.