托瑞米芬联合长春地辛和顺铂化疗方案治疗不能手术切除的非小细胞肺癌

目的 探讨托瑞米芬联合丝裂霉素、长春地辛和顺铂(MVP方案)对非小细胞肺癌(NSCLC)的治疗价值。方法 将A549细胞以10×104个/孔浓度接种到96孔培养板中,分别加入不同浓度的顺铂、长春地辛、丝裂霉素、托瑞米芬或托瑞米芬联合上述药物;72 h后用四甲基偶氮唑蓝法(MTT),检测上述药物对细胞的抑制作用。本研究包括63例初治。NSCLC和30例复治NSCLC(复治组)患者。初治患者经随机抽签分为对照组与治疗组。每例均进行MVP方案化疗,治疗组和复治组在化疗前5 d,开始口服托瑞米芬420 mg/d,共7 d。治疗2个周期后评价患者疗效,并随访不良反应与生存期。结果 托瑞米芬可降低化疗药物对A549细胞半数生长抑制的剂量,增强化疗药物的细胞毒性作用。初治患者治疗组有效率和中位生存期分别为47％(15/32)与11个月,较对照组的32％(10/31)和9个月略有增加;复治组有效率为17％,中位生存期为7个月,1年生存率为20％。3组不良反应无明显差异。结论 托瑞米芬能增强顺铂、丝裂霉素及长春地辛的抗肿瘤作用,联合MVP方案治疗NSClC安全有效。

Activity of toremifene plus mitomycin,vindesin and cisplatin regimen in unresectable non-small cell lung cancer

OBJECTIVE: To investigate the activity and clinical efficacy of toremifene plus mitomycin, vindesin and cisplatin regimen (MVP) in non-small cell lung cancer (NSCLC). METHODS: A549 cells were seeded into 96 wells at the concentration of 10 x 10(4)cells/well and exposed to different agents. Seventy-two hours later, the cytotoxicity of the agents were evaluated with the method of MTT. The clinical trial included 63 patients with chemtherapy-naive NSCLC and 30 patients who had received chemotherapy (Pre-treatment arm). The chemotherapy-naive patients were randomly divided into the toremifene-treatment arm and the control arm. Each patient was given MVP chemotherapy. Five days before the chemotherapy, those in the toremifene-treatment group and pre-treatment arm started toremifene 420 mg daily orally for 7 days. The response was evaluated after two cycles of chemotherapy and toxic side effects and the survival of the patients were followed up. RESULTS: Toremifene decreased the IC(50) of chemotherapeutic agents and increased their cytotoxicity. In the clinical trial, the response rate and median survival were 47% and 11 months in the toremifene-treatment arm and 32% and 9 months in the control arm, respectively. The difference between the two arms was not significant. The response rate and median survival were 17% and 7 months in the pre-treatment arm, respectively. The toxicity among the three groups was not significantly different. CONCLUSIONS: Toremifene can improve the cytotoxicity of cisplatin, mitomycin and vindesin. Toremifene plus MVP regimen is safe and effective in the treatment of NSCLC.