重组人血管内皮抑制素联合含铂方案治疗晚期非小细胞肺癌的临床观察

目的:评价重组人血管内皮抑制素联合含铂方案治疗晚期非小细胞肺癌的疗效和不良反应.方法:108例晚期非小细胞肺癌患者被随机分入试验组(54例)和对照组(54例).对照组患者接受含铂化疗方案治疗,试验组患者接受重组人血管内皮抑制素联合含铂化疗方案治疗.观察2组患者的近期有效率和临床获益率以及疾病进展时间和总生存期,并观察治疗前后患者Karnofsky体能状况评分以及血清癌胚抗原水平的变化.结果:试验组的近期有效率为38.46％,对照组为18.87％(P=0.026),试验组的临床获益率为80.77％,对照组为62.26％ (P=0.036).2组患者治疗前后的Karnofsky体能状况评分差异均无统计学意义(P＞0.05).2组患者治疗后的血清癌胚抗原水平均较治疗前明显下降(P＜0.05).试验组的中位疾病进展时间为6.2个月,对照组为4.7个月(P=0.022):试验组的中位总生存期为16.2个月,对照组为14.1个月(P=0.485).2组患者的不良反应相似,主要为骨髓抑制和消化系统反应等.试验组患者发生心脏毒性的比例高于对照组,但差异无统计学意义(P=0.086).结论:重组人血管内皮抑制素联合含铂方案治疗晚期非小细胞肺癌的近期疗效较好,可延长疾病进展时间,且耐受性良好.     

重组人血管内皮抑素的持续静脉泵入联合化疗在晚期肺鳞癌中的疗效分析

目的探讨晚期肺鳞癌患者一线应用重组人血管内皮抑素持续静脉泵入联合含铂双药化疗的临床疗效、预后及安全性。方法选取2012年1月至2016年12月于江苏省肿瘤医院接受一线应用重组人血管内皮抑素持续静脉泵入联合含铂双药化疗治疗的晚期肺鳞癌患者(临床分期为Ⅲ期或Ⅳ期)41例,其中应用重组人血管内皮抑素持续静脉泵入并在窗口期联合紫杉醇类药物加铂类化疗方案(联合TP方案组)29例,应用联合吉西他滨加铂类化疗方案(联合GP方案组)12例。参照实体瘤疗效评价标准(RESIST_1.1)进行疗效评价,计算客观缓解率(ORR)、疾病控制率(DCR)。对患者进行随访,统计无进展生存期(PFS)。记录持续静脉泵入重组人血管内皮抑素的过程中不良反应的发生情况。结果 41例中21例部分缓解(PR),11例疾病稳定(SD),9例出现疾病进展(PD),无人达到完全缓解(CR),客观缓解率为51.22%(21/41),疾病控制率为78.05%(32/41)。联合GP方案组与联合TP方案组的疗效差异均无统计学意义(均P0.05)。该组患者中位PFS为5.4(1.3～21.0)个月。联合GP方案组与联合TP方案组的中位PFS分别为6.4(1.5～21.0)个月、4.8(1.3～17.6)个月,两组PFS差异无统计学意义(P0.05)。治疗过程中与重组人血管内皮抑素相关的不良反应主要包括心脏毒性(3例)、消化道毒性(6例)以及全身症状(1例),无严重不良反应发生。结论一线应用重组人血管内皮抑素持续静脉泵入联合含铂双药化疗药物治疗晚期肺鳞癌可取得较好的临床疗效。     

重组人血管内皮抑制素治疗晚期非小细胞肺癌的效果及对血清促红细胞生成素及其受体表达情况的影响

目的 探讨重组人血管内皮抑制素治疗晚期非小细胞肺癌(NSCLC)的临床效果及对血清促红细胞生成素(EPO)及其受体表达情况的影响.方法 采用随机数字表法将122例晚期NSCLC患者随机分为联合组与对照组,各61例.两组患者均采用多西他赛+铂类药物(DP)方案进行化疗,联合组患者在此基础上采用重组人血管内皮抑制素进行治疗...     

重组人血管内皮抑制素联合顺铂化疗方案在非小细胞肺癌合并肺不张中的疗效观察

目的 探究重组人血管内皮抑制素联合顺铂化疗方案在非小细胞肺癌(NSCLC)合并肺不张中的疗效.方法 将80例NSCLC合并肺不张患者根据治疗方案的不同分为顺铂化疗组与抑制素组,每组40例.顺铂化疗组应用常规治疗方法及顺铂化疗,抑制素组在顺铂化疗组基础上使用重组人血管内皮抑制素.比较两组患者总生存期、视觉模拟评分法(VAS)评分、卡氏功能状态(KPS)评分、T淋巴细胞亚群水平、血清肿瘤标志物及不良反应发生情况.结果 抑制素组患者5年总生存率为38.73％,高于顺铂化疗组的21.08％,差异有统计学意义(χ2=6.87,P﹤0.05).治疗后,抑制素组患者VAS评分低于顺铂化疗组,KPS评分高于顺铂化疗组;抑制素组CD3+、CD4+水平均高于顺铂化疗组,CD8+水平低于顺铂化疗组;抑制素组患者癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)及鳞状细胞癌抗原(SCCA)水平均低于顺铂化疗组;抑制素组患者不良反应总发生率低于顺铂化疗组,差异均有统计学意义(P﹤0.05).结论 NSCLC合并肺不张患者治疗中,顺铂化疗方案基础上应用重组人血管内皮抑制素,能够延长患者生存期,缓解患者疼痛,降低CEA、CYFRA21-1及SCCA水平,提高免疫功能,降低不良反应的发生率.     

NRP1表达与晚期非小细胞肺癌一线含铂方案化疗敏感性及预后的相关性分析

背景与目的：神经菌毛素-1(neuropilin-1,NRP1)作为血管内皮生长因子(vascular endothelial growth factor,VEGF)受体,在肿瘤新生血管形成和肿瘤细胞迁移中发挥重要作用。本研究目的是探索NRP1表达与晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)含铂一线化疗敏感性及预后的相关性。方法：应用免疫组织化学法检测104例一线应用含铂双药方案化疗的晚期NSCLC肿瘤组织中NRP1表达,采用χ2检验及Logistic回归模型分析NRP1表达与化疗反应率的关系。采用Kaplan-Meier和Cox比例风险回归模型分析NRP1表达对生存期的影响。结果：在104例患者中,56例(53.8%)出现NRP1高表达。NRP1高表达与年龄、性别、组织类型、分化程度、行为状态和化疗方案等临床病理因素无关。NRP1低表达患者的化疗反应率高于高表达患者(43.8%vs 23.2%,P=0.026)。Logistic多因素分析结果显示,NRP1表达为化疗反应率的独立预测因素(OR=3.103,95%CI：1.320~7.290,P=0.009),NRP1低表达患者较高表达患者具有更长的无进展生存期(4.6个月vs 3.0个月,χ2=11.273,P=0.001)和总生存期(11.5个月vs 9.2个月,χ2=14.392,P=0.000),NRP1高表达是晚期NSCLC化疗反应率及总生存期的独立预测因素。结论：NRP1高表达与晚期NSCLC一线含铂联合化疗反应率和生存期相关,NRP1表达可能是预测晚期NSCLC化疗敏感性和预后的生物标志物。     

重组人血管内皮抑制素联合GP方案治疗晚期非小细胞肺癌

 【摘要】　目的　评价重组人血管内皮抑制素（商品名：恩度）联合吉西他滨加顺铂（GP）方案治疗晚期非小细胞肺癌（NSCLC）的疗效和安全性。方法　采用非随机同期对照的方法,以接受重组人血管内皮抑制素联合化疗的NSCLC患者32例为试验组,单纯GP方案化疗者40例为对照组。比较两组有效率（RR）、临床受益率（CBR）、肿瘤进展时间（TTP）、生活质量（QOL）及安全性。结果　试验组和对照组的总RR分别为40.6 %（13／32）和 20.0 %（8／40）,差异无统计学意义（χ2＝3.66,P＝0.07）,总 CBR分别为68.8 %（22 ／32）和42.5 %（17／40）,差异有统计学意义（χ2＝4.93,P＝0.034）,总的中位TTP分别为 5.2个月和3.9个月,差异有统计学意义（P＝0.042）。试验组与对照组不良反应的发生率差异无统计学意义（P＞0.05）。结论　重组人血管内皮抑制素联合 GP方案能明显提高晚期NSCLC的RR、CBR及中位TTP,安全性好,具有较好的临床应用前景。     

伊立替康和洛铂联合重组人血管内皮抑制素注射液治疗晚期小细胞肺癌的临床疗效

目的探讨伊立替康(CPT-11)+洛铂联合重组人血管内皮抑制素注射液治疗晚期复发小细胞肺癌(SCLC)的临床疗效。方法选取2012年7月至2014年7月间新疆维吾尔自治区人民医院收治的68例晚期复发SCLC患者,采用随机数字表法分为观察组(37例)和对照组(31例)。观察组患者接受CPT-11+洛铂联合重组人血管内皮抑制素注射液治疗,对照组患者接受CPT-11+洛铂治疗方案,观察并比较两组患者的疗效。结果观察组患者总有效率为59.5%,对照组为48.4%,组间差异无统计学意义(P>0.05)。两组患者均有不良反应发生,且大都可以耐受,观察组患者白细胞下降和肝功能异常的发生率明显降低。观察组和对照组的中位无进展生存期(PFS)分别为8个月(95%CI为2.7~12.1)和5个月(95%CI为2.1~6.3),组间差异无统计学意义(P=0.07)。观察组和对照组的总生存期(OS)分别为11.2个月(95%CI为0.9~52.6)和6.4个月(95%CI为7.8~16.9),组间差异有统计学意义(P=0.04)。结论 CPT-11+洛铂联合重组人血管内皮抑制素注射液治疗晚期复发小细胞肺癌的临床疗效较好,不良反应发生率较低,且可以延长患者的生存时间。     

重组人血管内皮抑制素联合NP方案治疗晚期非小细胞肺癌的疗效

目的:观察重组人血管内皮抑制素联合NP方案(长春瑞滨+顺铂)治疗晚期非小细胞肺癌的近期疗效和安全性.方法:30例晚期非小细胞肺癌患者接受重组人血管内皮抑制素联合NP方案化疗,至少2个化疗周期后评价近期疗效,并观察不良反应.结果:30例可评价疗效的患者完成2个化疗周期后完全缓解0例、部分缓解4例、无变化18例、进展8例,完成4个化疗周期后完全缓解0例、部分缓解4例、无变化4例、进展2例,完成6个化疗周期后完全缓解0例、部分缓解1例、无变化3例、进展1例.中位疾病进展时间为3.6个月(1.0～13.9个月),转移器官数目与中位疾病进展时间有关(P＜0.05).不良反应主要表现为骨髓抑制和消化系统反应.结论:重组人血管内皮抑制素联合NP方案能够提高晚期非小细胞肺癌患者的临床受益率,延长中位疾病进展时间,且安全性较好.     

培美曲塞/顺铂二线治疗晚期非小细胞肺癌:一例报告及文献复习

背景与目的 结合文献复习,探讨二线治疗晚期非小细胞肺癌的价值.方法 对重组人血管内皮抑制素联合GC方案一线治疗获完全缓解(complete response,CR)后给予吉非替尼维持治疗,无进展生存期(progression free survival,PFS)10.2个月之后进展的1例转移性非小细胞肺腺癌患者,采用培美曲塞/顺铂二线治疗,随访观察患者PFS和生存时间.结果 培美曲塞/顺铂治疗5周期肺原发灶疗效为CR,骨转移灶稳定,PFS为6.6个月,至今已生存22个月,提高了患者的生活质量.结论 晚期非小细胞肺腺癌一线治疗/维持治疗后复发或转移,适时启动培美曲塞/顺铂二线治疗可延长患者生存期,提高生存质量.     

培美曲塞联合顺铂对比吉西他滨联合顺铂一线治疗晚期非鳞非小细胞肺癌的随机、对照、多中心临床研究

背景与目的目前晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的标准治疗仍是含铂两药方案,国内外多项临床研究显示培美曲塞联合顺铂在晚期非鳞NSCLC具有较好的疗效及安全性,本研究拟评估国产培美曲塞二钠联合顺铂一线治疗晚期NSCLC的疗效与安全性。方法本研究是一项多中心、随机、阳性药物平行对照的临床试验。入组患者按1:1随机分为两组,分别接受培美曲塞二钠联合顺铂(PC组)或吉西他滨联合顺铂(GC组)治疗,21天为一个周期。主要研究终点为无进展生存期,次要研究终点主要包括1年生存率、客观缓解率、无3度或4度毒性生存期及其安全性。结果全国20家研究中心共纳入288例患者(各组144例),基于全分析集进行分析,PC组与GC组患者的中位无进展生存期分别为168天(5.6个月)和140天(4.7个月)(P=0.16);1年生存率分别为50.0%和54.9%(P=0.47);客观缓解率分别为24.4%和14.2%(P=0.06);无3度/4度毒性生存期分别为11.3个月和8.1个月(P=0.23)。总体不良反应发生率PC组明显低于GC组(81.95%vs93.75%,P=0.003)。结论两种含铂方案治疗晚期非鳞NSCLC具有相似的疗效,但PC方案不良反应更轻,有望成为晚期非鳞NSCLC一线治疗的新选择。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.