替尼泊甙和卡铂联合化疗晚期肺癌近期疗效评价

替尼泊甙和卡铂联合化疗晚期肺癌近期疗效评价钟义罗克枢邵文君关键词肺肿瘤替尼泊甙卡铂联合化疗中图号Ｒ７３４．２Ｒ７３０．５３表３ＶＭ－２６、ＣＢＰ化疗方案毒副反应（例，％）自１９４年１月至１９９５年４月，我院采用替尼泊甙（鬼臼噻吩甙、Ｔｅｎｉｐｏｓｉｄ...     

以替尼泊甙为主的化疗方案相伴放疗治疗小细胞肺癌

目的探讨替尼泊甙（ＶＭ－２６）为主的化疗方案相伴放疗治疗小细胞肺癌的临床疗效。方法５３例小细胞肺癌中，４８例选用ＶＭ－２６＋顺铂（ＤＤＰ）方案，ＶＭ－２６每天６０ｍｇ／ｍ２，ＤＤＰ每天２５ｍｇ／ｍ２，连用３天为一个疗程；另５例用卡铂取代ＤＤＰ，５００ｍｇ静脉滴注，１天完成。除第１个与第２个疗程化疗间隔４０天左右外，以后每４周重复１个疗程，共５个疗程。在第１个疗程化疗后１～４天内开始放射治疗。对局限期和广泛期患者分别照射不同的剂量和部位。结果局限期患者近期疗效为９７．８％［完全缓解（ＣＲ）为５３．３％，部分缓解（ＰＲ）为４４．８％］，１年和２年生存率分别为７７．１％（２７／３５）和４４％（１１／２５），中位生存期大于１８个月。广泛期患者近期疗效为７５％（ＣＲ２５％），一年生存率为３７．５％（３／８），中位生存期大于１１个月。结论以ＶＭ－２６为主的化疗方案相伴放疗是治疗小细胞肺癌的有效方案，可提高肿瘤的局部控制率。     

替尼泊甙－司莫司汀治疗颅内恶性肿瘤临床观察

目的评价替尼泊甙－司莫司汀（ＶＭ－２６—ＭｅＣＣＮＵ）联合方案治疗颅内恶性肿瘤的效果。方法经病理确诊的颅内恶性肿瘤６０例，随机分为两组。治疗组３０例，采用ＶＭ－２６—ＭｅＣＣＮＵ方案；对照组３０例，采用依托泊甙－司莫司汀（ＶＰ－１６—ＭｅＣＣＮＵ）方案。５天为一个周期，每个周期间隔４周，连续４个周期。观察指标包括临床症状和体征、头颅ＣＴ或ＭＲＩ检查。随访时间４～１２个月以上。结果治疗组与对照组的总有效率分别为６３．３％和３６．６％（Ｐ＜０．０５）。结论ＶＭ－２６—ＭｅＣＣＮＵ序列治疗颅内恶性肿瘤是一种安全有效的化疗方案。     

非小细胞肺癌化学治疗与血清sAPO-1/Fas、NO的变化

目的 观察化疗药物替尼泊甙（ＶＭ－２６）、表阿霉素（ＥＰＩ）、顺铂（ＤＤＰ）治疗非小细胞肺癌的疗效、毒性及治疗前后血清ｓＡＰＯ－１／Ｆａｓ、ＮＯ含量的变化。方法４２例诊断明确的晚期非小细胞肺癌（ＮＳＣＬＣ）患者（鳞癌２８例,腺癌１２例,未分化癌２例）采用ＶＭ－２６、ＥＰＩ、ＤＤＰ联合化疗２个周期。化疗前后分别用比抗体夹心ＥＬＩＳＡ方法测定血清ｓＡＰＯ－１／Ｆａｓ含量和用酶还原法测定血清ＮＯ含量。结     

ADMV方案治疗中晚期非小细胞肺癌62例近期疗效分析

采用ＡＤＭＶ（ＡＤＭ＋ＤＤＰ＋ＭＭＣ＋ＭＭＣ＋ＶＰ－１６）方案联合化疗，对６２例中晚期非小细胞肺癌近期疗效观察，ＣＲ２例，ＰＲ１８例，ＮＲ３２例，ＰＤ１０例，总有效率（ＣＲ＋ＰＲ）３２．２６％（２０／６２）。化疗毒副反应主要是消化道反应（５９．６８％）及骨髓抑制（白细胞下降占６１．２９％）。     

ADMV方案治疗中晚期非小细胞肺癌62例近期疗效分析

采用ＡＤＭＶ（ＡＤＭ＋ＤＤＰ＋ＭＭＰ＋ＭＭＣ＋ＶＰ－１６）方案联合化疗，对６２例中晚期非小细胞肺癌近期疗效观察，ＣＲ２例，ＰＲ１８例，ＮＲ３２例，ＰＤ１０例， 效率（ＣＲ＋ＰＲ）３２．２６％）２０／６２），化疗毒副反庆主要是消化道反 （５９．６８％）及骨髓抑制（白细胞下降占６１．２９％）．     

VM—26,DDP联合化疗对晚期肺癌的近期疗效观察

ＶＭ－２６、ＤＤＰ治疗晚期肺癌１７例，总缓解率５２．９％，其中小细胞肺癌的缓解率８３．３％，非小细胞肺癌３６．３％。初治病人的疗效明显高于复治病人，增加疗程能提高缓解率，由于ＶＭ－２６能透过血脑屏障，对肺癌脑转移的病人疗效较好。本方案疗效好，毒副反应低，值得进一步应用观察。     

鬼臼乙叉甙软胶囊治疗恶性肿瘤的临床验证报告

１９９３年６月～１９９４年４月，作者组织了全国５家医院，对南京药物研究所和江苏连云港制药厂研制的口服鬼臼乙叉甙（ＶＰ－１６）软胶囊进行临床验证。全组可评价疗效者１１０例，ＶＰ－１６单药口服治疗５０例，口服ＶＰ－１６联合治疗６０例，其它相应治疗对照４５例。结果表明，口服单药有效率在小细胞肺癌为５０％（９／１８），恶性淋巴瘤为８３．３％（１５／１８），卵巢癌为１／６，胃癌为０／８。联合用药治疗组与对照组的有效率：小细胞肺瘤为５７．１％及５５．６％，恶性淋巴瘤为９５％及８７．５％，胃癌为１／５及０／２．鬼臼乙叉甙口服胶囊毒副反应轻微，病人耐受性好，单药或联合用药治疗小细胞肺癌、恶性淋巴瘤、卵巢癌有较好疗效，可进一步扩大使用。     

丝裂霉素,长春花碱酰胺,顺铂联合治疗晚期非小细胞肺癌108例

目的 观察丝裂霉素（ＭＭＣ）、长春花碱酰胺（ＶＤＳ）、顺铂（ＤＤＰ）联合化疗治疗晚期非小细胞肺癌的疗效。方法 治疗非小细胞肺癌患者１０８例。病理类型以腺癌（７４例）和鳞癌（２３例）为主。初治７８例,复治者有效率１６．７％（Ｐ＝０．０１６９）。鳞癌有效率３０．４％,腺癌有效率３２．４％。淋巴结转移、肺原发肿瘤、肺内转移、肝转移和骨转移的有效率依次为４３．１％、３７．６％、３２．４％、２５．０％和０。     

三组不同联合化疗方案治疗晚期非小细胞肺癌病例的比较

目的 比较３组不同联合化疗方案对晚期非小细胞肺癌的疗效和毒性,统计分析用ＩＶＰ方案、ＭＶＰ方案及ＣＡＰ方案治疗的９３例晚期非小细胞肺癌病例的临床资料。结果 ＩＶＰ组有效率为４８．４％,其中完全缓解２例;ＭＶＰ组有效率为４０．０％,ＣＡＰ组有效率为２８．１％,毒副反应主要为骨髓抑制及脱发。结论 以长春地辛为主的ＩＶＰ及ＭＶＰ方案为治疗晚期非小细胞肺癌较为有效而较为安全的化疗方案。     

A randomized trial in inoperable non-small-cell lung cancer: vindesine and cisplatin versus mitomycin, vindesine, and cisplatin versus etoposide and cisplatin alternating with vindesine and mitomycin.

Patients with inoperable non-small-cell lung cancer (NSCLC) were randomly assigned to receive one of three dosage regimens: (1) vindesine and cisplatin (VP); (2) mitomycin, vindesine, and cisplatin (MVP); or (3) etoposide and cisplatin alternating with vindesine and mitomycin (EP/VM). In 199 assessable patients, the response rates were VP, 33%; MVP, 43%; and EP/VM, 19%. The addition of mitomycin to the VP regimen did not significantly improve the response rate. The response rate was significantly lower with the EP/VM regimen than with the MVP regimen (P less than .01). The median survival times were VP, 50 weeks; MVP, 42 weeks; and EP/VM, 40 weeks. These differences were not significant. Grade III or IV thrombocytopenia was significantly greater (P less than .01) in MVP patients (22%) than in the VP (5%). Other toxicities were similar in the three groups. Analyses of prognostic factors showed that treatment with MVP, sex, and histologic classification (squamous cell carcinoma) were predictive of improved response. Important factors for improved survival, according to the Cox regression analysis, were the stage of disease, performance status, sex, weight loss before diagnosis, and hemoglobin concentration.     

LP和TP方案治疗晚期非小细胞肺癌的临床研究(英文)

Objective:The aim of the study was to evaluate the responses and toxicities of liposome encapsulated paclitaxel (LEP) plus cisplatin (DDP) (LP regimen) and paclitaxel (TAX) plus DDP (TP regimen) in the treatment of advanced non-small cell lung cancer (NSCLC). Methods: A total of 89 cases with advanced NSCLC was randomized into two groups: the LP group (57 patients) and the TP group (32 patients). The responses, toxicities and survivals of the two groups were compared. Results: The response rates were 40.00%...     

VP方案与MVP方案治疗非小细胞肺癌的疗效比较

目的；比较ＶＰ方案与ＭＶＰ方案对非小细胞肺癌（ＮＳＣＬＣ）的治疗效果。方法：７８例患者分别用ＶＰ（ＶＤＳ＋ＤＤＰ）方案和ＭＶＰ（ＭＭＣ＋ＶＰ）方案治疗。结果：ＶＰ组和ＭＶＰ组有效分别为４５．７％和４７．２％，两者无显著怀差异。分析诸因素对疗效的影响发现，病期早较病期晚疗效好。生活质量评估Ｋａｍｏｆｓｋｙ评分一升高为７１．４％，ＭＶＰ组为６９．４％，两组无显著性差异。骨髓抑制为限制性毒性，白细胞下降     

健择联合顺铂治疗晚期非小细胞肺癌疗效分析

目的:观察健择(gemcitabine,GEM)/顺铂(DDP)每周给药方案治疗晚期非小细胞肺癌(nonsmallcelllungcancel,NSCLC)的近期疗效和毒性反应。方法:37例晚期NSCLC,分别于d1、d8和d15联合应用GEM(1000mg/m2)和DDP(25mg/m2),28d为1个周期。治疗至少2个周期评价疗效。结果:36例可评价疗效,所有患者无CR,PR12例,NC15例,PD9例,总有效率为33.3%(12/36)。37例可评价毒性,3、4度粒细胞减少、血小板减少分别为13.5%(5/37)和16.2%(6/37)。结论:GEM/DDP每周给药方案疗效与其他GEM/DDP联合方案疗效相仿,但毒性反应明显低于其他方案,可用于老年患者或一般状况较差患者的治疗。     

草酸铂加长春瑞滨和NP方案治疗晚期非小细胞肺癌疗效比较

目的比较L—OHP与NP方案治疗晚期NSCLC的近期疗效和毒副反应。方法将64例经病理检查确诊的NSCLC患者随机分为2组：治疗组32例,NVB25mg／m^2静脉点滴,第1、8天,L—OHP130mg／m^2静脉点滴2h,第2天,每21天为1个周期;对照组32例：NVB25mg／m^2静脉点滴,第1、8天,顺铂70mg／m^2分3天静脉滴注,从第2天开始,每21天为1个周期。对两组的总反应率和毒副反应作回顾性分析。结果治疗组与对照组的总反应率分别为62．5％（20／32）和34．4％（11／32）,有显著性差异（χ^2=4．0,P〈0．05）;治疗组有2例CR患者;两组主要毒副反应为血液和神经毒性。结论L—OHP＋NVB方案治疗晚期NSCLC近期疗效较NP方案好,毒副反应均能耐受。     

Overexpression of Multidrug Resistance Protein Gene in Human Cancer Cell Lines Selected for Drug Resistance to Epipodophyllotoxins

Overexpression of either the multidrug resistance 1 (MDR1) gene or multidrug resistance protein (MRP) gene is involved in acquisition of multidrug-resistant phenotypes in human cancer cells. In this study we examined whether selection for resistance to the epipodophyllotoxins, etoposide/teniposide (VP16/VM26), could induce overexpression of MDR1 or MRP. We have previously isolated two VP16/VM26-resistant KB cell lines. Two VP16/VM26-resistant KB cell lines, KB/VM-1 and KB/VM-4, which were selected by stepwise exposure to VM26 had decreased accumulation of [³H]VP16 and increased levels of MRP, but no apparent expression of MDR1 gene was observed. Another VP16/VM26-resistant KB cell line, KB/VP-4, which was further isolated from a VP16-resistant KB cell line, KB/VP-2, had decreased accumulation of [³H]VP16 and showed overexpression of MRP gene, but not that of MDR1 gene. We also isolated a VP16-resistant cell line, IN157/VP-1, from a human glioma cell line IN157. IN157/VP-1 cells showed decreased accumulation of [³H]VP16 and overexpression of MRP gene, but not of MDR1. These findings suggest that selection for resistance to VP16/VM26, preferentially induces overexpression of MRP gene.     

HP与MVP方案治疗晚期非小细胞肺癌比较

[目的]比较HP及MVP方案对晚期非小细胞肺癌的疗效和毒性.[方法]分析HP及MVP化疗方案治疗59例晚期非小细胞肺癌.[结果]HP组有效率为50.0%(其中5例复治者中PR3例),MVP组有效率为51.6%,两组间无差异性(P＞0.05),毒性反应以骨髓抑制、恶心呕吐及腹泻为主.[结论]HP方案是治疗晚期非小细胞肺癌的有效方案.     

Cisplatin-based combination chemotherapy for elderly patients with non-small-cell lung cancer

Purpose: To compare the response rates, toxicities and survival durations of elderly patients (70 years of age or more) with those of younger patients ( less than 70 years of age) with non-small-cell lung cancer (NSCLC) treated with cisplatin-based chemotherapy. Patients and methods: We analyzed retrospectively the data of 203 assessable patients entered on a prospective randomized trial of cisplatin-based combination chemotherapy. Chemotherapy consisted of three dosage regimens: (1) vindesine and cisplatin (VP); (2) mitomycin, vindesine and cisplatin (MVP); or (3) etoposide and cisplatin alternating with vindesine and mitomycin (EP/VM). Results: A greater proportion of elderly patients had localized disease and more squamous cell carcinoma than non-elderly patients. The overall response rates were 44% in the elderly group and 28% in the non-elderly group. In the EP/VM arm, the response rate was significantly better in the elderly group than in the non-elderly group. The frequency of grade 4 leukocytopenia in the MVP and EP/VM arms in the elderly group was significantly greater than in the non-elderly group (P < 0.05). No differences were found in nonhematological toxicities between the two groups. There was no difference in overall survival between the groups. Conclusion: Elderly patients treated with mitomycin-containing regimens have higher hematologic toxicities than younger patients. The results of this study are consistent with the previously reported pharmaco logic data on mitomycin suggesting altered pharmacokinetics in elderly patients. The improved response rate in the elderly patients was probably because more elderly patients had earlier disease, squamous cell carcinoma and better performance status. Cisplatin-based chemotherapy was tolerable for most elderly NSCLC patients with good performance status. Received: 30 October 1996 / Accepted: 20 March 1997