GP方案和MVP方案治疗晚期非小细胞肺癌的比较研究

晚期非小细胞肺癌(NSCLC)约占全部肺癌的80％，预后较差，总的5年生存率仅13％。在确诊时约70％已有远处转移或属局部晚期而不宜手术治疗，而在可手术的病例中，术后复发、转移高达50％以上。化疗是这些晚期NSCLC的主要治疗方法，但有效率较低。中位生存期仅4～12个月，5年生存率低于10％。由丝裂霉素(MMC)、长春地辛(VDS)和顺铂(DDP)组成的MVP方案自80年代起应用于临床，取得了一定疗效。吉西他滨(GEM，商品名健择)是20世纪90年代应用于临床的抗癌新药，为阿糖胞苷类似物，属于细胞周期特异性药物，主要作用于S期，可将细胞增殖阻滞在S期和G1期。     

MVP方案疗程与晚期非小细胞肺癌生存期之间的关系

肺瘤乃临床最常见恶性肿瘤之一，其中80％为非小细胞肺癌(NSCLC)，就诊时多已发生远处转移，失去手术与放疗的机会，只能采用化疗。许多资料表明以顺铂(DDP)为基础的化疗方案能改善晚期NSCLC的预后，DDP联合丝裂霉素(MMC)和长春地辛(VDS)方案(MVP)有效率在30％～60％之间。成为NSCLC标准化疗方案之一。但有关MVP方案与NSCLC生存期之间关系，报道不多，且化疗应持续多少周期目前尚有争议。为此，我们进行了回顾性研究。     

NP与MVP方案治疗晚期非小细胞肺癌的疗效比较

背景与目的:化疗是治疗晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的主要方法,但目前临床治疗效果不能令人满意。本研究的目的为比较NP方案和MVP方案治疗NSCLC的近期疗效和不良反应,为临床治疗提供指导。方法:48例Ⅲ～Ⅳ期NSCLC采用NP方案,即长春瑞滨(vinorelbine,NVB)25mg/m2d1,8及顺铂(cisplatin,DDP)35mg/m2d1～3联合化疗;62例Ⅲ～Ⅳ期NSCLC采用MVP方案,即丝裂霉素(mitomycin,MMC)6mg/m2d1、长春地辛(vindesine,VDS)3mg/m2d1,8及DDP30mg/m2d1～3联合化疗。结果:NP组CR和PR共24例,有效率50%,中位缓解期5.5个月,中位生存期11个月;MVP组CR和PR32例,有效率51.6%,中位缓解期6.5个月,中位生存期14.5个月,两组疗效无显著性差异(P>0.05)。结论:NP方案与MVP方案治疗晚期NSCLC疗效相近,不良反应可耐受。建议NP方案采用深静脉给药或改进给药方法,能较好地解决NVB所致的静脉炎。     

MVP方案治疗晚期非小细胞肺癌的临床观察

目的 观察采用由丝裂霉素（MMC）、长春花碱酰胺（VDS）、顺铂（DDP）组成的MVP方案治疗76例晚期非小细胞癌（NSCLC）的疗效和不良反应。方法 MMC8mg/m^2，静脉注射，第1天；VDS2．5－3．0mg/m^2静脉注射，第1、8天；DDP40－50mg/m^2，静脉滴注，第2、3天；3－4周为1个周期，连用2－3个周期。结果 CR1例，PR25例，总有效率为38．16％。初治有效率为44．00％，复治有效率为15．38％。鳞癌有效率为38．46％，腺癌有效率为37．90％。中位缓解期为4个月，中位生存期为8个月。该方案的剂量限制性毒性为白细胞下降，Ⅲ，Ⅳ度白细胞下降率为39．83％。结论 采用MVP方案治疗晚期非小细胞肺癌的有效率较高，不良反应可以耐受，价格适中，可作为临床治疗NSCLC的一线方案。     

MVP方案治疗晚期肺癌41例疗效观察

我科自 1998年 3月— 1999年 12月采用丝裂霉素 (MMC)、西艾克 (VDS)、顺铂 (DDP)联合组成化疗方案 MVP治疗晚期肺癌 4 7例 ,取得了较好的近期临床疗效。现将资料完整的 4 1例进行疗效及毒副作用分析 ,报告如下。1　资料与方法1.1　临床资料　 4 1例晚期肺癌患者 ,男性 2 8例 ,     

AT方案与NP方案治疗晚期乳腺癌临床疗效观察

目的比较AT方案与NP方案治疗晚期乳腺癌的临床疗效、毒副反应及临床受益反应(clinicalbenefitresponse,CBR)。方法Ⅲ～Ⅳ期乳腺癌患者64例,分为AT组(ADM+TAX)38例,NP组(NVB+DDP)26例。结果AT组有效率68.4%(26/38),CBR率55.3%(21/38);NP组有效率65.4%(17/26),CBR率53.8%(14/26)。组间疗效及CBR无显著性差异(P>0.05)。主要毒副作用为骨髓抑制、消化道反应和静脉炎,均为可逆性。结论AT方案和NP方案对于复发或有远处转移的晚期乳腺癌疗效确切,毒副作用可以耐受,均可作为一线治疗方案应用。     

HMVP与MVP方案治疗晚期非小细胞肺癌的临床研究

目的 :旨在观察羟基喜树碱 (hydroxycamptothecin ,HCPT)联合丝裂霉素 (mitomycin ,MMC)、长春花碱酰胺 (vindesine ,VDS)和顺铂 (cisplatin ,DDP)组成的HMVP和MVP方案治疗晚期NSCLC的近期、远期疗效和毒副反应。方法 :将 90例晚期NSCLC患者随机分为HMVP组 (4 6例 )与MVP组 (4 4例 ) ,观察两组的近期及远期疗效、毒副反应和生存情况。结果 :HMVP和MVP有效率分别为 39.5 4 %和 35 .5 7% ,两组之间无显著性差异 (P >0 .0 5 ) ;两组的中位缓解期、中位生存期、一年及二年生存率亦无明显差异。两组的Ⅲ～Ⅳ度白细胞抑制率、Ⅲ～Ⅳ度血小板抑制率、Ⅲ～Ⅳ度恶心 /呕吐发生率、Ⅲ～Ⅳ度便秘发生率之间均无显著性差异 (P >0 .0 5 )。结论 :MVP方案治疗晚期NSCLC的疗效略低于HMVP方案 ,但后者未显示出明显的疗效优势 ,却可能增加白细胞抑制、恶心 /呕吐和便秘的发生率 ,也增加了患者的经济负担 ;故在NSCLC化疗中宜选择MVP方案     

NP方案对含阿霉素方案治疗失败的晚期乳腺癌的疗效

目的 探讨去甲长春花碱联合顺铂(NP方案)对含阿霉素方案治疗失败的晚期乳腺癌的疗效和毒副作用。方法 按照既往对含阿霉素方案治疗的反应，将36例晚期乳腺癌患者分为A、B、C组3个组，采用NP方案化疗至少2个周期。结果 总有效率(CR PR)为44．4％(16／36)，其中CR为56％(2／36)；中位缓解期为6个月，中位肿瘤进展时间(TTP)为5个月，中位生存期为11个月。不良反应以骨髓抑制、胃肠道反应为主，无治疗相关死亡病例，耐受良好。结论 对曾应用含阿霉素方案治疗失败的晚期乳腺癌患者，NP方案的疗效较好，而且不良反应轻，应用安全。     

NP和MVP方案治疗晚期非小细胞肺癌的近期疗效观察

肺癌是当今世界上对人类健康与生命危害最大的恶性肿瘤之一，其发病率和死亡率在许多国家都有急剧增长的趋势，其中非小细胞肺癌(non-small cell lung cancer，NSCLC)占80％左右，约2／3的NSCLC就诊时已失去手术机会，化疗是其最重要的治疗手段。我科自2000年8月至2003年2月应用盖诺(NVB，江苏豪森制药有限公司)加顺铂(DDP)方案治疗NSCLC54例，并与同期MVP方案治疗NSCLC42例对照研究，现总结如下：     

NP方案治疗晚期乳腺癌22例的临床观察

目的观察长春瑞滨(NVB)、联合顺铂(DDP)治疗晚期乳腺癌的疗效和毒副反应。方法NVB25mg／m^2，d1，d8，DDP30mg／m^2，d1～3。结果全组22例，CR1例，PR11例。总有效率为54．5％，毒副反应主要是骨髓抑制和周围神经炎。结论NVB DDP方案治疗晚期乳腺癌疗效较好，毒副反应可以耐受。     

Clinical study of combination chemotherapy with mitomycin C, vindesine and cisplatin (MVP therapy) in advanced non-small cell lung cancer

Thirty-seven patients with inoperable non-small cell lung cancer were treated with the combination chemotherapy (MVP therapy) with mitomycin C (8 mg/m2), vindesine (3 mg/m2 X 2) and cisplatin (60 mg/m2). The partial responders were 13 cases (35%), and the median survival time was 271 days. In this study the cisplatin dose was less than in any other report of "MVP" therapy. But both the response rate and the median survival time did not differ from those reported elsewhere. The side effects (bone marrow suppression, renal toxicity, etc.) were mild, and did not prevent the continuance of this therapy. Thus, we could repeat more than 6 courses of "MVP" therapy for 8 patients. Nowadays, it is difficult to obtain complete responders with any chemotherapy for inoperable non-small cell lung cancer. To prolong lives of patients and maintain good quality of life, we recommend chemotherapy with low toxicity in often-repeatable courses.     

A randomized trial comparing vindesine plus cisplatin with mitomycin C, vindesine plus cisplatin in patients with advanced non-small cell lung cancer

Thirty-six evaluable patients with advanced non-small cell lung cancer were randomized to treatments involving vindesine (3 mg/m2 X 3) plus cisplatin (80-120 mg/m2) versus mitomycin C (8 mg/m2) plus vindesine (2 mg/m2 X 3) plus cisplatin (80-120 mg/m2). The response rate for the vindesine and cisplatin combination was 29%, versus 47% for the mitomycin C, vindesine and cisplatin combination. There was no evidence of improved duration of response in patients given mitomycin C, vindesine and cisplatin. The median survival for patients given mitomycin C, vindesine and cisplatin was 11.4 months, compared with 10.3 months for those given vindesine and cisplatin. Toxicity was almost comparable for the two treatments. The utility of addition of mitomycin C to vindesine and cisplatin should be evaluated in further investigations.     

多西紫杉醇联合顺铂治疗蒽环类耐药的晚期乳腺癌

Objective： To observe the effect and toxicity of docetaxel with cisplatin in anthracyclines-resistant advanced breast cancer. Methods： Forty-five female patients received docetaxel 60 mg/m^2 on dl and cisplatin 30 mg/m^2 on d1-d3 of every 28 days. Every patient was treated with at least 2 cycles and a median of 3 cycles （2-6 cycles ）. Results： Five patients achieved complete response （11.1%） and 18 partial response （40.0%）, 10 stable disease （22.2%）. The overall response rate was 51.1%. The clinical disease control rate was 73.3%, median time to tumor progression （TTP） was 7.8 months （1.0-34.5 months）, median survival time was 17.6 months （range 1.9-48.0 months）, and one year survival rate was 65.2%. The main side effect was marrow suppression. The treatment was well tolerated with grades Ⅲ and Ⅳ leukopenia in nine （20%） and ten （22.2%） patients. Conclusion： Combinative chemotherapy of docetaxel and cisplatin has a good anti-tumor activity on refractory advanced breast cancer with manageable toxicity.     

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.     

丝裂霉素、长春花碱酰胺和顺铂联合治疗晚期肺腺癌

目的:评价丝裂霉素、长春花碱酰胺和顺铂联合治疗晚期肺腺癌的疗效和毒性.方法:32例不能手术的肺腺癌Ⅲ～Ⅳ期,MVP方案化疗:丝裂霉素6mg/m~2,静脉冲入,第1、8天;长春花碱酰胺2.5mg/m~2,静脉冲入,第1、8天;顺铂60～80mg/m~2,静脉滴注,第3天,水化.每3周为一周期,二周期后评价疗效.结果:部分缓解率(12/32)40.6%.毒副反应主要为恶心、呕吐和白细胞下降.结论:MVP方案是治疗晚期肺腺癌疗效较高的方案.     

A four-drug combination chemotherapy with cisplatin, mitomycin, vindesine and 5-fluorouracil: A regimen associated with major toxicity in patients with advanced non-small cell lung cancer

PURPOSE:: To determine in patients with advanced non-small cell lung cancerthe activity of a 4-drug combination chemotherapy. PATIENTS AND METHODS:: Chemotherapy consisted of the administration of cisplatin (30mg/m² d 1–3 or 4), mitomycin C (10 mg/m² d 1), vindesine(3 mg/m² d 1) and 5-FU (1 g/m² d 1–3 or 4 by continuousintravenous infusion. RESULTS:: 182 were eligible patients. A 34% objective response rate wasobserved in the 164 evaluable patients. The overall median survivalwas 26 weeks. The most serious adverse event was the occurrenceof 18 (10%) cardiac or sudden deaths. These toxic deaths weresignificantly associated with a 5% loss of body weight priorto therapy. CONCLUSIONS:: The regimen studied resulted in a very significant cardiac toxicity. cardiac toxicity, chemotherapy, non-small cell lung cancer     

Random prospective study of vindesine versus vindesine plus high-dose cisplatin versus vindesine plus cisplatin plus mitomycin C in advanced non-small-cell lung cancer

In this phase III randomized study, 124 evaluable patients with unresectable non-small-cell lung cancer (NSCLC) were randomized to vindesine v cisplatin (120 mg/m2) plus vindesine v cisplatin (60 mg/m2) plus vindesine plus mitomycin C. The objective response rate for cisplatin and vindesine was 27% v 20% for cisplatin, vindesine, and mitomycin C, and 14% for vindesine alone (P = .25 for cisplatin and vindesine v vindesine). The percentage of patients having stable disease (no progression for a minimum of 3 months) was 20% (cisplatin and vindesine), 27% (cisplatin, vindesine, and mitomycin C), and 26% (vindesine alone), respectively. The median survival time for vindesine was 18 weeks, compared with 26 weeks for cisplatin and vindesine and 17 weeks for cisplatin, vindesine, and mitomycin C. Overall survival was not statistically different for cisplatin plus vindesine v vindesine (P = .65). There was no evidence for improved duration of remission or survival of responders with the cisplatin (120 mg/m2) and vindesine arm. This study failed to demonstrate sufficient therapeutic benefit for cisplatin and vindesine (+/- mitomycin C) compared with single-agent vindesine to justify the increased cost and toxicity of these combination regimens.     

多西紫杉醇联合顺铂治疗蒽环类耐药的晚期乳腺癌

目的:观察多西紫杉醇(DXL)联合顺铂(DDP)方案对蒽环类耐药的晚期乳腺癌患者的临床疗效及毒副作用。方法:2000年1月～2004年6月采用DXL联合DDP方案治疗晚期乳腺癌患者45例。DXL60mg/m2,静脉滴注,第1天;DDP30mg/m2水化后静脉滴入,第1～3天,每28天重复,至少应用2个周期,中位化疗周期数3个(2～6周期)。结果:45例患者中,CR、PR及SD率分别为11.1%(5/45)、40.0%(18/45)和22.2%(10/45),总有效率为51.1%(23/45),疾病控制率为73.3%(33/45)。45例患者中22例死亡,中位无进展生存时间为7.8(1.0～34.5)个月,中位生存时间为17.6个月(1.9～48.0月),1年生存率为65.2%。主要不良反应为骨髓抑制。结论:DXL联合DDP方案治疗蒽环类耐药的晚期乳腺癌疗效好,不良反应轻,是治疗蒽环类耐药的晚期乳腺癌较好的方案。     

吉西他滨联合顺铂治疗晚期乳腺癌的临床观察

目的探讨吉西他滨联合顺铂方案治疗一线治疗后失败的晚期乳腺癌的临床疗效和不良反应。方法对入组的32例经病理证实的既往治疗后进展的乳腺癌患者,应用吉西他滨1000mg/m2,静滴,第1天、第8天;顺铂25mg/m2,静滴,第2～4天;联合化疗,每21天为1个周期。至少2个周期后评价疗效。结果 32例患者中,部分缓解(CR)3例(9.4%),完全缓解(PR)15例(46.9%),疾病稳定(SD)9例(28.1%),疾病进展(PD)5例(15.6%),总有效率(CR+PR)56.3%,临床获益率为84.4%。中位疾病进展时间(TTP)8.7个月。1年生存率62.5%。不良反应以骨髓抑制、消化道反应最为常见。结论应用吉西他滨联合顺铂治疗既往化疗后进展的晚期乳腺癌,疗效较好,不良反应较轻,值得临床推广应用。