多西他赛与吉非替尼不同时序应用对人肺腺癌细胞的作用

目的 探讨多西他赛与吉非替尼不同时序应用对人肺腺癌细胞A549和PC-9的生长影响及其细胞学机制。方法 qPCR-HRM法检测人肺腺癌细胞EGFR和K Ras基因突变,MTT法检测细胞增殖, Western blotting检测细胞信号蛋白及磷酸化表达,FCM法检测细胞周期变化。结果 人肺腺癌A549细胞为EGFR基因野生型,PC-9细胞为EGFR第19外显子突变型。多西他赛和吉非替尼单药或联合用药均能抑制A549和PC-9细胞生长,呈浓度依赖性。多西他赛对A549和PC-9细胞生长的半数抑制浓度（IC₅₀）分别为5.24×10^-7和2.13×10^-8mol／L,吉非替尼分别为1.28×10^-5和4.58×10^-8mol／L。在IC₅₀浓度时,多西他赛序贯吉非替尼对A549和PC-9细胞的生长抑制率分别为60.00%和57.45%,均较单药组明显增高（P＜0.05）;而同时用药只对PC-9细胞有增效作用,抑制率为53.46％,较单药组明显增高（P＜0.05）。多西他赛表现为增强A549、PC-9细胞EGFR和ERK磷酸化,吉非替尼表现为抑制,两药均抑制PC-9细胞IGF-1R磷酸化。多西他赛序贯应用吉非替尼显著抑制EGFR和ERK磷酸化,两药同时应用对抑制PC-9细胞的IGF-1R磷酸化具有增强作用。多西他赛将A549及PC-9细胞阻滞在G₂期,吉非替尼将PC-9细胞明显阻滞在G₁期。结论 多西他赛序贯吉非替尼能够抑制EGFR野生型和突变型的A549及PC-9细胞生长,且呈增效作用,可能与影响细胞EGFR和ERK磷酸化有关;两药同时应用仅对PC-9细胞具有增效作用,可能与IGF-1R磷酸化抑制有关;不同时序应用的效果均可能与细胞周期相关。     

培美曲塞联合舒尼替尼对肝癌细胞生物学行为的影响

目的:探讨培美曲塞联合舒尼替尼对肝癌细胞增殖、细胞周期和细胞凋亡的影响。方法:以培美曲塞和舒尼替尼单药或联合处理肝癌SK-Hep1细胞后,MTT法检测细胞的增殖抑制率,FCM检测细胞的周期变化和凋亡率,Western blot检测蛋白激酶B（AKT）、磷酸化蛋白激酶B（p-AKT）、增殖细胞核抗原（PCNA）、B淋巴细胞瘤-2基因（Bcl-2）和切割型半胱天冬酶3（Cleaved caspase-3）蛋白的表达。结果:培美曲塞和舒尼替尼均能够呈时间-浓度依赖性抑制SK-Hep1细胞增殖,72 h IC50分别为（2.89±0.20）μmol/L和（2.12±0.12）μmol/L（P＜0.05）;培美曲塞和舒尼替尼均能够诱导SK-Hep1细胞凋亡（P＜0.05）;培美曲塞使SK-Hep1细胞周期阻滞于S期,舒尼替尼使细胞周期阻滞于G0/G1期（P＜0.05）;培美曲塞和舒尼替尼均可使p-AKT、PCNA、Bcl-2的表达下降,Cleaved caspase-3表达升高。两药联用使SK-Hep1细胞阻滞在G2/M期,细胞增殖抑制率和细胞凋亡率较单药更加明显,且p-AKT、PCNA、Bcl-2表达下降及Cleaved caspase-3表达升高更为显著（P＜0.05）。结论:培美曲塞联合舒尼替尼可抑制SK-Hep1细胞增殖,并诱导SK-Hep1细胞周期阻滞和凋亡,其作用机制可能与下调p-AKT、PCNA、Bcl-2表达和上调Cleaved caspase-3表达有关。     

TRAIL联合舒尼替尼对EGFR-TKIs抵抗的A549细胞株的抗肿瘤作用

[目的]探讨TRAIL与舒尼替尼(sunitinib)体外不同用药方式下对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)抵抗的NSCLC A549细胞的抗肿瘤活性及其机制。[方法]实验分为对照组、TRAIL组、舒尼替尼组、TRAIL联合舒尼替尼组(T+S)、TRAIL序贯舒尼替尼组(T→S)和舒尼替尼序贯TRAIL组(S→T)。CCK8法检测TRAIL和舒尼替尼对A549细胞的生长抑制作用;流式细胞术检测TRAIL和舒尼替尼作用后细胞周期变化及诱导的细胞凋亡;Western blot检测TRAIL和舒尼替尼作用后Akt、p-Akt蛋白表达的变化。[结果]T+S组及T→S组的抗增殖作用及诱导细胞凋亡的能力明显优于TRAIL组、舒尼替尼组及S→T组(P均<0.05)。细胞周期显示,TRAIL和舒尼替尼均能使细胞周期阻滞于G0/G1期,T+S组、T→S组对G0/G1期的阻滞作用明显增强。Western blot结果显示,TRAIL单独作用于A549细胞能明显上调p-Akt的表达,而舒尼替尼能下调p-Akt的表达;T+S组、T→S组、S→T组p-Akt的表达明显减少。[结论]舒尼替尼通过抑制TRAIL诱导的PI3K/Akt通路活化,增加TRAIL诱导的A549细胞凋亡。此外,两药物对A549细胞周期的特异性阻滞作用,也是诱导凋亡增加的原因之一。     

安罗替尼联合吉非替尼对吉非替尼耐药非小细胞肺癌PC9/GR细胞增殖的影响及其可能的作用机制

目的 探讨安罗替尼联合吉非替尼对吉非替尼耐药的人非小细胞肺癌PC9/GR（gefitinib resistance）细胞增殖的影响及其可能的作用机制。 方法 依据不同给药情况将PC9/GR细胞分为安罗替尼单药组、吉非替尼单药组、安罗替尼和吉非替尼联合用药组及阴性对照组,用MTT法检测各组细胞的增殖情况,流式细胞仪检测细胞的周期分布,Western blot检测p-ERK1/2和p-AKT蛋白的表达水平。 结果 安罗替尼和吉非替尼作用于PC9/GR细胞72 h的半数抑制浓度（half inhibitory concentration,IC₅₀）分别为（1.91±0.18） μmol/L和（4.83±0.15） μmol/L,两药均呈剂量依赖性的抗增殖作用,且两药联合时表现出明显的协同效应,联合指数（combination index,CI）小于1。安罗替尼和吉非替尼单药均可将PC9/GR细胞阻滞于G0/G1期（均P<0.05）。与各单药组比较,联合用药组表现出更明显的G0/G1期阻滞（均P<0.05）,且下调p-ERK1/2和p-AKT蛋白的表达水平（均P<0.05）。 结论 安罗替尼联合吉非替尼对非小细胞肺癌 PC9/GR细胞具有协同抗增殖作用,且可增强吉非替尼敏感性,其协同抗肿瘤机制可能与诱导细胞周期阻滞和下调p-ERK1/2和p-AKT蛋白的表达相关。     

拉帕替尼联合紫杉醇对人胃癌细胞NCI-N87抑制作用的实验研究

摘 要：［目的］ 研究拉帕替尼联合紫杉醇不同给药顺序对人胃癌细胞NCI-N87产生的不同抑制效应,探讨两者的最佳联合方案。［方法］ MTT方法检测单独应用拉帕替尼、紫杉醇及两药不同联合方案对人胃癌细胞NCI-N87的增殖抑制作用,计算半数抑制浓度（IC50）和联合指数(CI),确定最佳联合方案。流式细胞技术检测拉帕替尼与紫杉醇不同给药顺序对人胃癌细胞NCI-N87细胞周期和凋亡率的影响。［结果］ 拉帕替尼和紫杉醇单独应用对人胃癌细胞NCI-N87均有抑制作用,而两药联合作用受给药顺序影响,紫杉醇先于拉帕替尼给药两者CI值<1表现协同效应。拉帕替尼和紫杉醇作用于胃癌细胞NCI-N87,细胞周期分别阻滞于G1期和G2-M期;两者联合时受给药顺序影响：紫杉醇先于拉帕替尼组与拉帕替尼先于紫杉醇组相比G2-M期明显延长,凋亡率显著增加。［结论］ 拉帕替尼与紫杉醇对人胃癌细胞NCI-N87增殖抑制作用的最佳联合方案为先予紫杉醇诱导再序贯拉帕替尼,此方案可获得较高的凋亡率。     

多西他赛与吉非替尼序贯应用对人肺腺癌细胞H1975存活及凋亡通路的研究

背景与目的表皮生长因子受体(epidermal growth factor receptor,EGFR)酪氨酸激酶抑制剂(tyrosinekinase inhibitors,TKIs)被用于治疗进展性晚期非小细胞肺癌(non-small cell lung cancer,NSCLC),然而最初接受EGFR-TKIs治疗有反应的患者,大部分会在10个月左右出现获得性耐药。绝大多数报告称T790M的突变是产生获得性耐药的主要原因,约占获得性耐药的50%。本研究旨在探索多西他赛和吉非替尼序贯应用对肺腺癌细胞H1975增殖和凋亡通路的作用。方法 M法检测细胞的增殖。等效线图法和联合指数(combination index,CI)法评估多西他赛和吉非替尼序贯作用的效价。流式细胞术检测细胞凋亡和周期分布,Hoechest 33258染色法检测凋亡形态。化学比色发光法检测Caspases的活性。结果等效线图法和联合指数法均显示多西他赛序贯吉非替尼组较其它序贯作用组明显抑制了细胞增殖,增加了细胞的凋亡。细胞周期分布实验结果显示与吉非替尼序贯多西他赛组主要把细胞抑制在G0/G1期相比较,多西他赛序贯吉非替尼组主要把细胞抑制在G2/M期。在肺腺癌H1975中,所有序贯模型组都主要通过活化Caspase-8/Caspase-3来诱导激活细胞凋亡通路。结论先用多西他赛再用吉非替尼治疗模式可能是TKIs耐药后T790M突变肺癌的一个新选择。     

吉非替尼与培美曲塞对人肺腺癌细胞 SPC - A1 生长及细胞周期的作用

目的：探索培美曲塞与表皮生长因子酪氨酸激酶抑制剂（EGFR—TKIs）吉非替尼联合应用对人肺腺癌细胞SPC—A1生长的影响,探索二者序贯用药是否比单药更有效,并从细胞周期角度分析其可能的细胞学机制。方法：RT—PCR法检测人肺腺癌细胞SPC—A1中EGFRmRNA表达,Westernblot法检测SPC—A1细胞中EGFR蛋白表达,四甲基偶氮唑盐[3-（4,5-dimethylthiazol-2-y1）-2,5-diphenyl—tetrazoliumbro—mide,M1Tr]显色分光光度法检测细胞增殖,流式细胞术检测细胞周期。分别观察培美曲塞与吉非替尼单独、同时及间隔24小时序贯作用。结果：SPC—A1细胞中有EGFRmRNA和蛋白的表达,且其表达量为过表达。吉非替尼和培美曲塞分别在0．1pmol/L-1umoL／L和109-10-1g/L浓度范围内明显抑制SPC—A1细胞生长,呈浓度依赖性,IC50分别为：61．2nml/L（吉非替尼）和16．2ug/ml（培美曲塞）,二者在IC50下抑制作用呈时间依赖性,96h时达最大抑制。二者联合作用于细胞时对生长的影响与二者加药的次序有关,跟单药组相比,先用培美曲塞后用吉非替尼组对抑制细胞生长有明显增强作用（P〈0．05）,同时给药或先用吉非替尼后用培美曲塞组对抑制细胞生长无显著增强作用（P〉0．05）。细胞周期研究显示：吉非替尼和培美曲塞作用于不同的细胞周期,分别将SPC—A1细胞阻滞于G,期（G0／G1）和S期,先用吉非替尼后用培美曲塞组G1（G0／G1）期细胞显著增多,G2期（G2／M）细胞显著减少（P〈0．05）。同时用药组G1期（G0／G1）和s期细胞比例无显著变化,G2期（G2／M）细胞显著增多（P〈0．05）。先用培美曲塞后用吉非替尼组G1期（G0／G1）细胞显著减少,s期细胞比例无显著变化,G2期（G2／M）细胞显著增多（P〈0．05）。结论：吉非替尼和培美曲塞都能抑制SPC—A1细胞生长,二者联合作用对细胞生长的影响与给药次序有关,先用吉非替尼后用培美曲塞对抑制细胞生长无显著增强作用,而先用培美曲塞后用EGFR—TKIs则表现有明显的协同性,且这种关系可能与它们对细胞周期的影响相关。     

培美曲塞和吉非替尼不同时序应用对人肺腺癌细胞的作用和机制

目的 探讨培美曲塞与吉非替尼不同时序应用对肺腺癌细胞A549和PC-9生长及凋亡的影响, 并阐述其可能机制。方法 MTT法检测各组细胞的增殖抑制情况,流式细胞仪检测各组细胞凋亡及细胞周期分布,Western印迹法检测对EGFR下游信号通路及TS酶蛋白水平表达的影响。结果 培美曲塞序贯吉非替尼、培美曲塞同步联合吉非替尼对PC-9和A549细胞增殖抑制率及凋亡率较单药组均提高（P<0.05）,培美曲塞可以提高EGFR、AKT 、ERK磷酸化水平,而吉非替尼表现为抑制作用, 同时吉非替尼降低TS酶表达。培美曲塞序贯吉非替尼,培美曲塞同步联合吉非替尼抑制EGFR、AKT 、ERK磷酸化水平较单药更强。吉非替尼主要将PC-9、A549细胞阻滞在G0/G1期;培美曲塞主要将细胞阻滞在S期。培美曲塞序贯吉非替尼、培美曲塞同步联合吉非替尼较其他组G2/M期细胞比例提高（P<0.05）。结论 培美曲赛序贯吉非替尼、培美曲赛同步联合吉非替尼在PC-9、A549细胞中均起到协同增效作用,且培美曲赛序贯吉非替尼协同作用更为显著,可能主要与培美曲赛诱导EGFR、AKT 、ERK磷酸化及吉非替尼降低TS酶作用有关。     

阿帕替尼联合大剂量丹参酮IIA对肺腺癌A549细胞株凋亡及Bim异构体的影响

目的:观察阿帕替尼与丹参酮IIA单药及不同时序联合用药方案对人肺腺癌细胞A549凋亡的影响，并探究其作用机制。方法:培养肺癌A549细胞，用梯度浓度的阿帕替尼(0、5、10、20、40、80 μmol/L)及丹参酮IIA(0、5、10、20、40、80 μmol/L)分别处理A549细胞，应用CCK8法检测其对细胞增殖的抑制作用；流式细胞技术（Annexin V/PI 双染法）检测不同用药组作用48 h后的细胞凋亡率；半定量RT-PCR检测凋亡相关基因Bim异构体的表达情况。结果:阿帕替尼及丹参酮IIA单药对A549细胞的增殖均有抑制作用，且呈现浓度依赖性。两种药物联合使用时，联合用药组增殖抑制和凋亡率优于单药组和改变药物顺序的序贯组。结论:阿帕替尼与丹参酮IIA单药以及联合用药均可抑制A549细胞的增殖并促进凋亡；最佳联合方案为阿帕替尼联合丹参酮IIA同时使用，细胞凋亡率最高；其作用机制之一可能是联合用药通过转录和mRNA选择性剪接来上调Bim L基因的表达,从而促进细胞凋亡。     

吉非替尼对A549细胞增殖及细胞周期、凋亡的作用

目的:观察吉非替尼对人非小细胞肺癌A549的生长增殖、细胞周期及细胞凋亡的影响.方法:用5-40μmol/L浓度范围内的吉非替尼和A549细胞共培养24、48、72h,采用四甲基偶氮唑蓝(MTT)法检测吉非替尼对细胞增殖的影响;用流式细胞仪检测其对细胞凋亡及细胞周期分布的影响;利用抗Capspase-3 的ELISA(酶联免疫吸附)法检测是否发生细胞凋亡.结果:在5-40μmol/L浓度范围内,吉非替尼对A549细胞的增殖有明显的抑制作用,并呈时间和剂量依赖性,以40μmol/L作用72h时的抑制率最高.流式细胞仪检测显示10μmol/L-40μmol/L的吉非替尼作用可使细胞发生G0/G1期阻滞,但即使作用48h也未发现凋亡细胞.ELISA法显示48h内,吉非替尼组与正常细胞组的Capspase-3浓度无统计学差异,但作用72h时出现凋亡.结论:吉非替尼在5-40μmol/L浓度下作用时间小于48h时,其对A549细胞的增殖抑制可能是通过阻滞A549细胞于G0/G1期而非引起细胞凋亡实现的,但作用时间达到72h时,其可以诱导A549发生细胞凋亡.     

Sunitinib malate (SU-11248) alone or in combination with low-dose docetaxel inhibits the growth of DU-145 prostate cancer xenografts

The aim of the study was to evaluate the activity of the antiangiogenic agent SU-11248 (sunitinib malate, Sutent^®), alone or in combination with docetaxel. To this end, animals bearing DU-145 human hormone-refractory prostate cancer (HRPC) xenografts were treated with sunitinib (40 mg/kg daily, p.o.), docetaxel (10 or 30 mg/kg/week, i.v.), a combination of sunitinib (40 mg/kg daily) and docetaxel (10 mg/kg/week) or vehicle alone. At the end of the 3-week dosing schedule, single-agent treatment induced a tumor regression of 59%, 49% and 75% for sunitinib, docetaxel 10 mg/kg, and docetaxel 30 mg/kg, respectively. The combination of sunitinib with low-dose (10 mg/kg) docetaxel produced a tumor regression comparable to that obtained with high-dose (30 mg/kg) docetaxel, but tolerability was higher as indicated by mice weight. Both sunitinib and docetaxel inhibited tumor regrowth after initial treatment with the alternate drug. These results suggest that sunitinib alone or in combination with low-dose docetaxel may have a role in the treatment of HRPC.     

Concurrent and sequential administration of sunitinib malate and docetaxel in human non-small cell lung cancer cells and xenografts

Optimal scheduling of chemotherapy with molecular-targeted agents is important to maximize clinical benefit. We compared the effects of concurrent and sequential administration of docetaxel and multi-target inhibitor sunitinib malate on tumor cells and xenografts and studied several mechanisms involved in drug interaction to provide experimental data in support of their clinical use in non-small cell lung cancer (NSCLC). Human umbilical vein endothelial cells (HUVECs), NCI-H460 human non-small lung carcinomas cells, and NCI-H460 xenograft were treated with docetaxel and Sunitinib malate, using concurrent and sequential treatment schedules. Cell proliferation was detected by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)- 2H-tetrazolium (MTS) assay. Cell cycle analysis was conducted using flow cytometry. Extracellular signal-regulated kinases (ERK1/2) phosphorylation was evaluated by immunoblot analysis. Effects on xenografts were assessed by tumor growth delay. There were no significant difference in the cell proliferation and cell cycle distribution of NCI-H460 cells between concurrent treatment and the first sequential treatment. Both docetaxel and sunitinib malate had no effect on each other in inhibiting ERK1/2 phosphorylation in sequential treatments, while docetaxel eliminated inhibitory activity of sunitinib malate on ERK1/2 phosphorylation in concurrent treatment. For NCI-H460 xenografts, the first sequential treatment showed superior effect to concurrent treatment on inhibiting tumor growth. Combined treatment with sunitinib malate and docetaxel had a greater therapeutic effect than monotherapy, and the first sequential scheduling was more effective than concurrent scheduling, which partly due to the effect of docetaxel on receptor tyrosine kinase (RTK) signaling pathway.     

Sunitinib in combination with docetaxel in patients with advanced solid tumors: a phase I dose-escalation study

Purpose

Sunitinib in combination with docetaxel enhances antitumor activity in xenograft models of human breast and non-small cell lung cancer. We assessed the maximum tolerated doses (MTDs), safety, pharmacokinetic profiles, and preliminary efficacy of sunitinib plus docetaxel in patients with advanced solid tumors.

Methods

In this phase I study, successive patient cohorts received sunitinib 25, 37.5, or 50 mg/day for 4 weeks of a 6-week cycle (Schedule 4/2, 4 weeks on, 2 weeks off) or for 2 weeks of a 3-week cycle (Schedule 2/1, 2 weeks on, 1 week off) with docetaxel 60 or 75 mg/m² IV q21d to determine the MTDs of this treatment combination.

Results

Fifty patients enrolled: 10 on Schedule 4/2 and 40 on Schedule 2/1. MTDs were established as sunitinib 25 mg on Schedule 4/2 with docetaxel 60 mg/m² q21d, and as sunitinib 37.5 mg on Schedule 2/1 with docetaxel 75 mg/m² q21d. On Schedule 2/1, the most frequent dose-limiting toxicity was neutropenia (±fever; grade [G]3/4, n = 5) and the most common G3/4 non-hematologic adverse event (AE) was fatigue (G3, n = 8). Hematologic AEs were managed with growth factor support in 11 of 23 (48%) patients treated at Schedule 2/1 MTD. Three patients achieved a partial response at the Schedule 2/1 MTD. There were no pharmacokinetic drug–drug interactions with either schedule.

Conclusions

Oral sunitinib 37.5 mg/day on Schedule 2/1 with docetaxel 75 mg/m² IV q21d is a clinically feasible regimen with a manageable safety profile, no pharmacokinetic drug–drug interactions, and shows antitumor activity in patients with advanced solid tumors.     

肾癌的药物治疗

肾癌的药物治疗目前仍以免疫化学治疗为主,单纯化疗也有效,吉西他滨联合顺铂是目前的标准化疗方案.靶向治疗药物的出现使肾癌的治疗发生了改变,多靶点受体酪氨酸激酶抑制剂(如舒尼替尼和索拉非尼)、哺乳动物雷帕霉素靶蛋白抑制剂(temsirolimus)和抗肿瘤单克隆抗体(如贝伐单抗)等已成为肾癌的一线治疗选择.     

Docetaxel and non-small cell lung cancer

Docetaxel (Taxotere) is a taxoid used in various tumoral diseases. Its role in metastatic or locally advanced non small cell lung cancer treatment is undeniable. In pretreated patients with metastatic NSCLC, two recent phase III trials have shown an improvement of survival and quality of life for patients receiving docetaxel. In front line treatment, docetaxel administered alone every three weeks or in combination with a platine compound has became a gold standard treatment. Activity of the associations cisplatinium/docetaxel and carboplatin/docetaxel is similar to those reported with previous combinations containing a platine derivative. The weekly schedule of docetaxel and its combination with other well known active drugs in NSCLC such as gemcitabin or vinorelbin deserve further evaluations. Therapeutic options with docetaxel in adjuvant situation in resected NSCLC or in combination with radiation therapy in operable locally advanced NSCLC should be developed in the next future.     

Sunitinib in combination with docetaxel and prednisone in chemotherapy-naive patients with metastatic,castration-resistant prostate cancer: a phase 1/2 clinical trial

BackgroundThis phase 1/2 study assessed sunitinib combined with docetaxel (Taxotere) and prednisone in chemotherapy-naive metastatic, castration-resistant prostate cancer (mCRPC) patients.Patients and methodsTo determine the recommended phase 2 dose (RP2D), 25 patients in four dose escalation cohorts received 3-week cycles of sunitinib (2 weeks on, 1 week off), docetaxel and prednisone, preceded by a 4-week sunitinib 50 mg/day lead in. RP2D was evaluated in 55 additional patients. The primary end point was prostate-specific antigen (PSA) response rate.ResultsOne phase 1 dose-limiting toxicity occurred (grade 3 hyponatremia). The RP2D was sunitinib 37.5 mg/day, docetaxel 75 mg/m² and prednisone 5 mg b.i.d. During phase 2, confirmed PSA responses occurred in 31 patients [56.4% (95% confidence interval 42.3–69.7)]. Median time to PSA progression was 9.8 months. Forty-one patients (75%) were treated >3 months, 12 (22%) completed the study (16 cycles) and 43 (78%) discontinued (36% for disease progression and 27% adverse events). The most frequent treatment-related grade 3/4 adverse events were neutropenia (53%; 15% febrile) and fatigue/asthenia (16%). Among 33 assessable patients, 14 (42.4%) had confirmed partial response. Median progression-free and overall survivals were 12.6 and 21.7 months, respectively.ConclusionThis combination was moderately well tolerated, with promising response rate and survival benefit, justifying further investigation in mCRPC.     

基于PD-1/PD-L1抑制剂联合疗法对比舒尼替尼治疗晚期肾细胞癌安全性和有效性的Meta分析

目的：系统评价基于PD-1/PD-L1抑制剂的免疫联合治疗（以下称“免疫联合治疗”）对比舒尼替尼治疗晚期肾细胞癌（RCC）的安全性和有效性。方法：检索PubMed、Embase、Cochrane Library及中国知网（CNKI）数据库，收集国内外公开发表的免疫联合治疗对比舒尼替尼应用于晚期RCC的随机对照试验（RCT），检索时间均为自建库时间至2022年10月。由两名研究者独立评价纳入研究的质量、提取资料并交叉核对，采用StataMP16.0软件进行Meta分析。结果：共纳入6项RCT,Meta分析结果显示，（1）有效性：与舒尼替尼相比，免疫联合治疗显著提高了晚期RCC患者的总生存期[OS,HR=0.74,95%CI(0.67,0.80),P<0.01]和无进展生存期[PFS,HR=0.66,95%CI(0.51,0.81),P<0.01](;2)安全性：两治疗组均有较高的不良反应（AE）发生率，差异无统计学意义。但免疫联合治疗组发生皮肤及内分泌系统AE显著高于舒尼替尼治疗组，而血液系统相关AE则明显低于舒尼替尼治疗组（；3）以1%为临界点，免疫联合治疗组的RCC患者，...     

Phase II non-randomized study of three different sequences of docetaxel and vinorelbine in patients with advanced non-small cell lung cancer

Docetaxel and vinorelbine as single agents and in combination with cisplatin have shown significant activity in advanced non-small cell lung cancer (NSCLC). Significant neutropenia has been observed with the combination of docetaxel/vinorelbine. To gain insight into the potential synergism of this combination, we examined three different sequences of docetaxel 75 and vinorelbine 20 mg/m(2), every 3 weeks, in locally advanced and metastatic NSCLC patients. About 14 patients were evaluable in each schedule: schedule A, docetaxel day 1, vinorelbine days 1 and 6; schedule B, docetaxel day 6, vinorelbine days 1 and 6; schedule C, docetaxel day 1, vinorelbine days 6 and 15. Response rates were: 42.8, 7.1 and 21.4% for schedules A, B and C, respectively (P=0.01, schedule A vs. B). Median survival time was 16, 6.5 and 10.6 months for schedules A, B and C, respectively (P=0.04, schedule A vs. B). Neutropenia was the commonest toxicity; 43% of patients in schedule A and 57% of patients in schedule B had a febrile neutropenia episode. Prophylactic granulocyte-colony stimulating factor (G-CSF) was prescribed in schedule C after the first episode of febrile neutropenia. Non-hematologic toxicities were mild in all three schedules. For future studies, schedule A with lower doses is recommended.     

Second-line therapy with gefitinib in combination with docetaxel for advanced non-small cell lung cancer: a phase II randomized study

This randomized, open-label, parallel-group, phase II study evaluated the efficacy and safety of gefitinib and docetaxel in combination, as second-line therapy for advanced or metastatic non-small cell lung cancer (NSCLC). Eighty-nine patients who had failed first-line, platinum-based chemotherapy were randomly assigned to gefitinib (250 mg/day orally) in combination with docetaxel (75 mg/m² every 3 weeks) or single-agent docetaxel (75 mg/m² every 3 weeks). Objective response rates were 6.8% with gefitinib plus docetaxel and 9.1% with docetaxel alone. Disease control was experienced by a higher proportion of patients receiving gefitinib plus docetaxel (59.1%) versus docetaxel alone (34.1%). Median progression-free and overall survival appeared to be longer with gefitinib plus docetaxel (3.9 months [95% CI:2.3–5.4] and 7.6 months [95% CI:5.4–10.4], respectively) than with docetaxel alone (2.1 months [95% CI:2.1–3.7] and 6.2 months [95% CI:5.2–7.2], respectively). The most common non-hematological adverse events were diarrhea, alopecia, rash and dry skin in the combination arm, and vomiting and asthenia with docetaxel alone. Gefitinib and docetaxel combination therapy has antitumor activity and may be a feasible treatment option in patients with advanced NSCLC who have failed platinum-based chemotherapy.     

多西他赛联合奈达铂与多西他赛单药二线治疗晚期非小细胞肺癌的临床研究

目的 比较多西他赛联合奈达铂与多西他赛单药二线治疗晚期非小细胞肺癌(NSCLC)的疗效及毒副反应.方法 58例晚期NSCLC患者中,接受多西他赛联合奈达铂治疗(联合组)20例,多两他赛单药二线治疗(单药组)38例.评价两组患者的疗效、无进展生存时间(PFS)、中位生存时间(MST)和毒副反应.结果 联合组与单药组患者的中位PFS分别为4.35和4.0个月,差异有统计学意义(P＜0.05).联合组与单药组患者的MST分别为13.5和10.6个月,1年生存率分别为29.0%和22.0%,疾病控制率分别为50.0%和47.4%,差异均无统计学意义(P＞0.05).联合组中,鳞癌与非鳞癌患者的PFS差异无统计学意义(P＞0.05).联合组与单药组患者的3度以上骨髓抑制发生率分别为15.0%和10.5%(P=0.003),两组患者均无明显的胃肠道及肾脏毒性反应发生.结论 与多西他赛单药相比,多西他赛联合奈达铂二线治疗晚期NSCLC可提高疾病控制率,延长中位PFS,未增加明显毒副反应.