培美曲塞联合顺铂或卡铂治疗15例恶性胸膜间皮瘤近期疗效及安全性分析

目的：研究培美曲塞联合顺铂或卡铂治疗恶性胸膜间皮瘤的疗效和安全性。方法：回顾性研究了4年来我院收治的15例经病理及免疫组化确诊的Ⅱ-Ⅳ期恶性胸膜间皮瘤病例,均采用培美曲塞联合顺铂或卡铂治疗,评价其客观有效率、无进展生存期（PFS）以及毒副反应。结果：无完全缓解（CR）,部分缓解（PR）为38．46％,稳定（sD）为38．46％,进展（PD）为23．08％,中位PFS为3个月;毒副反应,骨髓抑制Ⅲ一Ⅳ度13．33％,乏力80．00％,无Ⅳ度消化道反应,重度黏膜反应为6．67％。结论：培美曲塞联合顺铂治疗恶性胸膜间皮瘤疗效较好,且毒副反应较轻。     

培美曲塞维持治疗恶性胸膜间皮瘤患者的疗效和安全性分析

背景 与目的恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)是原发于胸膜且恶性程度高的一类肿瘤.晚期胸膜间皮瘤预后差,中位生存时间不超过15个月.一线标准化疗方案推荐是含培美曲塞的双药联合,加或不加贝伐珠单抗.目前一线标准化疗有效的患者能否从培美曲塞维持化疗中获益,尚无统一结论.本...     

培美曲塞与顺铂化疗联合苦参治疗胸膜间皮瘤18例报道

目的:评价培美曲塞与顺铂静脉化疗同时联合苦参注射液胸腔灌注治疗恶性胸膜间皮瘤(MPM)合并胸腔积液的疗效与安全性。方法:回顾性分析18例经胸腔镜确诊MPM合并胸腔积液患者,使用培美曲塞500mg/m2,d1;顺铂75mg/m2,d1-3;每21天重复。同时胸腔闭式引流术引流尽胸腔积液,苦参注射液40ml胸腔注入,每隔4天重复注射。结果:18例患者中,CR 4例,PR 8例,SD 4例,PD 2例。总有效率为66.67%,疾病控制率为88.89%,肿瘤进展时间为7.2个月,中位生存期为12.3个月,1年生存率为43.85%。16例(88.89%)胸腔积液得到控制。主要毒副反应为骨髓抑制、胃肠道反应、发热、胸痛及皮疹等,对症支持处理后均可恢复。结论:培美曲塞与顺铂静脉化疗同时苦参注射液胸腔灌注治疗MPM合并胸腔积液有较好的疗效,毒副反应轻,值得临床推广应用。     

吉西他滨联合多西他赛与培美曲塞联合顺铂治疗晚期恶性胸膜间皮瘤初步疗效对比

目的:观察吉西他滨联合多西他赛与培美曲塞联合顺铂化疗治疗恶性胸膜间皮瘤(MPM)的疗效及安全性.方法:回顾性分析我院初诊的MPM患者,GD方案(吉西他滨联合多西他赛)为试验组,PP方案(培美曲塞联合顺铂)为对照组,21天为一个周期,对比两组间患者的临床疗效及毒副反应.结果:30例MPM中,GD组和PP组中位化疗周期(4 vs 4.5个)、疾病控制率(DCR) (85.7％ vs 87.5％)、中位生存时间(mOS)(14 vs 15个月),两组差异均无统计学意义(P =0.086、P=0.982、P=0.564).GD组血液学毒性发生率高于PP组(64.3％ vs 18.8％),两组血液学毒性有差异(P=0.024);但GD组胃肠道反应发生率低于PP组,两组间无统计学差异(14.3％ vs 31.3％,P=0.399).结论:GD方案与PP方案在晚期MPM患者一线化疗中疗效相当;GD方案在血液学毒性高于PP方案,但多以Ⅰ-Ⅱ度骨髓抑制为主,安全性可接受.     

培美曲塞联合顺铂治疗晚期复治乳腺癌的临床研究

[目的]观察和评价培美曲塞联合顺铂治疗晚期复治乳腺癌的疗效及不良反应。[方法]回顾性分析2008年1月～2011年1月经病理证实的晚期复治乳腺癌患者38例,接受培美曲塞联合顺铂化疗方案治疗。对其疗效进行评价。[结果]全组38例均可评价疗效,患者有效率(CR+PR)为39.5%,疾病控制率(CR+PR+SD)为73.7%;中位TTP为5个月,中位OS为12个月;主要不良反应为皮疹、黏膜炎、恶心呕吐和骨髓抑制。[结论]培美曲塞联合顺铂治疗晚期复治乳腺癌有一定的疗效,且毒性反应轻,可耐受,可以作为晚期乳腺癌治疗的方案之一。     

普来乐联合顺铂治疗恶性胸膜间皮瘤的疗效观察

目的：观察普来乐联合顺铂治疗恶性胸膜间皮瘤的疗效。方法：选择36例恶性胸膜间皮瘤患者,男24例,女12例,年龄35-67岁,平均年龄46.3±2.6岁。给予普来乐联合顺铂进行治疗。结果：胸痛、呼吸困难等症状基本消失,胸水体征消失或明显减轻,全身状况好转;5例症状有所减轻,但仍有原不适主诉存在,全身状况所有不明显改善。36例病人完全缓解0例,部分缓解20例,无效16例,有效率为55.6%。结论：普来乐联合顺铂治疗恶性胸膜间皮瘤疗效显著。     

普来乐联合顺铂治疗恶性胸膜间皮瘤的疗效观察

目的:观察普来乐联合顺铂治疗恶性胸膜间皮瘤的疗效。方法:选择36例恶性胸膜间皮瘤患者,男24例,女12例,年龄35-67岁,平均年龄46.3±2.6岁。给予普来乐联合顺铂进行治疗。结果:胸痛、呼吸困难等症状基本消失,胸水体征消失或明显减轻,全身状况好转;5例症状有所减轻,但仍有原不适主诉存在,全身状况所有不明显改善。36例病人完全缓解0例,部分缓解20例,无效16例,有效率为55.6%。结论:普来乐联合顺铂治疗恶性胸膜间皮瘤疗效显著。     

培美曲塞单药与培美曲塞联合顺铂二线治疗晚期胃癌的疗效对比

目的:观察培美曲塞联合顺铂作为二线方案治疗晚期胃癌与单纯使用培美曲塞的临床疗效。方法:选取晚期胃癌患者193例,随机分为两组。对照组96例,单纯使用培美曲塞治疗;观察组97例,使用培美曲塞联合顺铂进行治疗。于治疗3个疗程后对两组患者治疗效果进行评价,治疗6个月后对患者生存率进行随访。记录两组患者治疗期间不良反应发生情况。结果:经过3个疗程治疗,对照组患者PR、SD、PD以及RR分别为39.58%、28.13%、32.29%和39.58%;观察组分别为44.33%、27.84%、27.84%和44.33%,两组比较差异没有统计学意义。随访半年,对照组患者生存率为43.75%,观察组为72.16%,明显高于对照组,两组比较差异有统计学意义（P<0.05）。对照组患者血液学毒性、消化道反应、肝功能异常、肾功能异常、脱发以及神经毒性的发生率分别为63.54%、56.25%、12.50%、12.50%、67.71%和60.42%,观察组分别为68.04%、55.67%、15.46%、12.37%、68.04%和59.79%,两组相比无统计学意义。经过治疗,观察组患者日常生活、社会生活、抑郁、焦虑以及总分方面均较对照组明显高,两组比较差异有统计学意义（P<0.05）。结论:与培美曲塞单药治疗相比,培美曲塞联合顺铂二线治疗晚期胃癌可以有效延长患者的生存期,且不会增加患者的不良反应,是一种有效而安全的化疗方案。     

培美曲塞联合奈达铂有效治疗腹膜间皮瘤1 例

培美曲塞(pemetrexed disodium for injection,PEM)是一种含有核心为吡咯嘧啶基团的抗叶酸制剂,通过破坏细胞内叶酸依赖性的正常代谢过程,抑制细胞复制,从而抑制肿瘤的生长.主要用于治疗无法手术的恶性胸膜间皮瘤.临床前研究显示培美曲塞体外可抑制间皮瘤细胞系(MSTO-211H和NCI-H2052)的生长.间皮瘤细胞系MSTO-211H的研究显示出培美曲塞与顺铂联合有协同作用.奈达铂(nedaplatin,NDP),广谱抗癌药,是一种疗效好、不良反应少的新一代铂类抗癌药.它与肿瘤细胞的DNA碱基结合,阻碍DNA复制,而发挥其抗肿瘤效果.培美曲塞和奈达铂作为二线抗肿瘤药物,多用于一线药物治疗无效的肿瘤患者.本文报道1例晚期腹膜间皮瘤顺铂治疗失败后应用培美曲塞+奈达铂治疗有效的病例.     

培美曲塞联合顺铂治疗晚期乳腺癌的疗效观察

在我国城市女性中,乳腺癌的发病率居第一、二位,是女性癌症死亡的最常见原因之一[1].随着蒽环类和紫杉类等新药上市,晚期乳腺癌的疗效有较大提高,合理治疗可使患者得到长期生存,但是长程的化疗容易使患者出现多药耐药,其中有50%的患者易出现复发转移,而目前临床上尚缺乏公认有效的解救方案[2].     

恶性胸膜间皮瘤的外科治疗

目的　恶性胸膜间皮瘤的治疗尚无统一方案 ,手术切除仍是主要的治疗手段。本文探讨了恶性胸膜间皮瘤的手术方式、手术指征 ,以及影响术后生存的因素。方法　收集本院自 1985年以来手术治疗的恶性胸膜间皮瘤患者的资料 ,对临床表现、TNM分期、细胞类型、手术方式、生存期等分析 ,研究胸膜外全肺切除和胸膜切除两种不同手术方式以及不同分期、不同细胞类型对预后的影响。结果　 33例手术治疗者中胸膜外全肺切除术 16例 ,胸膜切除术 17例 ,总中位生存期为 2 1个月 ,2年生存率和 5年生存率分别为 36 .6 %和 13.3% ,不同手术方式之间术后生存期差异无显著性 ;不同TNM分期之间生存期差异有显著性 (P =0 .0 4 2 8)。结论　无论胸膜外全肺切除还是胸膜切除 ,都只能达到肉眼下的完全切除 ,可缓解症状 ,并为综合治疗创造条件。两种手术方式对预后的影响差异无显著性。早期诊断和尽早手术治疗是取得良好效果的关键。     

培美曲塞与卡铂静脉化疗联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤的临床观察

目的　评价培美曲塞与卡铂化疗同时联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤（ＭＰＭ）合并胸腔积液的疗效与安全性。方法　回顾性分析１５例ＭＰＭ合并胸腔积液患者的临床资料,具体用药：培美曲塞５００ｍｇ／ｍ２,ｄ１;卡铂（ＡＵＣ＝５）ｄ２,每２１天重复;同时引流尽胸腔积液,榄香烯乳２００ｍｇ／ｍ２胸腔注入,ｄ１或ｄ８。结果　１５例患者中,１３例（８６.７％）胸腔积液得到控制,１０例（６６.７％）胸腔积液癌细胞检查由阳性转为阴性;获ＣＲ４例,ＰＲ６例,ＳＤ３例,ＰＤ２例;总有效率为６６.７％,疾病控制率为８６.７％,中位无进展时间为５.０个月,中位总生存时间为１１.１个月,１年生存率为３６.０％。主要毒副反应为骨髓抑制、发热、胸痛、皮疹,多为１～２级,支持对症处理后均可恢复。结论　培美曲塞联合卡铂化疗同时榄香烯乳胸腔灌注治疗ＭＰＭ合并胸腔积液有较好的疗效,毒副反应轻,值得临床推广应用。     

恶性胸膜间皮瘤靶向治疗进展

恶性胸膜间皮瘤（MPM）是胸膜罕见的恶性肿瘤,由于其潜伏期约为20年,目前正是该疾病的高发阶段.由于该疾病发现时大部分已处于晚期,除了经典的培美曲塞联合顺铂一线化疗方案疗效确定之外,手术、放疗及二三线化疗疗效仍未知.近年来发展迅猛的分子靶向治疗又为MPM的个体化治疗提供了新的方向.     

Randomized phase II trial of pemetrexed/cisplatin with or without CBP501 in patients with advanced malignant pleural mesothelioma

Background

CBP501, a synthetic duodecapeptide, increases cisplatin influx into tumor cells through an interaction with calmodulin enhancing cisplatin cytotoxicity, and effects cell cycle progression by abrogating DNA repair at the G2 checkpoint. In phase I clinical trials of CBP501 alone or in combination with cisplatin, the most common toxicity was infusion-related urticaria. Activity of CBP501 plus cisplatin was observed in patients with ovarian cancer and mesothelioma, including some patients previously treated with cisplatin.

Methods

Chemotherapy naïve patients with unresectable MPM were stratified by histology and performance status, and randomized 2:1 to pemetrexed/cisplatin plus CBP501 25 mg/m² IV (Arm A) or pemetrexed/cisplatin alone (Arm B). The primary endpoint was progression free survival (PFS) at 4 months.

Results

65 patients were randomized, and 63 were treated. Patient characteristics in the two arms were balanced. Based on independent radiology review of the treated population, 25/40 patients (63%) in Arm A and 9/23 (39%) in Arm B had PFS ≥ 4 mo; the median PFS was 5.1 mo (95% CI, 3.9, 6.5) vs 3.4 mo (2.5, 6.7). Median OS was 13.3 mo (9.2, 16.3) in Arm A and 12.8 (6.5, 16.1) in Arm B. Adverse events were not different than expected from standard chemotherapy, and comparable in the two arms, aside from infusion reactions which occurred in 70% of patients treated with CBP501.

Conclusions

While this randomized phase II trial met its primary endpoint of PFS at 4 months, other parameters such as response rate and overall survival suggest that the addition of CBP501 does not improve the efficacy of standard chemotherapy for MPM.     

Combination chemotherapy with cisplatin and gemcitabine in malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma is a rare neoplasm with a rapidly fatal course. The response of this disease to treatment is poor because it tends to be advanced at diagnosis and tends to have inherent resistance to chemotherapeutic treatment. We describe three patients with malignant peritoneal mesothelioma who received combination chemotherapy with cisplatin and gemcitabine. After a histopathological diagnosis of epithelial-type malignant peritoneal mesothelioma, all patients underwent systemic chemotherapy because of the advanced disease stage. Moreover, one patient would have been at high risk of cardiac events, because of congenital heart malformation if complete surgical resection had been performed. This chemotherapy achieved a partial response in two patients, but had no effect in one. Combination chemotherapy with cisplatin and gemcitabine may prove to be one of the recommended treatments for patients with malignant peritoneal mesothelioma in the near future.     

胞必佳联合顺铂治疗恶性胸腔积液的临床研究

目的：评价胞必佳联合顺氯氨铂治疗恶性胸腔积液的疗效和毒性。方法：６０例恶性胸腔积液患随机分为两组,Ａ组单用胞必佳治疗,Ｂ组：胞必佳＋顺氯氨铂（ＤＤＰ）。结果：在治疗后头４个月,两组完全缓解率没有明显差异,但在治疗后６个月,Ｂ组的完全缓解率明显高于Ａ组,有明显差异性,不良反应主要为胃肠道反应、胸痛和低热,较轻,对症处理可缓解。结论：胞必佳联合顺氯氨铂治疗恶性胸腔积液的疗效明显高于单药胞必佳的治疗效果。     

Feasibility of boron neutron capture therapy (BNCT) for malignant pleural mesothelioma from a viewpoint of dose distribution analysis

PURPOSE: To investigate the feasibility of boron neutron capture therapy (BNCT) for malignant pleural mesothelioma (MPM) from a viewpoint of dose distribution analysis using Simulation Environment for Radiotherapy Applications (SERA), a currently available BNCT treatment planning system. METHODS AND MATERIALS: The BNCT treatment plans were constructed for 3 patients with MPM using the SERA system, with 2 opposed anterior-posterior beams. The (10)B concentrations in the tumor and normal lung in this study were assumed to be 84 and 24 ppm, respectively, and were derived from data observed in clinical trials. The maximum, mean, and minimum doses to the tumors and the normal lung were assessed for each plan. The doses delivered to 5% and 95% of the tumor volume, D(05) and D(95), were adopted as the representative dose for the maximum and minimum dose, respectively. RESULTS: When the D(05) to the normal ipsilateral lung was 5 Gy-Eq, the D(95) and mean doses delivered to the normal lung were 2.2-3.6 and 3.5-4.2 Gy-Eq, respectively. The mean doses delivered to the tumors were 22.4-27.2 Gy-Eq. The D(05) and D(95) doses to the tumors were 9.6-15.0 and 31.5-39.5 Gy-Eq, respectively. CONCLUSIONS: From a viewpoint of the dose-distribution analysis, BNCT has the possibility to be a promising treatment for MPM patients who are inoperable because of age and other medical illnesses.