奥希替尼联合贝伐珠单抗治疗伴EGFR T790M突变肺腺癌的疗效与机制研究

  目的  通过移植瘤动物实验探讨奥希替尼联合抗VEGF单克隆抗体靶向药物贝伐珠单抗的疗效及作用机制,为进一步临床试验提供理论依据。  方法  构建EGFR T790M突变的H1975人肺腺癌细胞移植瘤动物模型。实验分组:低剂量奥希替尼组、高剂量奥希替尼组、低剂量奥希替尼联合贝伐珠单抗组、高剂量奥希替尼联合贝伐珠单抗组。每组各5只小鼠,给药  方法  奥希替尼2.5 mg/kg/d或5 mg/kg/d,采用每天灌胃处理;贝伐珠单抗5 mg/kg,每周2次腹腔注射。接种后和给药期间绘制肿瘤生长曲线,给药2周后处死裸鼠,活检整个肿瘤。免疫组织化学SP法检测肿瘤HIF-1α、VEGF和微血管密度（microvessel density,MVD）。应用Western blot法检测EGFR及其下游AKT和ERK信号通路蛋白的表达。  结果  给药2周后,高剂量奥希替尼单药组较低剂量奥希替尼单药组肿瘤体积明显缩小,HIF-1α、VEGF表达率和MVD显著降低（P < 0.05）,p-EGFR、p-AKT和p-ERK表达减少（P < 0.05）。低剂量奥希替尼联合贝伐珠单抗组肿瘤体积明显小于低剂量奥希替尼单药组（P < 0.05）,上述因子均明显降低（P < 0.05）。低剂量奥希替尼联合组与高剂量奥希替尼单药组比较,肿瘤体积差异无统计学意义（P=0.178）,p-EGFR、p-AKT、p-ERK表达差异无统计学意义（P＞0.05）。高剂量奥希替尼联合组与高剂量奥希替尼单药组体积差异无统计学意义（P=0.642）。两个联合组之间,体积差异均无统计学意义（P=0.072）,上述因子表达差异均无统计学意义（P＞0.05）。  结论  贝伐珠单抗能够显著增加奥希替尼对伴EGFR T790M突变的肺腺癌移植瘤的杀伤能力。贝伐珠单抗与奥希替尼协同作用是通过降低肿瘤中VEGF表达,改善肿瘤微环境,增强抑制EGFR下游信号通路激活而实现的。      

重组人血管内皮抑制素联合贝伐珠单抗体内抑瘤作用的效果及分析

背景与目的研究重组人血管内皮抑制素和贝伐珠单抗在体内对肺腺癌抑制作用的差别及联合用药的效果。方法首先建立A549肺腺癌细胞系的荷瘤Balb/c小鼠动物模型,然后将小鼠随机分为4组,对照组使用普通生理盐水每日瘤周注射。重组人血管内皮抑制素治疗组使用重组人血管内皮抑素(3mg/kg)每日瘤周注射连续16天贝伐珠单抗治疗组使用贝伐珠单抗(5mg/kg)每周两次瘤周注射给药。贝伐珠单抗、重组人血管内皮抑制素联合用药组使用贝伐珠单抗(5mg/kg)每周两次瘤周注射给药+重组人血管内皮抑素(3mg/kg)每日瘤周注射给药。治疗16天后处死所有实验鼠切取肿瘤标本比较实体瘤大小,采用Westernblot的方法检测血管内皮生长因子A和C(vascularendothelialgrowthfactor/VEGF-A,C)在各组表达情况的差异。结果重组人血管内皮抑制素和贝伐珠单抗在体内实验中均表现出了抑制肿瘤生长的作用,贝伐珠单抗作用更加明显(52.36%vs38.68%)。联合使用可获得更好的效果(64.15%)。贝伐珠单抗只对VEGF-A有抑制作用(60.8%),重组人血管内皮抑制素对VEGF-A/C都有抑制作用(14.6%,30.3%)。联合用药组对VEGF-A/C的抑制作用最强(79.4%,44.2%)。结论重组人血管内皮抑制素和贝伐珠单抗都在裸鼠动物模型试验中表现出了明显的抑瘤效果,联合使用抑制肿瘤效果更加明显。恩度对肿瘤组织内VEGF-A/C都表现出了抑制作用贝伐珠单抗对VEGF-A表现出了较明显的抑制作用联合用药组对VEGF-A/C抑制作用更加明显。     

活体观察贝伐单抗对人骨肉瘤裸鼠移植瘤模型的作用

目的 探讨贝伐单抗（Avastin）对人骨肉瘤143-B裸鼠移植瘤模型生长和血管生成的影响。方法 将成功建立的红色荧光蛋白标记的人骨肉瘤143-B裸鼠原位种植模型随机分为3组：对照组（生理盐水）、低剂量贝伐单抗组（Avastin-L,2.0mg/kg）和高剂量贝伐单抗组（Avastin-H,5.0mg/kg）,每组7只。贝伐单抗每次腹腔注射0.2ml,1周2次,持续3周;对照组给予等体积生理盐水。每隔3天记录各组体质量,每隔7天用荧光影像系统测量原位肿瘤大小并计算抑瘤率;采用免疫组化En Vision法检测各组肿瘤组织中的CD34表达并计算微血管密度（MVD）;酶联免疫吸附法检测各组血浆和肿瘤组织的血管内皮生长因子（VEGF）的水平。结果 3组实验裸鼠体质量及肺部转移率的差异无统计学意义（P＞0.05）;与对照组相比,Avastin-L组和Avastin-H组的肿瘤体积减小,MVD、血浆及肿瘤组织的VEGF水平降低,差异均有统计学意义（P＜0.05）;Avastin-H组对上述指标的改善程度优于Avastin-L组（P＜0.05）。结论 Avastin对人骨肉瘤143-B肿瘤生长有抑制作用,同时可降低血管生成及VEGF水平,但对肺部转移无明显抑制作用。     

不同剂量贝伐单抗联合伊立替康对荷人结肠癌DLD-1裸鼠皮下移植瘤生长的影响

[目的]观察不同剂量贝伐单抗与伊立替康联合对人结肠癌裸鼠皮下移植瘤生长及肿瘤血管生成的影响。[方法]接种人结肠癌DLD-1细胞的裸鼠21只,随机分为4组:无菌生理盐水对照组(A组),5mg/kg贝伐单抗联合伊立替康化疗组(B组),10mg/kg贝伐单抗联合伊立替康化疗组(C组)和单纯伊立替康化疗组(D组)(A、B、C组每组各5只,D组6只,各组伊立替康剂量均为66.7mg/kg)。于d1,5,9(q4d×3)分别给药,治疗第10d处死裸鼠,观察肿瘤生长情况,计算抑瘤率,免疫组化法检测肿瘤组织微血管密度(MVD),评价肿瘤坏死情况。[结果]A、B、C、D组肿瘤体积分别为:646.24±397.33mm3、240.11±147.44mm3、346.21±298.59mm3、399.11±254.09mm3。B、C两组比较,肿瘤体积差异未达统计学意义(P=0.208)。与A组比较,B、C、D组抑瘤率分别为62.85%、47.91%、39.59%。A、B、C、D各组微血管密度(microvesseldensity,MVD)分别为7.000±0.71、4.940±0.58、5.080±1.25、5.557±2.04,经Dunnett检验,与A组比,B、C组肿瘤MVD均有显著性差异(P值分别为0.028、0.039),而D组与A组,及B组与C组在MVD表达上差异未达到统计学意义(P值分别为0.086、0.083)。移植瘤组织HE染色后发现各组肿瘤组织内均有不同程度的坏死。其中,对照组多以轻中度坏死为主,用药后坏死面积均增加,各组坏死分级经秩和检验,χ2=4.73,P=0.193。两两间比较,P值均大于0.05,各治疗组间的坏死差异并不明显。治疗组肿瘤细胞的凋亡较明显。[结论]不同剂量贝伐单抗联合伊立替康对荷DLD-1裸鼠移植瘤有抑制作用,联合用药有显著协同作用,推测其作用机制可能与抑制肿瘤微血管形成、诱导细胞凋亡和死亡增加有关。5mg/kg及10mg/kg贝伐单抗对移植瘤体积及MVD上的作用差异不显著。     

贝伐单抗与重组人血管内皮抑素对人乳腺癌MCF-7细胞裸鼠移植瘤生长的影响

[目的]探讨贝伐单抗、重组人血管内皮抑素对人乳腺癌MCF-7细胞裸鼠移植瘤生长的影响。[方法]建立人乳腺癌裸鼠移植瘤模型,随机分为对照组、低剂量贝伐单抗组、高剂量贝伐单抗组、低剂量莺组人血管内皮抑素组、高剂量重组人血管内皮抑素组、低剂量联合组以及高剂量联合组,用药3周。检测裸鼠体重、移植瘤体积、移植瘤重量,计算抑瘤率。[结果]与对照组相比,低剂量贝伐单抗组、高剂量贝伐单抗组、低剂量联合组、高剂量联合组裸鼠移植瘤生长曲线较平缓,移植瘤重量明显下降（P〈0．01）,抑瘤率分别为67．69％、68．88％、78.32％和79．26％。低剂量联合组与低剂量贝伐单抗组移植瘤重量存在统计学差异（P〈0．05）。低剂量重组人血管内皮抑素组、高剂量重组人血管内皮抑素组移植瘤生长与对照组无统计学差异（P〉0．05）。[结论]贝伐单抗能抑制人乳腺癌MCF-7细胞裸鼠移植瘤生长,低剂量贝伐单抗联合重组人血管内皮抑素能进一步提高抗肿瘤作用。     

基于NF-κB/HIF-1α/VEGF信号通路探讨贝伐珠单抗联合化疗对上皮性卵巢癌的疗效及调控机制

目的 探究贝伐珠单抗联合化疗对卵巢癌的疗效以及调控机制。方法 使用贝伐珠单抗以及联合化疗药物处理SKOV3细胞,通过流式细胞术检测SKOV3细胞凋亡率;通过细胞集落形成实验分析细胞生长能力;通过Trans well实验分析SKOV3细胞侵袭能力。然后将SKOV3细胞注入BALBc-Nude裸鼠体内建立肿瘤模型,通过测量肿瘤体积大小评估贝伐珠单抗以及联合化疗药物的疗效;通过免疫组化实验检测Ki-67的表达;通过Western blotting检测NF-κB/HIF-1α/VEGF以及Bax、Bcl-2蛋白的表达。结果 体外研究发现,贝伐珠单抗以及联合化疗能够抑制SKOV3细胞中NF-κB/HIF-1α/VEGF的蛋白表达,同时还能抑制SKOV3细胞的增殖和侵袭能力,促进SKOV3细胞凋亡。体内研究发现,贝伐珠单抗以及联合化疗能够抑制肿瘤组织中NF-κB/HIF-1α/VEGF的蛋白表达,同时还能抑制肿瘤生长,抑制肿瘤组织Ki-67蛋白的表达。结论 贝伐珠单抗联合化疗能够抑制卵巢癌的恶性发展,该作用可能与抑制NF-κB/HIF-1α/VEGF信号通路相关。     

贝伐珠单抗治疗肺腺癌脑转移瘤伴难治性脑水肿效果观察

目的探讨贝伐珠单抗治疗肺腺癌脑转移瘤伴难治性脑水肿的效果及对血清血管内皮生长因子(VEGF)的影响。方法回顾性分析2015年7月至2018年12月青岛市中心医院收治的25例肺腺癌脑转移伴难治性脑水肿患者的临床资料,既往经甘露醇联合糖皮质激素脱水降颅压治疗无效。患者分为单用贝伐珠单抗组和联用贝伐珠单抗组。给予贝伐珠单抗(5 mg/kg)治疗后评估患者临床症状、功能状态评分(KPS)、瘤周水肿程度以及血清VEGF水平的变化。结果治疗后19例患者症状明显减轻,6例患者症状改善不明显;所有患者KPS评分高于治疗前,瘤周水肿指数较治疗前下降,差异均具有统计学意义(均P<0.05)。治疗后血清VEGF水平较治疗前降低,且联用贝伐珠单抗组血清VEGF水平低于单用贝伐珠单抗组,差异均有统计学意义(均P<0.05)。治疗中出现高血压3例,便血及咯血各1例,经对症处理后好转,无严重不良反应发生。结论贝伐珠单抗治疗肺腺癌脑转移伴难治性瘤周水肿具有一定疗效,可以改善患者生命质量,且可有效降低患者血清VEGF水平,提示VEGF有可能成为判断疗效及疾病进展的重要指标之一。     

NRP-1单抗联合节律化疗对裸鼠胃癌移植瘤生长的抑制

目的：探讨NRP-1 单抗联合多西他赛节律化疗对胃癌裸鼠移植瘤的抗肿瘤疗效。方法：BALB/c裸鼠皮下接种胃癌BGC-823 细胞制备移植瘤模型,将荷瘤裸鼠以数字随机表法随机分为对照组、NRP-1 单抗组、节律化疗组(MCT)、联合组(NRP-1mAb+MCT),每组6 只。除对照组,其余各组于造模第8 天开始分别给予相应治疗,给药2 周,观察裸鼠一般状况,隔天测量裸鼠体重及肿瘤体积。裸鼠处死后称瘤质量,H-E 染色观察瘤组织形态,免疫组化检测裸鼠瘤组织中NRP-1 蛋白、VEGF、MVD表达。结果：联合组移植瘤的体积和质量显著低于其他各组[ （0.394±0.128）vs（0.748±0.152）、0.867±0.361）、（1.247±0.494）g;（0.613±0.223) vs (0.866±0.115)、(1.098±0.343)、(1.474±0.644) cm3。均P<0.05],抑瘤率较其他治疗组差异有统计学意义(P<0.05)。对照组癌组织细胞生长良好,血管丰富,给药组癌组织出现不同程度的片状坏死,血管成分减少。免疫组化染色显示,对照组NRP-1 表达明显高于治疗各组(P<0.05),联合组的NRP-1、VEGF、MVD表达均显著低于其余各组(P<0.05)。结论：NRP-1单抗联合多西他赛节律化疗可能通过下调NRP-1 表达而显著抑制BGC-823 胃癌移植瘤的生长及血管生成。     

贝伐珠单抗治疗脑转移瘤难治性瘤周水肿的疗效分析

目的 观察贝伐珠单抗治疗恶性肿瘤脑转移瘤难治性瘤周水肿的疗效及不良反应。方法 回顾性分析于本院接受贝伐珠单抗治疗的14例伴难治性瘤周水肿的恶性肿瘤脑转移瘤患者的临床资料,包括乳腺癌脑转移7例、肺癌5例、食管癌1例、右上颌窦腺样囊性癌1例。所有患者均为甘露醇、地塞米松等常规治疗无效的难治性脑水肿病例。评估患者在贝伐珠单抗治疗前后的临床症状、生活质量评分及MRI显示的水肿体积,并详细记录治疗相关不良反应。结果 全组患者接受贝伐珠单抗治疗的中位剂量为4.76 mg/kg。全组14例患者中,11例患者在贝伐珠单抗给药后头晕、头痛症状明显减轻,3例患者症状改善不明显。全组14例患者贝伐珠单抗治疗后瘤周水肿体积较治疗前明显减少［（38 804±14 859）mm3 vs.（80 100±28 338）mm3,P=0.02］,水肿指数较治疗前有降低的趋势（15.38±7.12 vs. 26.40±16.52,P＞0.05）,但差异无统计学意义。14例患者中有1例于第2次贝伐珠单抗治疗后出现上颌窦创面大量出血死亡,3例患者出现可控制的高血压,未出现蛋白尿、贫血、口腔炎等其他并发症。结论 贝伐珠单抗可控制恶性肿瘤脑转移的难治性瘤周水肿,为严重脑水肿患者争取放疗机会,但应谨慎掌握适应证,警惕严重不良反应。     

三氧化二砷联合TNP-470对裸鼠人肝癌移植瘤的影响

目的:探讨三氧化二砷(As2O3)联合烟曲霉的提取物烟曲霉醇(TNP-470)对裸鼠人肝癌移植瘤生长的影响及其作用机制。方法:人肝癌转移模型(HCC)-LCI-D20原位移植瘤裸鼠32只,随机分4组(每组8只)给药:As2O3联合TNP-470组、As2O3组、TNP-470组、生理盐水(NS)对照组,给药21天后,对裸鼠移植瘤大小、肿瘤微血管密度(MVD)、免疫组化、透射电镜结果进行观察。结果:As2O3组、TNP-470组及联合组的平均瘤重及平均瘤体积均低于对照组(P<0.05);计算两药相互作用系数(CDI)值:瘤重CDI(0.95)<1,体积CDI(0.89)<1,两药有协同抑制移植瘤生长的作用。As2O3组抑制移植瘤VEGF、EGFR的表达;TNP-470组抑制移植瘤EGFR的表达,对移植瘤VEGF的表达无影响;联合组明显抑制移植瘤EGFR的表达,抑制移植瘤VEGF的表达作用等同As2O3组。裸鼠原位移植瘤的光镜、电镜下观察结果有意义;各用药组裸鼠原位移植瘤的MVD值均低于对照组(P<0.05)。结论:As2O3联合TNP-470协同抑制裸鼠人肝癌移植瘤的血管新生,能有效抑制移植瘤生长。     

Expressions of MVD, VEGF, Ki67 in Residual Prostate Cancer after Cryoablation

OBJECTIVE To analyze the effects of cryoablation on the mice bearing Rm-1 prostate cancer through detecting tumor angiogenesis and cancer cell proliferation in the mice after cryoablation, and to explore the effects of cryoablation on vascular endothelium growth factor (VEGF), Ki67 protein expression and microvessel density (MVD) in the mice bearing prostate cancer.METHODS Sixty Rm-1 mouse models of prostate cancer were established. Experimental mice were randomized into 2 groups:the cryoablation group (n=30) and the control group (n=30).After the therapy, tumor tissues of the mice in group A and B were obtained at day 0 (without cryoablation), 1st, 3rd, 5th, 7th, 14th day, respectively, after cryoablation, and the expressions of MVD,VEGF and Ki67 proteins were detected at the same time points.RESULTS The expressions of MVD, VEGF and Ki67 proteins in group A were decreased. The lowest values of the factors were detected on the 3rd day after cryoablation, and increased slowly after that. The expressions of MVD, VEGF and Ki67 proteins in the control group were not changed. Significant changes of the expressions of MVD, VEGF and Ki67 proteins in the group A were found at different time points. Correlation analysis suggested a positive correlation between the expressions of VEGF and MVD proteins (r=0.8793), a positive correlation between the expressions of Ki67 and MVD proteins (r=0.7614), and a positive correlation between the expressions of VEGF and ki67 proteins (r=0.6921).CONCLUSION After argon-helium cryoablation treatment for the mice bearing prostate cancer, the expressions of MVD, VEGF and Ki67 proteins in local tumor were reduced on the 1st day. The lowest values of the factors were detected on the 3rd day after cryoablation, and then increased after that. Cryoablation combined with other modalities of treatment may effectively improve the treatment effects of cryoablation for prostate cancer.     

贝伐单抗联合放射方案的实验研究

目的 实时测定贝伐单抗和放射线作用人肺腺癌细胞系(NCI-H141)裸鼠移植瘤后活体乏氧调节蛋白(HIF-1α)水平变化,为优化贝伐单抗和放射线联合计划提供依据.方法 用HIF-1α荧光蛋白报告质粒转染NCI-H441细胞连续测定肿瘤乏氧水平,并观察贝伐单抗与放射线(122Scγ射线)早晚联合后HIF-1α水平变化、血管数量和渗透性、肿瘤反应、乏氧分子标记、凋亡率和肿瘤生长延迟的异同.结果 单纯贝伐单抗作用后24 h肿瘤HIF-1α表达水平较对照组轻度下降(3.1×106:6.1×106;t=-1.73,P>0.05),功能血管密度升高(16.6:12.1;t=-1.40,P>0.05)和血管渗透指标明显改善(2.9%:11.5%;t=6.80,P<0.01);随后HIF-1α表达水平迅速升高(7.4×106:20.4×106;t=2.36,P<0.05)并维持至疗后8～10 d(第3天时高于对照组3～4倍)且总血管密度明显下降(37.4:15.9;t=5.36,P<0.01).贝伐单抗治疗72 h后联合放射线作用组比24 h后联合作用组肿瘤血管记数高(联合作用后第3天,9.33:3.17;t=-2.43,P<0.05)、凋亡记数低(联合作用后第3天,23.33:43.83;t=2.54,P<0.05),生长延迟时间也明显缩短(10.5:23.0;t=2.67,P<0.05).结论 贝伐单抗联合放射线作用后72 h贝伐单抗诱导的乏氧对血管和肿瘤细胞具有明显的放射抵抗作用,提示血管靶向药物联合放射作用可能存在时间增益窗口.     

Efficacy of the combined use of bevacizumab and irinotecan as a postoperative adjuvant chemotherapy in colon carcinoma

We evaluated the efficacy of anti-human VEGF antibody (bevacizumab) with or without irinotecan (CPT-11) against lung metastases in which neovascularization was already induced, as a postoperative adjuvant therapy using orthotopically implanted colon cancer in rat. The high VEGF productive KM12SM human colon cancer cells were injected into the cecal wall. At 5 weeks after the injection, the cecum was removed including the tumor. Then, 5 mg/kg of bevacizumab and 40 mg/kg of CPT-11 were administered, alone or in combination, intravenously once a week for 3 weeks, from day 15 after the cecal removal. The results show that the incidences of macroscopic and/or microscopic lung metastases in the bevacizumab-alone group (B) and in the combination group (C) were significantly lower (B, p=0.001 and C, p=0.037) than that in the control group at day 35 after the cecal removal. The number of lung metastases in B was 0.8+/-0.8 (p=0.024) and in C 2.4+/-1.8 (p=0.060), each value lower than the 12.4+/-4.2 of the control group. The growth of a subcutaneously implanted tumor was significantly inhibited in the combination group compared to either the CPT-alone (p=0.003) or the bevacizumab-alone groups (p=0.027). Apoptosis was significantly (p<0.001) induced in the combination group. In conclusion, a beneficial effect of bevacizumab against postoperative lung metastases may be expected even after the establishment of neovascularization in metastatic foci in nude rat. The results from the present subcutaneously implanted tumor model suggested that a higher efficacy may be expected when bevacizumab is combined with the cytotoxic agent CPT-11, compared to bevacizumab alone, against tumors with a variety of VEGF production levels in clinical situations.     

Antitumor effects of bevacizumab in combination with fluoropyrimidine drugs on human oral squamous cell carcinoma

Vascular endothelial growth factor (VEGF) serves an important role in new blood vessel formation or angiogenesis, which is a critical event in tumor growth and metastasis. Bevacizumab is a humanized monoclonal antibody against VEGF-A, whereas S-1 is a fluoropyrimidine antineoplastic agent that induces apoptosis in various types of cancer cells. The present study evaluated the antitumor effects of bevacizumab in combination with 5-fluorouracil (5-FU) or S-1 against oral squamous cell carcinoma (OSCC) in vitro and in vivo. Two human OSCC cell lines were used, namely the high VEGF-A-expressing HSC-2 cells and the low VEGF-A-expressing SAS cells. MTT assay was used to evaluate the effect of bevacizumab and/or 5-FU against HSC-2 and SAS cell proliferation. Additionally, the antitumor effect of bevacizumab was evaluated alone and in combination with S-1 against HSC-2 tumors in nude mice. S-1 (6.9 mg/kg/day) was administered orally every day for 3 weeks, and bevacizumab (5 ml/kg/day) was injected intraperitoneally twice per week for 3 weeks. Apoptotic cells in mouse tumors were detected using the TUNEL method, and cell proliferation and microvessel density (MVD) were determined by immunohistochemical staining of Ki-67 and CD31, respectively. Bevacizumab alone did not inhibit OSCC cell proliferation in vitro, and did not exhibit any synergistic inhibitory effect in combination with 5-FU in vitro. However, combined bevacizumab and S-1 therapy exerted synergistic and significant antitumor effects in vivo on HSC-2 tumor xenografts, and induced apoptosis in tumor cells. Furthermore, this combination therapy led to decreased MVD and cell proliferative abilities, as well as increased apoptosis in residual tumors. The present findings suggested that the bevacizumab plus S-1 combination therapy may exert antitumor effects in high VEGF-A-expressing OSCC cells.     

低剂量紫杉醇联合沙利度胺抑制小鼠S-180肉瘤血管生成的研究

目的:探讨低剂量紫杉醇联合沙利度胺对小鼠S-180肉瘤血管生成的作用。方法:建立S-180移植瘤小鼠模型,将40只荷瘤小鼠随机分为4组。A组:生理盐水组(对照组);B组:紫杉醇组,腹腔内注射20 mg/kg,每周3次,连续2周;C组:沙利度胺组,200 mg/kg灌胃,每周3次,连续2周;D组:紫杉醇+沙利度胺组,腹腔内注射紫杉醇(20 mg/kg)和沙利度胺(200 mg/kg)灌胃,每周3次,连续2周。观察瘤重、抑瘤率、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达和微血管密度(microvessel density,MVD)计数。结果:与对照组比较,B、C、D组均能降低瘤重、减少VEGF的表达、降低MVD计数(P<0.05);D组分别与B、C组比较,VEGF的表达及MVD计数均低于B、C组,且差异具有统计学意义(P<0.05)。结论:小剂量紫杉醇联合沙利度胺能一定程度上抑制S180肉瘤血管的生长,两者具有协同作用。     

腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的临床观察

目的 观察腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效和安全性,分析腹水内血管内皮生长因子（VEGF）水平对贝伐珠单抗治疗卵巢癌腹腔积液的临床意义。方法 将46例卵巢癌伴腹腔积液患者随机分为治疗组（n=25）和对照组（n=21）,均应用TC方案（紫杉醇135mg／m2静脉注射d1+卡铂 AUC=5 静脉注射d1）全身化疗,3周重复1次;同时腹腔内给予顺铂40mg／m2+43～45℃ 0.9%生理盐水1500～3000ml热灌注化疗,每2周重复1次,连续治疗6周。治疗组在上述治疗基础上每次热灌注化疗后腹腔内注入贝伐珠单抗300mg,治疗6周。评价患者疗效、生活质量改善及不良反应。酶联免疫吸附法（ELISA）检测46例患者治疗前、后腹水中VEGF水平。结果 治疗组治疗后腹水VEGF水平为（468.30±42.80）pg/ml,明显低于治疗前的（2785.89±305.22）pg/ml（P＜0.05）;治疗组治疗后腹水VEGF水平明显低于对照组治疗后的（820.20±61.49）pg/ml（P＜0.05）。治疗组的有效率（RR）为92.0％（23／25）,对照组为61.9％（13／21）,差异有统计学意义（P＜0.05）。治疗组中VEGF阳性者的RR达1000％,VEGF阴性者为50.0％,差异有统计学意义（P＜0.05）。治疗组的生活质量（QOL）改善率为92.0％,对照组为57.1％,差异有统计学意义（P＜0.05）。46例患者对治疗的耐受良好,无严重不良反应。结论 腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效优于单纯腹腔热灌注化疗,生活质量明显改善,安全性好,尤其对于腹水VEGF阳性卵巢癌患者更加适合。     

Antiangiogenic gene therapy with soluble VEGF-receptors -1, -2 and -3 together with paclitaxel prolongs survival of mice with human ovarian carcinoma

We compared effects of antiangiogenic gene therapy with a combination of soluble sVEGFR-1, sVEGFR-2 and sVEGFR-3 to chemotherapy with carboplatin and paclitaxel and to antiangiogenic monoclonal anti-VEGF-antibody bevacizumab in an intraperitoneal ovarian cancer xenograft model in mice (n = 80). Gene therapy was also combined with chemotherapy. Therapy was initiated when sizable tumors were confirmed in magnetic resonance imaging (MRI). Adenovirus-mediated gene transfer was performed intravenously (2 × 109 pfu), while chemotherapy and monoclonal anti-VEGF-antibody were dosed intraperitoneally. The study groups were as follows: AdLacZ control (n = 21); combination of AdsVEGFR-1, -2 and -3 (n = 21); combination of AdsVEGFR-1, -2, -3 and paclitaxel (n = 9); bevacizumab (n = 14); paclitaxel (n = 9) and carboplatin (n = 5). Effectiveness was assessed by survival time and surrogate measures such as sequential MRI, immunohistochemistry, microvessel density and tumor growth. Antiangiogenic gene therapy combined with paclitaxel significantly prolonged the mean survival of mice (25 days) compared to the controls (15 days) and all other treatment groups (p = 0.001). Bevacizumab treatment did not have any significant effect on the survival. Tumors of the mice treated by gene therapy were significantly smaller than in the control group (p = 0.021). The mean vascular density and total vascular area were also significantly smaller in the tumors of the gene therapy group (p = 0.01). These results show potential of the antiangiogenic gene therapy to improve efficacy of chemotherapy with paclitaxel and support testing of this approach in a phase I clinical trial for the treatment of ovarian cancer.     

As2O3 对ACC-2移植瘤血管生成的影响

目的研究三氧化二砷（As2O3）对人腺样囊性癌ACC-2裸鼠移植瘤生长及血管生成的抑制作用,探讨其抗肿瘤的作用机制。方法通过建立ACC-2裸鼠移植瘤模型,将28只荷瘤鼠随机分为4组：阴性对照组（生理盐水即NS）、阳性对照组[5-Fu10mg／（kg·d）]、低剂量组[As2O3．5mg／（kg·d）]、高剂量组[As2O3 5．0mg／（kg·d）]。连续经腹腔注射用药10天。测量肿瘤的体积和重量,采用HE染色光镜观察,免疫组织化学法检测VEGF、MVD的表达并进行统计学分析。结果高、低剂量As2O3组移植瘤的瘤体积、瘤重均低于两对照组（Ns组和5-Fu组）,且高剂量As2O3组抑瘤最明显,瘤体积抑制率为52．17％,瘤重抑制率为56．04％（P〈0．01）。在移植瘤表面,与两对照组相比,高、低剂量As2O3组血管密度减小,管径变细。高、低剂量As2O3组抑制移植瘤VEGF的表达、降低MVD值,高剂量As2O3组抑制作用最明显。与两对照组比较以及高、低剂量As2O3组之间比较差异均有统计学意义（P〈0．01）。结论As2O3对人腺样囊性癌ACC-2裸鼠移植瘤及血管生成有明显抑制作用,其作用机制可能为降低VEGF表达及MVD值,此抑制作用与剂量有关。