平消胶囊联合化疗治疗非小细胞肺癌的疗效观察

目的：观察平消胶囊联合诺维本、顺铂治疗非小细胞肺癌的疗效和毒副反应,对平消胶囊降低化疗药物毒副反应、改善临床症状和提高患者生存质量的临床疗效进行评价。方法：对2004年5月-2006年3月期间符合本研究的40例住院患者随机分为两组,治疗组20例,对照组20例,两组均接受NP化疗方案,进行2周期化疗,21天为1周期,2周期为1疗程。治疗组化疗期间联合使用平消胶囊。观察治疗后两组近期疗效、生活质量（KPS评分）、化疗期间和化疗后消化道副反应及血液学毒性分级情况。结果：两组近期疗效（CR＋PR）虽无统计学意义,而治疗组在KPS评分、化疗后消化道副反应及血液学毒性分级情况方面均优于对照组（P〈0.05）,具有显著性差异。结论：平消胶囊联合NP化疗方案治疗非小细胞肺癌疗效较好,毒副反应轻,值得进一步研究应用。     

平消胶囊联合化疗治疗非小细胞肺癌的疗效观察

目的:观察平消胶囊联合诺维本、顺铂治疗非小细胞肺癌的疗效和毒副反应,对平消胶囊降低化疗药物毒副反应、改善临床症状和提高患者生存质量的临床疗效进行评价。方法:对2004年5月~2006年3月期间符合本研究的40例住院患者随机分为两组,治疗组20例,对照组20例,两组均接受NP化疗方案,进行2周期化疗,21天为1周期,2周期为1疗程。治疗组化疗期间联合使用平消胶囊。观察治疗后两组近期疗效、生活质量(KPS评分)、化疗期间和化疗后消化道副反应及血液学毒性分级情况。结果:两组近期疗效(CR PR)虽无统计学意义,而治疗组在KPS评分、化疗后消化道副反应及血液学毒性分级情况方面均优于对照组(P<0.05),具有显著性差异。结论:平消胶囊联合NP化疗方案治疗非小细胞肺癌疗效较好,毒副反应轻,值得进一步研究应用。     

紫杉醇与长春瑞滨联合顺铂治疗晚期非小细胞肺癌

目的比较紫杉醇（T）及长春瑞滨（N）联合顺铂（P）治疗Ⅲb／Ⅳ期非小细胞肺癌（NSCLC）的疗效、毒副反应。方法对晚期非小细胞肺癌48例,分别应用TP和NP方案化疗,治疗2周期评价疗效和毒副反应。结果44例可评价疗效,两组近期有效率分别为45．0％和46．8％,无显著性差异（x^2=2．25,P=0．512）。两组间主要毒性反应为消化道反应和骨髓抑制,其Ⅲ、Ⅳ度反应发生率无统计学差异（P〈0．05）,TP组过敏性休克2例,心衰2例,但对症处理后均恢复,无死亡病例。NP组无过敏性休克和心脏毒性反应。结论两方案的近期疗效和血液毒性及消化道毒性反应相近,但应用紫杉醇时应注意过敏性休克和心衰的发生,一旦发生,如及时对症处理,一般无严重后果。两方案均为目前非小细胞肺癌较好的治疗方案。     

平消胶囊配合化疗治疗中晚期非小细胞肺癌的临床研究

目的：观察平消胶囊配合化疗治疗中晚期非小细胞肺癌（NSCLC）的疗效及毒副反应.方法：对118例中晚期非小细胞肺癌随机分组,治疗组用平消胶囊配合金喜素加顺铂（TP）方案化疗,对照组单用TP方案化疗.结果：治疗组有效率为63.49%,对照组为43.63%,两组对比有差异性（P＜0.05）.治疗组Ⅲ～Ⅳ度白细胞下降率为42.86%,血小板下降率为17.46%;对照组Ⅲ～Ⅳ度白细胞下降率85.45%,血小板下降率为38.18%,两组对比,也有明显差异性（P＜0.05）.结论：平消胶囊配合化疗既能增加疗效,又具有保护骨髓作用,值得临床应用.     

国产吉西他滨联合顺铂治疗晚期非小细胞肺癌的疗效观察

背景与目的目前铂类药物为基础的联合化疗被认为是治疗晚期非小细胞肺癌的有效方案。本研究旨在观察国产吉西他滨(gemcitabine，GEM)与顺铂(cisplatin，DDP)联合化疗方案治疗晚期非小细胞肺癌的临床疗效及毒副反应。方法32例患者均为不能手术的Ⅲ、Ⅳ期非小细胞肺癌患者。吉西他滨1000mg／m^2静脉滴注，第1、8、15天；顺铂20mg静脉滴注，第1～5天。每28天为一个周期，治疗3～4周期。结果全组无完全缓解的患者，总有效率为34．4％(11／32)。中位生存期为329天，1年生存率为32．7％。主要毒副反应为骨髓抑制及恶心呕吐，但没有严重的Ⅳ度损害；无明显的肝肾功能损害；无一例因毒性反应而延期化疗。结论吉西他滨加顺铂联合化疗方案治疗晚期非小细胞肺癌有较好的疗效，且耐受性较好。     

国产吉西他滨联合卡铂治疗晚期非小细胞肺癌的临床观察

背景与目的 化疗在晚期非小细胞肺癌的治疗中具有极为重要的作用。本研究的目的是观察国产吉西他滨（泽菲）联合卡铂治疗晚期非小细胞肺癌的近期疗效、临床受益和毒副反应。方法 对34例初治的晚期（ⅢB及Ⅳ期）非小细胞肺癌患者给予国产吉西他滨联合卡铂治疗。卡铂AUC5，第1天；吉西他滨1000mg／m^2，第1、8天，静脉滴注。21天为一个周期，每例患者治疗3～4周期。结果 34例患者临床有效率（完全缓解＋部分缓解）为44％（15／34），总的临床受益反应率为53％（18／34）。主要毒副反应为血液学毒性，Ⅲ～Ⅳ度白细胞和血小板下降发生率分别为47％和24％，其余毒副反应较轻，可耐受。结论 国产吉西他滨联合卡铂治疗初治的晚期非小细胞肺癌有较好的疗效，毒性反应可以耐受。     

吡柔比星为主的联合方案治疗晚期非小细·论著·胞肺癌的临床观察

目的探讨吡柔比星为主联合化疗对晚期非小细胞肺癌的疗效。方法采用以吡柔比星为主的联合化疗方案治疗２４例非小细胞肺癌。结果ＣＲ３例，ＰＲ１１例，ＲＲ５８．３％，有效生存期明显延长，主要毒副反应为消化道反应及血液毒性。结论吡柔比星是一种高效、广谱的抗肿瘤药物，安全性较好，对于难治性肿瘤可考虑首选。     

健择加顺铂联合治疗晚期非小细胞肺癌近期疗效观察

目的 观察健择(GEM,Gemcitabine,Gemzer,吉西他滨)与顺铂(DDP,Cisplatin)联合化疗方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效及毒副反应。方法 36例均为Ⅲ、Ⅳ期非小细胞肺癌患者。健择1000 mg/m~2静滴d1,d8,顺铂40 mg静滴d1～d3,21d为1个周期,治疗2～3周期。结果 总有效率为44.4％(均为部分缓解)。主要毒副反应为Ⅱ～Ⅲ度骨髓抑制及恶心呕吐。骨髓抑制主要表现为血红蛋白、白细胞及血小板的降低,但没有严重的Ⅲ～Ⅳ度损害。无明显的肝肾功能的损害。无一例因毒性反应而延期化疗者。结论 健择加顺铂联合化疗方案治疗晚期非小细胞肺癌有较好的疗效,且耐受性较好。     

平消胶囊联合化疗治疗贲门癌临床观察(附87例)

目的:观察平消胶囊联合化疗治疗贲门癌的疗效及毒副反应。方法:从2004年5月至2007年3月应用平消胶囊联合常用化疗药物组成的联合化疗方案治疗贲门癌87例。结果:两组近期疗效(CR PR)无统计学意义,但治疗组在化疗后消化道副反应及血液学毒性分级情况均优于对照组,P<0.05。结论:平消胶囊与其它化疗药物联合治疗贲门癌能够减轻化疗药物消化道副反应,且能减轻血液学毒性。     

含诺维本的联合化疗对47例中晚期肺癌的近期疗效

目的：探讨含诺维本的联合化疗治疗中晚期肺癌的近期疗效及毒副反应。方法：应用以诺维本为主，与顺铂及阿霉素联合治疗47例中晚期肺癌有效率及毒副反应。结果：47例中晚期肺癌总有效率为48．9％。其中非小细胞肺癌有效率为56．8％（肺鳞癌为57．8％，肺腺癌为55．6％），小细胞肺癌有效率为20％.两组差异显著（P＜0．05），而鳞癌和腺癌疗效无明显差别（P＞0．05）。本方案毒副反应主要是骨髓抑制、神经毒性，胃肠道反应则较少。结果提示含有诺维本的联合化疗不仅对非小细胞肺癌有较好疗效，且毒副反应较轻。结论：含有诺维本的联合化疗，是一个值得临床更深入研究及应用的治疗非小细胞肺癌方案。     

肺癌干细胞与肺癌转移相关机制的研究进展

肺癌干细胞是来源于肺癌具有自我更新及多向分化潜能的一部分细胞群,被认为是肺癌发生发展的根源,其在肺癌转移过程中扮演重要角色,可能的作用机制主要包括上皮间质转化、肿瘤微环境、肿瘤血管生成、肿瘤耐药性、信号转导通路等几个方面.本文将对肺癌干细胞与肺癌转移相关机制做进一步探索,以期为防治肺癌转移提供新策略.     

A Phase III Study on Intermittent Versus Weekly Cisplatin and Etoposide in the Treatment of Advanced Non-Small Cell Bronchogenic Carcinoma

Summary

A group of 55 patients with advanced non-small cell bronchogenic carcinoma entered a random study on combined cisplatin (CDDP) and etoposide (VP16), either intermittendy (I = CDDP 60 mg/m² day 1 and VP16 120 mg/m2 day 1-3 every 3-4 weeks) or weekly (W = CDDP 20 mg/m² and VP16 120 mg/m²). Five out of 31 (16%) évaluable patients in group I and 6/27 (22%) in group W obtained partial remission (no statistical difference). Toxicity was mild and survival was similar for both groups. The authors conclude that the weekly combination of CDDP plus VP16 is neither less toxic nor more effective than the intermittent one.     

小细胞肺癌与非小细胞肺癌的CT特征对比研究

目的:比较小细胞肺癌与非小细胞癌的CT表现,探讨小细胞肺癌的CT特征.方法:140例患者经肺穿刺活检病理结果分为小细胞肺癌组(35例)与非小细胞肺癌组(105例),分析两组患者的CT特征.结果:两组CT表现特征对比,在病灶长径与支气管关系、有无毛刺、是否存在胸膜凹陷、是否累及纵隔大血管、是否存在远处转移、是否累及叶、段支气管方面差异有统计学意义(P＜0.01).结论:小细胞肺癌的CT表现特点为病灶与支气管长径多平行,周边光滑、毛刺少见,常累及叶支气管、甚至累及段支气管,胸膜凹陷少见,常累及纵隔大血管等.     

Targeting Angiogenesis in the Treatment of Lung Cancer

Inhibition of angiogenesis now plays a central role in the management of many malignancies. Angiogenesis plays an important role in lung cancer and increasing numbers of antiangiogenesis agents are being investigated in all types of pulmonary malignancies. The monoclonal antibody, bevacizumab, has demonstrated efficacy (improved response rates and overall survival) in phase II and III trials in combination with standard first-line chemotherapy in non-small cell lung cancer. However patients in the large phase III studies were highly selected to reduce the risk of fatal hemoptysis. Many small molecule tyrosine kinase inhibitors, particularly sorafenib, sunitinib, vandetanib, and cediranib, are currently being investigated in phase III trials as monotherapy or in combination with standard therapy. Alternative antiangiogenesis approaches such as vascular endothelial growth factor-trap and anticoagulation are also being investigated. Targeting angiogenesis is an exciting and attractive area in the treatment of lung cancer, and the results of ongoing trials are eagerly awaited. More work is required to identify subgroups of patients most likely to benefit from these drugs.     

Immunotherapy – new perspective in lung cancer

Lung carcinoma is associated with a high mortality worldwide, being the leading cause of cancer death. It is mainly classified into squamous non-small cell lung cancer (NSCLC), non-squamous NSCLC, and small cell lung cancer. However, such malignancy has been increasingly subdivided into histological and molecular subtypes to guide treatment. Therapies can be used in adjuvant and palliative settings. Regarding immunotherapy, it has been widely tested in both first or subsequent palliative lines. In this sense, drugs such as pembrolizumab, nivolumab, atezolizumab, ipilimumab, avelumab, and durvalumab have been assessed in large studies. Some of these trials have also studied these medicines in adjuvant and in maintenance therapy. In recent years, advances in immunotherapy have raised the hope that the unfavorable prognosis observed in several affected individuals can be changed. Immunotherapy has increased the overall survival in squamous NSCLC, non-squamous NSCLC, and small cell lung cancer. However, it has added to the oncology practice some side effects that are unusual in standard chemotherapy and require special clinical support. In order to show how immunotherapy is being applied in the treatment of lung carcinoma, we reviewed the main studies in adjuvant and palliative scenarios. What is the better scheme? What is the better combination? What is the better dose? When should we use immunotherapy? Does programmed cell death ligand 1 expression significantly interfere in immunotherapy efficiency? Some of these questions have already been answered, while others require more investigations.     

Current Strategies for Extensive Stage Small Cell Lung Cancer Beyond First-line Therapy

Extensive stage small cell lung cancer carries extremely poor prognosis and adding immune checkpoint inhibitor to platinum etoposide combination in first line only improved outcomes modestly. Once disease recurs, treatment response is only transient in nature. Various strategies that are being explored include dual checkpoint blockade, BiTE and CAR-T cell approaches. Immune checkpoint inhibitors are being combined with PARP inhibitors. Other approaches currently being investigated include liposomal irinotecan and combining known active agents for SCLC in relapsed setting such as newly approved lurbinectedin with doxorubicin, paclitaxel, irinotecan or topotecan with ATR inhibitor (Berzosertib). Temozolomide has also been tested in combination with a Parp inhibitor. New antibody or small molecule drug conjugates are being actively investigated, so is a biomarker based approach. Better understanding of small cell lung cancer disease biology via high through-put genomic, proteomic and methylation profiling offer glimpse of hope in our efforts to contain this deadly disease. A table of representative molecular targets under investigation is provided in the end.     

Evaluation of the Simplified Comorbidity Score (Colinet) as a prognostic indicator for patients with lung cancer: A cancer registry study

Introduction

A Simplified Comorbidity Score (SCS) provided additional prognostic information to the established factors in patients with non-small cell lung cancer lung cancer. We undertook this analysis to test the prognostic value of the SCS in a population-based study.

Patients and methods

Retrospective survey of all Victorians diagnosed with lung cancer in January–June 2003, identified from the Victorian Cancer Registry.

Results

There were 921 patients, with data available for 841 (91.3%). Median age was 72 years (range 30–94) and 63.1% were male. A tissue diagnosis was made for 89.9%, of which 86.6% were non-small cell (NSCLC), and 13.4% small cell carcinoma (SCLC). Comorbidities on which the SCS is based were distributed: cardiovascular 54.6%; respiratory 38.9%; neoplastic 19.9%; renal 4.6%; diabetes 11.7%; alcoholism 5.5%; and tobacco 83.1%.In patients with NSCLC, higher SCS score (>9) was associated with increasing stage, ECOG performance status, male sex, increasing age, tobacco consumption and not receiving treatment. Using Cox regression, survival was analysed by SCS score after adjusting for the effect of age, sex, cell type (NSCLC, SCLC, no histology), ECOG performance status and stage for all patients and then restricted to NSCLC. As a continuous or dichotomous (≤ or >9) variable, SCS was not a significant prognostic factor for all patients or when restricted to NSCLC.

Conclusion

In this retrospective analysis of population based registry patients, SCS did not provide additional prognostic information in patients with lung cancer. ECOG performance status may be a substitute for the effect of comorbidity.     

A Phase II Study with Teniposide (VM26) in Patients with Progressed or Relapsed Small Cell Lung Cancer (SCLC)

Summary

Sixteen patients with advanced small cell lung cancer who relapsed or progressed under first-line therapy, were treated with second-line chemotherapy consisting of: teniposide, 60 mg/m², i.v. days 1-5, every 3 weeks until further progression.

The response rate was: 3 minor responses, 6 stable disease, 5 progressive disease, 1 early death and 1 not evaluable. After the introduction of teniposide, median survival was 4.5 (range 1-11) months, compared to the median survival (2 months, range 1-11) observed in 40 contemporary patients of our series, who relapsed or progressed and subsequently received no treatment. The assessment of the difference was significant: chi-square = 4.05, P<0.05. In addition a particular comparison was performed with 15/40 patients who matched according to the major predictive parameters of disease. These patients experienced 2 months (range 1-7) of median survival which was significantly shorter than that of the teniposide treated group (chi-square = 4.48, P< 0.05). On these bases, teniposide appeared to be effective, but the small size of the study suggests caution in evaluating the results.     

国产多西他赛治疗乳腺癌和非小细胞肺癌的临床观察

目的:评价国产多西他赛(深圳万乐医药公司产品)单药以及多西他赛 顺铂联合化疗方案对乳腺癌和非小细胞肺癌的临床疗效和安全性,并以进口多西他赛(安万特公司) 顺铂联合化疗方案作对照.方法:1)单药治疗分为2组:多西他赛(万乐)75mg/m2第1天静脉滴注,21天为一周期,治疗乳腺癌(A组)和非小细胞肺癌(B组);2)联合治疗分为4组:乳腺癌患者随机分为多西他赛(万乐)70mg/m2 顺铂80mg/m2(C组),或泰索帝(进口)70mg/m2 顺铂80mg/m2(D组),21天为一周期;肺癌患者随机分为多西他赛(万乐) 顺铂(E组)或泰索帝(进口) 顺铂(F组),方案与乳腺癌相同.结果:147例患者中138例可评价疗效,141例可评价不良反应,单药有效率乳腺癌(A组)21.7%,单药非小细胞肺癌(B组)6.1%,联合治疗组有效率C组60.0%,D组35.0%,E组23.8%,F组28.6%.不良反应主要为骨髓抑制、恶心呕吐、脱发.联合治疗方案多西他赛(万乐)组与泰索帝(安万特)组比较,疗效和不良反应相似.结论:多西他赛(万乐)单药及联合顺铂方案治疗乳腺癌和非小细胞肺癌安全有效,耐受性好,与进口泰索帝疗效和不良反应相似.