Temozolomide in combination with fotemustine in patients with metastatic melanoma

Purpose  Temozolomide and fotemustine are both active drugs for treating metastatic melanoma. The present study was designed to assess the efficacy and safety of combination therapy with temozolomide + fotemustine in patients with metastatic melanoma. Methods  Forty patients (median age 50.5 and 22 males) with pathologically confirmed, unresectable, AJCO stage IV melanoma were enrolled into the study. The primary endpoints were tumor response and safety. Patients received oral temozolomide 125 mg/m² on days 1–7 and intravenous fotemustine 80 mg/m² on day 3 every 3 weeks. Results  Fourteen (35%) patients achieved an objective response, including 3 (7.5%) complete and 11 (27.5%) partial responses. Median overall survival time was 6.7 months and 6-month survival rate was 57.4%. Myelosupression, particularly thrombocytopenia, was the primary toxicity. Conclusion  The regimen, temozolomide combined with fotemustine, is an active and moderately safe first-line chemotherapy regimen with acceptable and easily manageable toxicities in patients with metastatic melanoma.     

替莫唑胺联合放射治疗复发性恶性脑胶质瘤的临床疗效

目的探讨替莫唑胺联合放射治疗复发性恶性脑胶质瘤的临床疗效。方法选取52例复发性恶性脑胶质瘤患者为研究对象,随机将患者分为对照组和实验组,每组26例,给予对照组患者三维适形放射治疗,实验组在对照组的基础上给予口服150 mg/(m^2·d)替莫唑胺治疗,分析比较2组患者的临床疗效及不良反应,并对2组患者进行为期1年的随访,记录患者生存状态。结果实验组患者临床治疗有效率为73.08%,明显高于对照组的46.15%(P<0.05)。治疗后实验组患者的卡氏评分及生活质量改善率明显高于对照组(P<0.05)。2组临床均未见治疗性死亡患者,主要临床不良反应表现为中轻度白细胞计数减少、放射性脑水肿、恶心呕吐、发热、骨髓抑制及贫血等症状(P>0.05)。实验组患者1年随访生存率为92.31%,明显高于对照组的84.62%;复发率(3.85%)明显低于对照组的15.38%(P<0.05)。结论替莫唑胺联合放射治疗是复发性恶性脑胶质瘤较为理想的治疗方式,对于改善患者生活质量、提高患者生存率有积极作用,值得临床推广应用。     

脑神经胶质瘤替莫唑胺耐药 circRNA-miRNA-mRNA调控网络的构建

目的 筛选脑神经胶质瘤替莫唑胺耐药细胞株U87/TR与亲本细胞株U87的环状RNA(circRNA)差异表达谱以及构建关键环状RNA(circRNA)-微小RNA(miRNA)-信使RNA(mRNA)调控网络.方法 2020年1—6月,应用circRNAs芯片检测神经胶质瘤替莫唑胺耐药细胞circRNAs差异表达谱,并进行RT-PCR验证.用miRanda数据库预测circRNA-miRNA靶向结合关系,通过miRanda v5、TargetScan、miBase数据库预测靶基因,Cytoscape软件构建circRNA-miRNA-mRNA调控网络.结果 circRNA芯片结果显示,与U87细胞比较,U87/TR细胞有313个差异有统计学意义表达的circRNAs(P<0.05),其中145个显著上调,168个明显下调;RT-qPCR验证结果与芯片结果相符.miRNA靶位点预测结果显示,关键上调人环状RNAhsa_circRNA_009054,hsa_circRNA_104338(n=3,t=12.09、9.52,P=0.007、0.011)以及下调hsa_circRNA_016459,hsa_circRNA_101975(n=3,t=13.86、7.75,P=0.005、0.016)可与hsa-miR-33a-5p,hsa-miR-15b-3p以及hsa-miR-193b-5p,hsa-miR-23a-5p等多个miRNAs靶向结合,关键circRNA-miRNA-mRNA调控网络包括4个关键circRNAs,20个关键miRNAs,以及278个关键mRNAs.结论 cir?cRNA在脑神经胶质瘤替莫唑胺耐药细胞中异常表达,hsa_circRNA_009054,hsa_circRNA_104338以及hsa_circRNA_016459,hsa_circRNA_101975等关键circRNA可能通过circRNA-miRNA-mRNA调控网络参与脑神经胶质瘤替莫唑胺的耐药过程.     

Leptomeningeal carcinomatosis from gastric cancer successfully treated by the intrathecal methotrexate plus temozolomide and simultaneous radiotherapy: Case report and literatures review

Leptomeningeal carcinomatosis (LMC) from gastrointestinal cancer is rare. A 56-year-old man with complaint of upper abdominal pain exhibited adenocarcinoma upon histopathologic examination of biopsy specimens. At the end of adjuvant chemotherapy, the patient was affected by hearing loss. Malignant cells were observed by cerebrospinal fluid (CSF) cytology. Therefore, the patient received intrathecal methotrexate and oral temozolomide chemotherapy and radiotherapy. The progress-free survival was approximately 11 months. To our knowledge, such cases of LMC from gastric cancer are very rare. Here, we describe the case of a patient with LMC from gastric cancer and review the literature associated with treatment. We hope that the present report may be helpful when considering how to improve treatment of LMC in gastric cancer patients and offer some tips for the adjuvant treatment modality.     

重组腺病毒p53上调凋亡调控因子增强胶质瘤细胞对替莫唑胺敏感性的体内研究

 目的　通过体内实验探讨外源性p53上调凋亡调控因子（PUMA）对人类脑胶质瘤细胞生长的影响及其增强胶质瘤细胞对替莫唑胺（TMZ）敏感性的机制。方法　建立人类脑胶质瘤细胞株U87MG裸鼠皮下移植瘤模型,将胶质瘤裸鼠用随机区组法随机分为四组,于建模2周后,分别自腹腔注射0.9 % NaCl溶液100 μl（对照组）、2×108 pfu／100 μl Ad-PUMA（PUMA组）、TMZ 10 mg／kg（TMZ组）和2×108 pfu／100 μl Ad-PUMA + TMZ 10 mg／kg （联合组）,每组8只。治疗20 d后处死裸鼠,剖腹测量原位肿瘤体积、抑瘤率。TUNEL检测肿瘤细胞凋亡情况及计算凋亡指数（AI）。半定量RT-PCR和Western blot法检测DNA损伤修复蛋白6-氧-甲基鸟嘌呤DNA甲基转移酶（MGMT）mRNA和MGMT蛋白表达情况。结果　治疗20 d时对照组、PUMA组、TMZ组、联合组诱发肿瘤瘤体积分别为（3.68±0.09）、（2.63±0.13）、（2.13±0.07）、（0.97±0.02）cm3,四组体积进行两两比较差异有统计学意义（P均<0.05）。治疗组抑瘤率分别为28.5 %、42.1 %、73.6 %,两两比较差异有统计学意义（P均＜0.05）。TUNEL染色并计算AI：对照组（2.0±1.2）%、Ad-PUMA组（11.4±2.6） %、TMZ组（7.6±3.2）%、联合组（20.6±8.6）%,进行两两比较差异有统计学意义（P均< 0.05）。半定量RT-PCR和Western blot法检测显示MGMT mRNA和MGMT蛋白在TMZ组中表达最高,与其他三组比较差异有统计学意义（P均＜0.05）。结论　Ad-PUMA联合TMZ具有协同抑制胶质瘤生长作用,其机制可能与Ad-PUMA促进凋亡和抑制MGMT表达有关。     

放化疗同步与单纯放疗治疗胶质母细胞瘤的疗效比较

目的 比较单纯放疗(RT)与放疗加替莫唑胺(RT-TMZ)治疗胶质母细胞瘤的局控率、生存率及不良反应.方法 对60例首次术后的胶质母细胞瘤随机分为接受单纯放疗、放疗加每天持续的替莫唑胺治疗以及6个周期的替莫唑胺辅助治疗.每组30例.主要研究目标为整体生存率.结果 RT-TMZ组与RT组总有效率分别为53.3%和26.6%;1年累计局部复发率分别为63.3%和90.0%,1年无复发生存率分别为36.7%和10.0%,1年生存率分别为56.7%和16.7%(P<0.05).RT-TMZ组常见不良反应是恶心,呕吐,白细胞和血小板下降,但仅限于Ⅰ～Ⅱ度.结论 在提高局控率、延缓肿瘤复发与提高患者无瘤生存期方面RT-TMZ组要优于RT组,而不良反应方面两组反应均较轻微.     

Temozolomide in malignant gliomas: current use and future targets

Temozolomide (TMZ) is an oral alkylating agent that is regarded as a tolerable and effective drug. When combined with radiotherapy in patients with newly diagnosed glioblastoma, survival is significantly prolonged. This finding has led to widespread use of TMZ for patients with this disease. We summarize developing concerns regarding the use of TMZ, imaging of malignant gliomas, and the pharmacology of TMZ—mechanism of action, scheduling and strategies for overcoming resistance.     

Chemotherapy in the treatment of recurrent glioblastoma multiforme: ifosfamide versus temozolomide

Purpose: Despite the progress made in neurosurgery and radiotherapy, the prognosis of glioblastoma multiforme (GB) is poor, due to the lack of an effective salvage therapy. In vitro analysis revealed activity for ifosfamide and temozolomide. The usefulness of these agents in recurrent disease was investigated. Methods: Six adult patients with recurrent GB received one to four courses of 1,500 mg/m² ifosfamide given over 5 days intravenously. Furthermore, temozolomide (100–200 mg/m²) was given orally over 5 days to 14 patients. Results: After ifosfamide treatment, one partial response and two cases of stable disease were observed. The median survival time was 24 weeks (range of 9–52 weeks). Toxicity analysis revealed one paranoid reaction, three grade III leukocytopenia, and one grade I–II nausea, anemia, and hematuria. Temozolomide therapy resulted in three partial responses and four cases of stable disease. The median survival time (Kaplan-Meier) was 21 weeks (range 4–64 weeks). The major toxicities were grade I–II nausea and hematological side effects (one case of grade IV leuko- and thrombocytopenia). Conclusions: Ifosfamide treatment might be a feasible approach, but it necessitates hospitalization. Temozolomide showed promising results. Due to its oral application, the patient's quality of life (time out of hospital) is favorable. Subgroups with improved survival were observed. Received: 7 December 1998 / Accepted: 21 January 1999     

长周期替莫唑胺治疗脑胶质瘤:附32例报告

背景与目的 :替莫唑胺(temozolomide,TMZ)国内外多推荐为胶质瘤的一线化疗药物,化疗周期通常为六周期。长周期(超过六周期)TMZ治疗胶质瘤国外已有多篇文献报道,但中国脑胶质瘤患者这方面信息较少。本文总结我们近年来长周期TMZ治疗32例胶质瘤的临床经验,重点探讨其安全性。方法:32例高级别胶质瘤(high-grade gliomas,HGGs)或低级别胶质瘤(low-grade gliomas,LGGs)采用了TMZ长周期治疗。TMZ化疗方案的选择基于肿瘤组织DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)的免疫组化检测结果,用甲基化特异PCR(MSP-PCR)检测了其中6例的MGMT启动子甲基化程度。MGMT阴性表达(±或-)者接受TMZ标准化疗(200mg/(m2.d),d1-5,四周方案),MGMT阳性表达(+或++)者接受TMZ剂量密度方案[75mg/(m2.d),d1-21,4周方案],或顺铂(cisplatin,DDP)联合TMZ化疗方案[DDP 75mg/(m2.d),d1-2;TMZ 200mg/(m2.d),d2-6,四周方案]。结果:32例患者共接受318周期TMZ方案化疗。患者化疗周期数为7~24(中位周期数为9.4)。最常见的严重毒性反应是Ⅲ度淋巴细胞减少症与白细胞减少症,发生率均为9.4%(3/32)。最常见的轻至中度毒性反应依次为疲乏(86.9%)、中性粒细胞减少症(46.9%)、脱发(46.9%)、血小板减少症(40.6%)、便秘(41.2%)及淋巴细胞减少症(25.0%)等。中位无进展生存(progress free survival,PFS)为28.6月。6月PFS、12月PFS分别为100%与71%。32例患者中,15例肿瘤完全切除,至今无病生存。依据意向性治疗原则(intention-to-treatprinciple,ITT),1例(3.1%)取得完全缓解(complete response,CR),14例(43.8%)微效(minor response,MR),2例(6.2%)稳定(stable disease,SD)。总反应率(overall response rate,ORR)为81.5%(95%CI,50%~96%),疾病控制率(disease control rate,DCR)为89.2%(95%CI,64%~98%)。结论:长周期TMZ化疗治疗胶质瘤是安全的。长周期TMZ化疗具有较高的反应率(ORR)与无进展生存(PFS)。