替莫唑胺治疗国人恶性脑胶质瘤:31例临床疗效分析

目的:评价新药替莫唑胺(temozolomide,TMZ)治疗国人恶性脑胶质瘤的近期疗效和不良反应。方法:经手术后病理确诊的恶性脑胶质瘤病人31例,用含TMZ的方案化学疗法(化疗),通过免疫组织化学方法检测病人肿瘤组织MGMT蛋白表达,分析阳性表达组和非阳性表达组的疗效。结果:31例病人总的客观有效率为25％,疾病控制率为61％。其中14例间变性星型细胞瘤(AA)病人客观有效率和疾病控制率分别为36％和71％。12例多形性胶质母细胞瘤(GBM)病人客观有效率和疾病控制率分别为8％和42％。2组的客观有效率及疾病控制率无统计学差异(P>0.05)。MGMT阳性表达组和非阳性表达组的客观有效率(16％和42％)和疾病控制率(53％和75％)无统计学差异(P>0.05)。含TMZ化疗较常见的不良反应是I-Ⅱ级中性粒细胞减少(27％)、恶心和(或)呕吐(12％)及肝功能损伤(12％)。Ⅲ级不良反应为腹痛(1％)和疲劳(4％)。结论:含新药TMZ化疗方案对中国人恶性脑胶质瘤有较好的近期疗效,和国外文献报道疗效相似,没有明显人种差异,不良反应大多为轻到中度,耐受性好。

Effects of temozolomide capsules in treatment of 31 Chinese patients with malignant gliomas

AIM:To evaluate the short term efficacy and adverse reactions of temozolomide(TMZ)in the treatment of Chinese patients with malignant gliomas.METHODS:Thirty-one patients with surgico-pathologic confirmed malignant gliomas were enrolled in this srudy.After chemotherapy with TMZ,MGMT protein expres- sion of the resected glioma specimen were tested by immunohistochemistry for further evaluation of the efficacies in positive and negative groups.RESULTS:The overall objective response rate was 26 % and disease control rate was 61%.The objective response rates and disease control rates for anaplastic astrocytoma(AA)and glioblastoma muhiforme(GBM)were 36% vs 71%,and 8% vs 42%,respectively.Statistical difference wasn't demonstrated in AA and GBM patient(P>0.05).The objective response rates and disease control rates were 16% vs 53% in MGMT expression positive group,and 42% vs 75% in MGMT expression negative group,showing no significance statistical difference(P>0.05).The main adverse reactions included grade I-II changes of neutropenia(27%),nausea/vomiting(12%)and liver function impairments(12%).Grade III adverse reactions consisted of 1% abdominal pain and 4% fatigue.CONCLUSION:Temozolomide is a safe and rather good short term effective drug in the treatment of Chinese patients with malignant gliomas,with similar efficacy to those on published literatures,no conspicuous racial discrepancy,only mild to moderate adverse re- actions and good tolerance.