替尼泊苷与尼莫司汀联合方案治疗肺癌脑转移瘤近期疗效分析

背景与目的：脑转移瘤的原发肿瘤以肺癌最为常见，肺癌脑转移瘤患者治疗效果并不理想。本研究应用替尼泊苷（VM-26）和尼莫司汀（ACNU）联合方案治疗肺癌脑转移瘤患者，观察其对肺癌脑转移瘤的临床治疗效果，评价其不良反应。方法：2006年12月至2008年5月，中国抗痛协会神经肿瘤专业委员会组织全国15家单位对经手术或病理活检确诊的肺癌脑转移瘤患者，应用VM-26与ACNU联合方案化疗，观察近期疗效。化疗方案为VM-26，每天80～100mg／m^2，d1-3；6-8周重复一次；ACNU，2-3mg／kg，d1，6-8周重复一次。结果：278例患者资料完整、可行近期疗效评价，上述病例共行897周期化疗，平均3．2个周期。全组无完全缓解（complete response，CR）病例，77例（27．7％）部分缓解（partial response，PR），139例（50％）稳定（stable disease，SD），62例（22.3％）进展（progressive disease，PD）。客观有效率（CR＋PR）为27．7％，疾病控制率（CR＋PR＋SD）为77．7％。化疗的主要剂量限制性毒性为骨髓抑制，Ⅲ、Ⅳ度中性粒细胞减少症发生率分别为23．1％（207／897）；20.1％（180／897），Ⅲ、Ⅳ级血小板减少症发生率分别为19．6％（176／897）、14．5％（130／897）。按既往是否接受化疗，患者可分为既往接受化疗组、未接受化疗组，前者较之后者，Ⅳ度中性粒细胞减少症、Ⅳ度血小板减少症、Ⅲ及Ⅳ度中性粒细胞减少症、Ⅲ度及Ⅳ度血小板减少症发生率均明显升高（P均〈0．05）。结论：VM-26与ACNU联合方案主要毒性为Ⅲ、Ⅳ度骨髓抑制，在既往行化疗患者发生率较高，但可控制。该方案治疗肺癌脑转移瘤，客观有效率与其它常用方案相似、疾病控制率较高。

Teniposide and Nimustine Regimen for Brain Metastases from Neoplasm of Lung

BACKGROUND ＆ OBJECTIVE： Currently, brain metastases can not be satisfiedly controlled, and they mainly originate from neoplasm of lung cancer. This carried program was to elucidate the efficiency and side effects of teniposide （VM-26） and nimustine （ACNU） regimen for brain metastases from lung cancer. METHODS：Three hundred and six patients with brain metastases from lung cancer were enrolled in this study. The chemotherapeutic regimen consisted of ACNU 2-3 mg/kg administered once and VM-26 300mg/m^2,which was divided for 1-3 days intravenous administration with every 6-8 weeks a cycle. The clinical effect was evaluated according to RECIST（Response Evaluation Criteria in Solid Tumours） standard,and side-effects were assessed according to NCI （National Cancer Institute） standard. RESULTS： Two hundred and seventy eight patients and 897 cycles were included for evaluation. No complete response （CR） was achieved. And 77 （27.7%）, 139（50%）and 62 （22.3%） patients were PR （partial response）, SD （stable dlsease）,and PD （progressive disease）, respectively. Meanwhile, objective response rate （CR＋PR） was 27.7%, and clinical benefit rate （CR＋PR＋ SD） was 77.7%. The major toxicity of the regimen was myelotoxicity.The incidences of grade Ⅲ and Ⅳ leukopenia were 23.1%（207 / 897）and 20.1% （180 / 897）, and those of grade Ⅲ and Ⅳ plateletpenia were 19.6%（176 / 897）and 14.5% （130 / 897）. The incidences of grade Ⅳ leukopenia, grade Ⅳ plateletpenia, grade Ⅲ and Ⅳ leukopenia, and grade Ⅲ and Ⅳ plateletpenia in patients previously treated with chemotherapy were signicificantly higher than those without previously chemotherapy（P 〈0.05）. CONCLUSION：VM-26 and ACNU regimen for brain metastases from lung cancer is beneficial with acceptable side effects.