重组人血管内皮抑制素和参一胶囊联合化疗药物治疗胚胎性横纹肌肉瘤

目的：观察和探索抗肿瘤血管生成药与化疗联合治疗胚胎性横纹肌肉瘤（ＥＲＳ）的可行性和模式。方法：２例难治性ＥＲＳ，采用重组人血管内皮细胞抑制素（恩度）和参一胶囊与常规化疗药物联合治疗，恩度１５ｍｇｄ１～ｄ１４，ｑ３ｗ；参一胶囊２０ｍｇ，ｂｉｄ，连续服用。病例１的化疗采用改良ＡＤ方案（表阿霉素６０ｍｇｄ１，氮烯咪胺２００ｍｇｄ１～ｄ５，ｑ３ｗ）；病例２为ＴＰ方案（紫杉醇１２０ｍｇｄ１、ｄ８，顺铂２０ｍｇｄ２～ｄ６，ｑ３ｗ）。按照ＲＥＣＩＳＴ标准进行疗效评价，按ＮＣＩＣＴＣ（３.０版）评价毒性。结果：例１获得ＣＲ，现已维持ＣＲ６个月，生活正常。例２获得ＰＲ，维持缓解２个月，后因手术，伤口迁延不愈，停用恩度和参一胶囊，病情迅速进展，总生存期１.５年。均未出现３～４级毒性反应。结论：初步提示恩度和参一胶囊联合化疗药物治疗难治性ＥＲＳ有效，可能是一种新的治疗选择和策略。抗肿瘤血管生成药物宜连续、不间断地应用，必要时可以联合不同的药品或剂型，有助于维持抗血管作用和增加疗效。

Treatment of refractory embryonal rhabdomyosarcoma using endostar and Shenyi capsule combined with chemotherapy

To observe and explore the feasibility and modality of anti-angiogenic agents combined with chemotherapy for the refractory embryonal rhabdomyosarcoma （ ERS ）. Methods： Two cases refractory ERS were treated with rh-endostatin （ endostar, 15mg ivgtt, qd, d1 -d14, q3w） and Shenyi capsule（20mg po. bid continuously） combined with routine chemotherapy. Endostar was administrated intravenously with 15mg every, day on days 1-14 and Shenyi capsule given orally with 20mg twice a day continuously. For chemotherapy, case 1 was combined with modified AD regimen （E-ADM 60mg iv d1 ,DTIC 200rag iv gtt. d1 -d5 , q3w）and case 2 was combined with TP regimen（Taxol 120mg iv gtt. d1 ,d8, PDD 20mg iv gtt. d2-d6, q3w） subsequently. The tumor response was evaluated according RECIST criteria and the toxicities according to NCI CTC （V3.0）. Results： Case 1 has received CR lasting for 6 months till now and quality of life （QOL） improved markedly. Case 2 has received PR （lasting 2 months）. But endostar and Shenyi capsule were discontinued due to the wound healing delayed by palliative operation in case 2. Thus the tumor progressed rapidly with the overall survival of 1.5 years. Conclusion：Endostar plus Shenyi capsule is a new feasible therapeutic selection and strategy, for refractory ERS. Meanwhile, the anti-angiogenesis drugs should be continuously administrated, and the combination of he different drugs was reasonable for maintaining and increasing the efficacy, such as endostar plus Shenyi capsule.