白蛋白结合型紫杉醇联合铂类或异环磷酰胺治疗复发性卵巢癌的疗效及安全性分析

目的:观察白蛋白结合型紫杉醇联合铂类或异环磷酰胺治疗复发性卵巢癌的临床疗效及毒副反应。方法:回顾分析我院46例复发性卵巢癌患者接受含不同制剂紫杉醇的联合化疗的疗效及安全性。26例铂敏感复发患者分别采用白蛋白结合型紫杉醇或溶剂型紫杉醇联合铂类化疗,20例铂耐药复发患者采用白蛋白结合型紫杉醇或溶剂型紫杉醇联合异环磷酰胺方案,每21天为1疗程,直至完全缓解后再巩固2个疗程或疾病进展或出现不可耐受的不良反应。比较患者间临床效果、毒副作用及预后差异。结果:铂敏感复发患者中,白蛋白结合型紫杉醇组的完全缓解率显著高于溶剂型紫杉醇组(60%vs 18.8%,P0.05);两组的客观缓解率分别为90%、75%。铂耐药复发患者中,白蛋白结合型紫杉醇组的完全缓解率显著高于溶剂型紫杉醇组(16.7%vs 0%,P0.05);两组的客观缓解率分别为66.7%、57.1%。铂敏感复发患者中,白蛋白结合型紫杉醇组及溶剂型紫杉醇组的中位无进展生存时间(PFS)分别为10.25、7.5个月(P0.05);铂耐药复发患者中白蛋白结合型紫杉醇组及溶剂型紫杉醇组的中位PFS分别为7.8、5.6个月(P0.05)。4组患者的不良反应主要表现为骨髓抑制和胃肠道反应,铂敏感、铂耐药患者中白蛋白结合型紫杉醇组及溶剂型紫杉醇组各种严重不良反应的发生率均无显著差异。结论:与溶剂型紫杉醇比较,含有白蛋白结合型紫杉醇的联合化疗方案治疗铂敏感或铂耐药复发性卵巢癌均有更高的完全缓解率,可有效延长PFS,且不额外增加严重毒副反应的发生率。

Efficacy and safety of albumin-bound paclitaxel combined with platinum or ifosfamide in the treatment of recurrent ovarian cancer

Objective:To observe the clinical efficacy and safety of albumin-bound paclitaxel combined with platinum or ifosfamide in the treatment of recurrent ovarian cancer.Methods:46 cases of recurrent ovarian cancer patients received different formulations of paclitaxel combined with platinum or ifosfamide were analyzed retrospectively.26 platinum-sensitive patients with recurrent ovarian cancer were treated with either albumin-bound paclitaxel or solvent-based paclitaxel combined with carboplatin.20 platinum-resistant patients with recurrent ovarian cancer were treated with albumin-bound paclitaxel or solvent-based paclitaxel combined with ifosfamide,every 21 days a cycle,until complete remission and consolidation for another two courses or disease progression or intolerable adverse reactions.The clinical effects,side effects and prognosis of four groups were compared.Results:In platinum-sensitive patients,the complete remission rate was 60% in albumin-bound paclitaxel-treated patients and 18.8% in solvent-based paclitaxel-treated patients (P<0.05).The objective response rates were 90% and 75%,respectively.In platinum-resistant patients,the complete remission rate was 16.7% in albumin-bound paclitaxel group and 0% in solvent-based paclitaxel group (P<0.05).The objective response rates were 66.7% and 57.1% respectively.In platinum-sensitive relapsed patients,the median progression-free survival (PFS) of albumin-bound paclitaxel and solvent-paclitaxel groups were 10.25 and 7.5 months respectively (P<0.05).In platinum-resistant relapsed patients,the PFS of albumin-bound paclitaxel and solvent-based paclitaxel groups were 7.8 and 5.6 months respectively (P<0.05).The main adverse effects of the four groups are bone marrow suppression and gastrointestinal reaction.In platinum-sensitive or platinum-resistant patients,there were no significant differences in the incidence of Ⅲ~Ⅳ grade adverse reactions between albumin-bound paclitaxel and solvent-based paclitaxel groups (P>0.05).Conclusion:Compared with solvent-based paclitaxel,albumin-bound paclitaxel based chemotherapy regime has a higher complete remission rate,prolonger PFS and no more toxicity in platinum-sensitive or platinum-resistant recurrent ovarian cancer patients.