肝癌导向治疗的临床研究(1980～1999年临床研究总结)

目的　探讨核素 (或药物 ) 抗AFP抗体、1 31 I或 (1 2 5I) 抗AFP(AFP .McAb或AFPAb) MMC“双弹头”、1 2 5I LUF标记物治疗原发性肝癌病人的治疗效果及毒副反应。方法　 1 用改良氯胺T法将纯化AFP抗体标记核素1 31 I或1 2 5I获得标记物1 31 I(或1 2 5) 抗AFP抗体 ;用改良氨胺T法和过碘酸钠氧化法标记核素1 31 I或1 2 5I与MMC制备“双弹头” :1 31 I 抗AFP单抗 (AFP .McAb) MMC(称双弹头I)和1 31 I(或1 2 5I) 抗AFP多抗 (AFPAb) MMC(称双弹头Ⅱ ) ;催化置换反应制备1 2 5I 超液化碘油 (1 2 5I LUF) ;2 治疗后行肿瘤放射免疫定位显像 ;3 治疗 :1 94例进入临床试验 :1 31 I 抗AFP(n =72 ) ,1 2 5I 抗AFP(n =2 2 ) ,抗癌药 抗AFP(n =2 1 ) ,1 31 I或1 2 5I 抗AFP MMC(n =41 ) ,1 2 5I LUF(n =38)。结果　 1 治疗后病人瘤 /肝 (T/L)比值 ,以1 2 5I LUF(3 46) >双弹头 (2 2 6) >单一弹头 (1 5～ 2 5) ,T/L以ia途径 >iv ;2 早期研究的病例晚期者居多 ,1 31 I 抗AFP、1 2 5I 抗AFP和双弹头Ⅰ、Ⅱ治后 1年存率分别为 33 3 % (2 2 / 66)、47 1 % (8/ 1 7)和 58 5 % (2 4 / 4 1 ) ,以抗癌药 抗AFP最低 (1 9 0 % ) ,而1 2 5I LUF则高达 81 6 % (31 / 38) ,其中 1 8例加外照射者为 1 0 0 % (1 8/ 1 8)

Clinical study on targeting therapy of liver cancer(Clinical Study from 1980 to 1999)

Objective To study the therapeutic effects and side effect of nuclide 131 I or 125 I,anti AFP antibody(AFP Ab),MMC and 125 I lipiodol ultra fluide(LUF)used as targeting therapy for primary liver cancer (PLC). Methods AFP Ab was used as targeting carrier, and the nuclide 131 I and 125 I and the anticancer drug MMC as the warheads. The PLC patients were divided into:Group A, 72 cases received 131 I AFP Ab;Group B, 22 cases received 125 I AFP Ab:Group C, 21 cases received AFP Ab MMC;Group D, 41 cases, received 131 I (or 125 I )AFP Ab MMC;and Group E, 38 cases received 125 I LUF.Results 1 A clear image of tumor were shown in SPECT scanning.After injection of drugs, the tumor/liver (T/L) radioactivity ratio in Group E was 3.46,in Group D 2.66 , and in Group B 1.86. 2 The 1 year survival rate in Group E was 81.6%, the highest, followed by Group D 58.5%,Group B 47.1%,Group A 33.3%, and Group C 19.0%. 3 In Group E, 18 cases received additional external radiation and the 1 year rate reached 100%. 4. After targeting therapy, the tumors of 9 cases withered enough and were resected, 8 of them survived for 3 years (88.9%). Conclusion 1 This kind of targeting therapy is effective in killing massive liver cancer cells. 2 The efficacy is concerned with the synergy of antibody, nuclide in ternal radiation and anticancer drug. 3. The internal radiation of 125 I LUF plus external radiation may give some improving effect for late liver cancer cases.