替莫唑胺治疗恶性脑胶质瘤97例多中心随机对照研究

目的 评价国产替莫唑胺(TMZ)胶囊治疗恶性脑胶质瘤的临床疗效和安全性.方法 采用多中心、随机、双盲、阳性药平行对照研究,将恶性脑胶质瘤患者随机分为试验组(TMZ组)和环已亚硝脲对照组(CCNU)组.试验组于第1～5天给予TMZ胶囊150 mg/m2口服,第1天需同时口服CCNU安慰剂130 mg/m2;对照组于第1天口服CCNU胶囊130 mg/m2,第1～5天口服TMZ安慰剂150 mg/m2.两组均每28天为1个周期,连续治疗3个周期.结果 共入组97例,可评价疗效者86例:TMZ组42例,CCNU组44例.治疗12周后,TMZ组:完全缓解(CR)1例,部分缓解(PR)14例,稳定(SD)23例,进展(PD)4例;CCNU组:CR 3例,PR 1例,SD 29例,PD 11例.TMZ组和CCNU组的有效率(CR+PR)分别为35.71%和9.09%(P<0.01),临床受益率(CR+PR+SD)分别为90.48%和75.00%(P<0.05).TMZ常见的不良反应为恶心呕吐,多为轻、中度.结论 国产TMZ胶囊治疗恶性脑胶质瘤的疗效优于CCNU,耐受性良好,是一种安全有效的治疗恶性脑胶质瘤的化疗药.

A multicenter randomized controlled study of temozolomide in 97 patients with malignant brain glioma

Objective To investigate the efficacy and safety of temozolomide (TMZ) and lomustine (CCNU) in malignant brain gliomas. Methods In this multicenter, randomized, double-blind, positive-controlled study, patients with malignant glioma of a histological grade Ⅲ/Ⅳ were randomly divided into two groups. In experiment group, TMZ capsule 150 mg/m2 was given orally on days 1 through 5 and CCNU placebo 130 mg/m2 while on day 1. In control group, CCNU capsule 130 mg/m2 was taken orally on day 1 and TMZ placebo 150 mg/m2 while on days 1 through 5. In both groups drugs were given on the first 5 days of 28 day therapeutic course. Every patient was administered at least 3 cycles continuously. Results 97 patients were enrolled in the clinical trial , 86 cases of which were evaluable for efficacy. The basic conditions of patients in both groups were comparable. After 12 weeks, the response rates in TMZ and CCNU group were 35.71% and 9.09% (P<0.01) respectively, and the clinical benefit rates in TMZ and CCNU group were 90.48% and 75.00% (P<0.05)respectively. No obvious improvement was showed in quality of life and neural symptoms in both groups. The common side effects of TMZ were nausea and vomiting with grade Ⅰ/Ⅱ. Condusion TMZ capsule can produce higher efficacy than CCNU in the treatment for refractory malignant brain glioma patients with an acceptable safety profile, indicating that TMZ could be an ideal chemotherapy selection for malignant brain glioma.