阿帕替尼治疗晚期肺癌的临床疗效观察
发布时间：2018-10-13 07:13
【摘要】：背景与目的肺癌是恶性程度极高的肿瘤,居男性癌症死亡率第一位,在女性癌症中死亡率仅次于乳腺癌,居第二位。最新数据显示,在过去一年中我国肺癌新发病例73万,死亡病例61万,分别占全部恶性肿瘤的17.1%和21.7%,且大多数患者确诊时已属晚期,一半以上在1年内死亡,5年生存率不足18%。目前治疗肺癌的常用方法有手术、化疗、放疗及免疫治疗,这些治疗手段仅能在一定程度上缓解病情,当肿瘤复发或转移后往往没有特效的药物治疗。吉非替尼、厄洛替尼以及克唑替尼是肺癌常用的靶向治疗药物,但它们只能局限于基因突变阳性的患者,并不能够在临床上广泛应用。阿帕替尼是一种小分子的血管内皮生长因子受体酪氨酸激酶抑制剂,能够抑制肿瘤新生血管的生成。在关于胃癌的各期临床试验中均显示出了抗肿瘤效果,m PFS和m OS分别达3.67个月、4.83个月之久。有鉴于此,中国FDA于2014年10月批准阿帕替尼上市,用于二线或二线以上治疗失败的晚期胃腺癌及胃-食管结合部腺癌的治疗。目前关于阿帕替尼的研究主要集中于胃癌,在肺癌、乳腺癌、胆管癌及结直肠癌中的研究较少。本研究旨在探讨阿帕替尼用于晚期肺癌的临床疗效及安全性,并探讨预后的影响因素。收集2015年1月~2017年3月郑州大学第一附属医院诊治的经病理组织学或细胞学证实,接受过二线或二线以上治疗,且病情进展的IIIA~IV期肺癌患者39例。给予阿帕替尼425mg/d,28天为一个治疗周期,直至病情进展或出现无法耐受的不良反应。观察临床治疗效果及不良反应发生情况。资料统计学方法采用SPSS 17.0软件对数据进行分析,应用Kaplan-Meier法进行生存分析,应用Log-Rank时序检验进行单因素分析筛选出影响预后的因素,应用Cox回归模型对多因素进行分析确认独立影响因素。P0.05为差异有统计学意义。结果1.生存情况:共入组39例晚期肺癌患者,中位年龄62岁(33~75岁),均可进行数据分析。中位无进展生存期为3.5个月,中位总生存期为5.1个月。完全缓解(CR)占0%,部分缓解(PR)占2.6%,疾病稳定(SD)占58.9%,疾病进展(PD)占38.5%。总缓解率(ORR)和疾病控制率(DCR)分别为2.6%和61.5%。2.不良反应发生情况:主要有高血压(35.9%)、蛋白尿(25.6%)、手足综合征(25.6%)、腹泻(20.5%)以及骨髓抑制(38.5%),给予积极对症处理后均可获得缓解。3.单因素分析结果:组织分化程度、ECOG评分、服用阿帕替尼后不良反应发生程度均与患者的预后相关,其中高分化、ECOG评分0~1分、不良反应≤2级的患者预后较好。性别、年龄、病理类型、肿瘤大小等与预后无关。4.多因素分析结果:组织分化程度、ECOG评分、服用阿帕替尼后不良反应发生程度为阿帕替尼治疗晚期肺癌的独立影响因素。结论:阿帕替尼用于二线或二线以上治疗失败的晚期肺癌,仍具有一定的临床疗效,不良反应可控制。组织分化程度好,体能状况较佳且服药后不良反应轻微的患者预后更好。
[Abstract]:Background & objective Lung cancer is a malignant tumor with the highest mortality rate in males and the second highest mortality rate in females after breast cancer. The latest data show that in the past year, 730000 new cases of lung cancer and 610000 cases of death were found in China, accounting for 17.1% and 21.7of all malignant tumors, respectively. Most of the patients were diagnosed with advanced stage, more than half died within one year, and the 5-year survival rate was less than 18%. At present, the commonly used methods for the treatment of lung cancer are surgery, chemotherapy, radiotherapy and immunotherapy. These treatments can only alleviate the disease to a certain extent. When the tumor recurs or metastases, there is no special drug treatment. Gefitinib, erlotinib and czoltinib are common target drugs for lung cancer, but they can only be used in patients with positive gene mutation and can not be widely used in clinic. Apatinib is a small molecular inhibitor of vascular endothelial growth factor receptor tyrosine kinase, which can inhibit tumor angiogenesis. The antitumor effects of, m PFS and m OS were 3.67 months and 4.83 months, respectively. In view of this, the Chinese FDA approved the Apatinib listing in October 2014 for the treatment of advanced gastric adenocarcinoma and gastroesophageal adenocarcinoma with failure of second-line or second-line treatment. Current studies on apatinib focus on gastric cancer, but less on lung cancer, breast cancer, bile duct cancer, and colorectal cancer. The purpose of this study was to investigate the clinical efficacy and safety of apatinib in the treatment of advanced lung cancer and to explore the prognostic factors. From January 2015 to March 2017, 39 patients with IIIA~IV stage lung cancer who were diagnosed and treated in the first affiliated Hospital of Zhengzhou University were confirmed by histopathology or cytology. Apatinib 425 mg / d was given for 28 days as a treatment cycle until the disease progressed or an intolerable adverse reaction occurred. To observe the effect of clinical treatment and the occurrence of adverse reactions. Data were analyzed by SPSS 17.0 software, survival analysis by Kaplan-Meier method and univariate analysis by Log-Rank time series test. Cox regression model was used to analyze the multiple factors to confirm the independent factors. P0.05 as the difference was statistically significant. Result 1. Survival: a total of 39 patients with advanced lung cancer, median age 62 (3375 years), can be analyzed. The median progression-free survival was 3.5 months and the total median survival was 5.1 months. Complete remission (CR) accounted for 0%, partial remission (PR) accounted for 2.6%, disease stable (SD) accounted for 58.9%, disease progression (PD) accounted for 38.5%. Total remission rate (ORR) and disease control rate (DCR) were 2.6% and 61.5%, respectively. The main adverse reactions were hypertension (35.9%), proteinuria (25.6%), hand and foot syndrome (25.6%), diarrhea (20.5%) and bone marrow depression (38.5%). The results of univariate analysis showed that the degree of tissue differentiation, ECOG score and the degree of adverse reactions after taking apatinib were all related to the prognosis of the patients. The patients with high differentiation, ECOG score 0 ~ 1 and adverse reactions 鈮，
本文编号：2267747
[Abstract]:Background & objective Lung cancer is a malignant tumor with the highest mortality rate in males and the second highest mortality rate in females after breast cancer. The latest data show that in the past year, 730000 new cases of lung cancer and 610000 cases of death were found in China, accounting for 17.1% and 21.7of all malignant tumors, respectively. Most of the patients were diagnosed with advanced stage, more than half died within one year, and the 5-year survival rate was less than 18%. At present, the commonly used methods for the treatment of lung cancer are surgery, chemotherapy, radiotherapy and immunotherapy. These treatments can only alleviate the disease to a certain extent. When the tumor recurs or metastases, there is no special drug treatment. Gefitinib, erlotinib and czoltinib are common target drugs for lung cancer, but they can only be used in patients with positive gene mutation and can not be widely used in clinic. Apatinib is a small molecular inhibitor of vascular endothelial growth factor receptor tyrosine kinase, which can inhibit tumor angiogenesis. The antitumor effects of, m PFS and m OS were 3.67 months and 4.83 months, respectively. In view of this, the Chinese FDA approved the Apatinib listing in October 2014 for the treatment of advanced gastric adenocarcinoma and gastroesophageal adenocarcinoma with failure of second-line or second-line treatment. Current studies on apatinib focus on gastric cancer, but less on lung cancer, breast cancer, bile duct cancer, and colorectal cancer. The purpose of this study was to investigate the clinical efficacy and safety of apatinib in the treatment of advanced lung cancer and to explore the prognostic factors. From January 2015 to March 2017, 39 patients with IIIA~IV stage lung cancer who were diagnosed and treated in the first affiliated Hospital of Zhengzhou University were confirmed by histopathology or cytology. Apatinib 425 mg / d was given for 28 days as a treatment cycle until the disease progressed or an intolerable adverse reaction occurred. To observe the effect of clinical treatment and the occurrence of adverse reactions. Data were analyzed by SPSS 17.0 software, survival analysis by Kaplan-Meier method and univariate analysis by Log-Rank time series test. Cox regression model was used to analyze the multiple factors to confirm the independent factors. P0.05 as the difference was statistically significant. Result 1. Survival: a total of 39 patients with advanced lung cancer, median age 62 (3375 years), can be analyzed. The median progression-free survival was 3.5 months and the total median survival was 5.1 months. Complete remission (CR) accounted for 0%, partial remission (PR) accounted for 2.6%, disease stable (SD) accounted for 58.9%, disease progression (PD) accounted for 38.5%. Total remission rate (ORR) and disease control rate (DCR) were 2.6% and 61.5%, respectively. The main adverse reactions were hypertension (35.9%), proteinuria (25.6%), hand and foot syndrome (25.6%), diarrhea (20.5%) and bone marrow depression (38.5%). The results of univariate analysis showed that the degree of tissue differentiation, ECOG score and the degree of adverse reactions after taking apatinib were all related to the prognosis of the patients. The patients with high differentiation, ECOG score 0 ~ 1 and adverse reactions 鈮，
本文编号：2267747
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