进展性碘难治性分化型甲状腺癌患者阿帕替尼治疗后血清学与影像学指标变化

发布时间：2018-10-16 21:57

【摘要】：目的:评估阿帕替尼对于局部进展性碘难治性分化型甲状腺癌(radioactive iodine-refractory differentiated thyroid cancer,RAIR-DTC)中位随访7.9个月后的治疗效果。方法:随访中国医学科学院北京协和医院自2016年3月至2016年6月入组阿帕替尼治疗RAIR-DTC临床实验的受试者10例,从血清生化角度,甲状腺球蛋白(thyroglobulin,Tg)、甲状腺球蛋白抗体(thyroglobulin antibody,Tg-Ab)及影像学角度,靶病灶长度(target lesions,TL)观察阿帕替尼疗效及相关性,总结随访期间的不良事件(adverse event,AE)。结果:中位随访时间为7.9个月,在平均服用阿帕替尼6周内Tg呈快速下降趋势,平均下降60%,最大可达90%,提示该药物血清学疗效反应迅速,此后呈现稳定趋势,但停药3~14天即可观察到Tg的反弹趋势,升幅波动在4%~135%;TL在服用阿帕替尼平均8周内呈快速下降趋势,平均下降40%,最大可达60%,提示该药物快速的影像学疗效反应,此后呈稳定趋势,受停药影响不明显;Tg周变化速率(Tgvn)和TL周变化速率(TLvn)呈正相关[TLvn=0.17×Tgvn+0.50(r=0.56,P0.05)];受试者因不良反应均有不同程度的剂量下调,剂量调整后AE于3~14天缓解,下调剂量至250 mg/d仍能有效控制病情。结论:阿帕替尼治疗进展性RAIR-DTC具有快速、持久的血清学及影像学反应,Tgvn和TLvn呈正相关,且Tg较TL更为敏感,应作为RAIR-DTC靶向治疗评估的客观指标。
[Abstract]:Objective: to evaluate the efficacy of apatinib in the treatment of local progressive iodine refractory thyroid carcinoma (radioactive iodine-refractory differentiated thyroid cancer,RAIR-DTC) after a median follow-up of 7.9 months. Methods: from March 2016 to June 2016, 10 patients with RAIR-DTC were followed up in Beijing Union Hospital of Chinese Academy of Medical Sciences from March 2016 to June 2016. Thyroid globulin (thyroglobulin,Tg), thyroglobulin antibody (thyroglobulin antibody,Tg-Ab), imaging angle and target lesion length (target lesions,TL) were used to observe the efficacy and correlation of apatinib, and to summarize the adverse events (adverse event,AE) during follow-up. Results: the median follow-up time was 7.9 months. The Tg decreased rapidly within 6 weeks after the administration of apatinib on average, and decreased by 60 cents on average, the maximum was 90. The results indicated that the serological efficacy of the drug was rapid, and then showed a stable trend. However, the rebound trend of Tg could be observed after 3 ~ 14 days of withdrawal, and the increase fluctuated in the range of 4 ~ 135T / TL, which showed a rapid downward trend within an average of 8 weeks after taking apatinib, with an average drop of 40 and a maximum of 60. This indicated that the drug had a rapid radiologic response and showed a stable trend since then. There was a positive correlation between Tg weekly change rate (Tgvn) and TL weekly change rate (TLvn) [TLvn=0.17 脳 Tgvn 0.50 (r = 0.56% P 0.05)], but the dose of AE was alleviated at 3 ~ 14 days after dose-adjusted, and the condition could still be effectively controlled by lowering the dose to 250 mg/d. Conclusion: Apatinib has a rapid and persistent serological and imaging response in the treatment of progressive RAIR-DTC. Tgvn and TLvn are positively correlated, and Tg is more sensitive than TL. It should be used as an objective index for the evaluation of RAIR-DTC targeted therapy.
【作者单位】：中国医学科学院北京协和医院核医学科;北京大学国际医院肿瘤内科;
【基金】：国家自然科学基金项目(编号:81571714)资助~~
【分类号】：R736.1

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