EP方案序贯IP方案一线治疗广泛期小细胞肺癌的临床对比分析
发布时间：2018-12-15 17:14
【摘要】：小细胞肺癌(small-cell lung cancer,SCLC)占所有肺癌的20%-25%,新发病例中60%-70%是广泛期疾病。SCLC恶性程度高,转移早而广泛,大部分患者出现血行转移,仅1/3患者病变局限于胸腔。SCLC对化疗、放疗高度敏感,初治缓解率高,但极易发生继发性耐药,最终死于肿瘤复发。目前SCLC仍以全身化疗为主要治疗手段,自20世纪80年代以来,EP(依托泊苷联合顺铂)化疗方案逐渐取代CAV(环磷酰胺+阿霉素+长春新碱)方案,并因其生存优势最终成为小细胞肺癌的一线标准治疗方案。EP方案的客观缓解率为60%-70%,中位总生存时间为9-11个月,2年生存率5%。多数患者在化疗停止6个月内疾病发生进展,为此如何提高SCLC的治疗有效率,延长患者的生存时间,减少耐药性成为临床研究的热点。本文对EP方案稳定者进行序贯化疗的治疗效果进行分析对比,旨在探索改善广泛期SCLC预后的有效方法。研究目的:研究广泛期小细胞肺癌(ED-SCLC)的一线治疗,依托泊苷联合顺铂(EP)方案序贯伊立替康联合顺铂(IP)方案在疾病稳定患者中的疗效以及不良反应的发生情况。方法:回顾性分析55例初治ED-SCLC患者的临床病例资料,所有的患者均应用EP方案化疗2个周期,而且疗效评估稳定。根据治疗方法的不同将所有患者分为两组,其中序贯应用IP方案者25例EP+IP方案组,继续应用EP方案者30例EP方案组,所有的患者均完成至少4个周期的化疗,每个周期评价不良反应,每2个周期评价疗效,并且对两组患者的治疗效果及不良反应的发生情况进行对比分析。结果:共55例初治ED-SCLC患者,EP+IP方案组25例CR 0例,PR 17例,SD 6例,PD 2例,ORR为68.0%,中位FPS为7.0个月,OS为16.0个月;EP方案组30例CR 0例,PR 8例,SD 17例,PD 5例,ORR为26.7%,中位FPS为5.0个月,OS为12.0个月,差异有统计学意义(P0.05)。两组患者的不良反应主要是血液学和消化道的不良反应,EP+IP方案组的白细胞减少、血小板减少的发生率低于EP方案组,差异有统计学意义(P0.05);而EP+IP方案组的迟发性腹泻发生率高于EP方案组,但是大多为Ⅰ~Ⅱ度,患者均可以耐受,没有化疗相关性死亡。结论:1、初治ED-SCLC,应用EP方案一线治疗2个周期,疗效评估稳定的患者,序贯IP方案优于继续应用EP方案。2、EP方案序贯应用IP方案可以提高ORR,延长PFS和OS。3、安全性方面,两组患者不良反应主要为血液学和消化道不良反应,均可耐受,无化疗相关性死亡。
[Abstract]:Small cell lung cancer (small-cell lung cancer,SCLC) accounts for 20-25% of all lung cancers, and 60% -70% of the new cases are extensive diseases. SCLC has a high degree of malignancy, and metastasis is early and widespread. Most of the patients have blood metastases. Only one third of the patients were confined to the chest cavity. SCLC was highly sensitive to chemotherapy, highly sensitive to radiotherapy, and had a high initial remission rate, but it was prone to secondary drug resistance and eventually died of tumor recurrence. At present, SCLC still uses systemic chemotherapy as the main treatment method. Since 1980s, EP (etoposide combined with cisplatin has gradually replaced CAV (cyclophosphamide adriamycin vincristine) regimen. The objective remission rate of EP regimen was 60-70, the median survival time was 9-11 months, and the 2-year survival rate was 5. Most patients develop within 6 months after chemotherapy, so how to improve the effective rate of SCLC, prolong the survival time of patients and reduce drug resistance has become the focus of clinical research. The effect of sequential chemotherapy on patients with stable EP regimen was analyzed and compared in order to explore an effective method to improve the prognosis of extensive SCLC. Objective: to study the efficacy and adverse effects of etoposide combined with cisplatin (EP) regimen in the treatment of extensive small cell lung cancer (ED-SCLC) in patients with stable disease. Methods: the clinical data of 55 patients with ED-SCLC were analyzed retrospectively. All patients were treated with EP regimen for 2 cycles, and the curative effect was evaluated stably. All patients were divided into two groups according to different treatment methods, including 25 cases of EP IP regimen with sequential IP regimen and 30 cases with EP regimen. All patients completed at least 4 cycles of chemotherapy. Adverse reactions were evaluated in each cycle and curative effects were evaluated every 2 cycles. The therapeutic effects and adverse reactions in the two groups were compared and analyzed. Results: there were 25 cases of CR, 17 cases of PR, 6 cases of SD, 2 cases of PD, 68.0 months of ORR, 7.0 months of FPS and 16.0 months of OS. In EP group, 30 cases of CR, 8 cases of PR, 17 cases of SD, 5 cases of PD, ORR were 26.7 months, median FPS was 5.0 months, OS was 12.0 months, the difference was statistically significant (P0.05). The adverse reactions of the two groups were mainly hematological and gastrointestinal adverse reactions: leukopenia and thrombocytopenia in, EP IP group were lower than those in EP group (P0.05). However, the incidence of delayed diarrhea in EP IP group was higher than that in EP group, but most of them were 鈪，
本文编号：2381013
[Abstract]:Small cell lung cancer (small-cell lung cancer,SCLC) accounts for 20-25% of all lung cancers, and 60% -70% of the new cases are extensive diseases. SCLC has a high degree of malignancy, and metastasis is early and widespread. Most of the patients have blood metastases. Only one third of the patients were confined to the chest cavity. SCLC was highly sensitive to chemotherapy, highly sensitive to radiotherapy, and had a high initial remission rate, but it was prone to secondary drug resistance and eventually died of tumor recurrence. At present, SCLC still uses systemic chemotherapy as the main treatment method. Since 1980s, EP (etoposide combined with cisplatin has gradually replaced CAV (cyclophosphamide adriamycin vincristine) regimen. The objective remission rate of EP regimen was 60-70, the median survival time was 9-11 months, and the 2-year survival rate was 5. Most patients develop within 6 months after chemotherapy, so how to improve the effective rate of SCLC, prolong the survival time of patients and reduce drug resistance has become the focus of clinical research. The effect of sequential chemotherapy on patients with stable EP regimen was analyzed and compared in order to explore an effective method to improve the prognosis of extensive SCLC. Objective: to study the efficacy and adverse effects of etoposide combined with cisplatin (EP) regimen in the treatment of extensive small cell lung cancer (ED-SCLC) in patients with stable disease. Methods: the clinical data of 55 patients with ED-SCLC were analyzed retrospectively. All patients were treated with EP regimen for 2 cycles, and the curative effect was evaluated stably. All patients were divided into two groups according to different treatment methods, including 25 cases of EP IP regimen with sequential IP regimen and 30 cases with EP regimen. All patients completed at least 4 cycles of chemotherapy. Adverse reactions were evaluated in each cycle and curative effects were evaluated every 2 cycles. The therapeutic effects and adverse reactions in the two groups were compared and analyzed. Results: there were 25 cases of CR, 17 cases of PR, 6 cases of SD, 2 cases of PD, 68.0 months of ORR, 7.0 months of FPS and 16.0 months of OS. In EP group, 30 cases of CR, 8 cases of PR, 17 cases of SD, 5 cases of PD, ORR were 26.7 months, median FPS was 5.0 months, OS was 12.0 months, the difference was statistically significant (P0.05). The adverse reactions of the two groups were mainly hematological and gastrointestinal adverse reactions: leukopenia and thrombocytopenia in, EP IP group were lower than those in EP group (P0.05). However, the incidence of delayed diarrhea in EP IP group was higher than that in EP group, but most of them were 鈪，
本文编号：2381013
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