贝伐珠单抗在晚期非鳞非小细胞肺癌中的应用观察
发布时间：2019-03-30 09:12
【摘要】：肺癌的发病率逐年升高,特别是非小细胞肺癌,其中四分之三以上的患者在疾病确诊时已处于晚期,目前单纯化疗的疗效已到达瓶颈状态。研究证实,血管内皮生长因子是血管异常增生过程中各种影响因素的主要介质。贝伐珠单抗作为抗血管生成药物,能与人血管内皮生长因子结合并阻断其生物活性,从而抑制肿瘤新生血管的生成,进而切断肿瘤营养供给,抑制肿瘤细胞增生与迁移。它是首个被美国食品药品监督管理局批准的用于晚期非小细胞肺癌的一线治疗的抗血管生成药物。许多研究已证实贝伐珠单抗联合化疗治疗晚期非小细胞肺癌可以有效延长患者的生存期,对贝伐珠单抗在实际临床中的应用价值值得进一步验证与分析。研究目的:本研究旨在观察贝伐珠单抗联合化疗在治疗晚期非鳞非小细胞肺癌的临床应用中的疗效性与安全性。研究方法:回顾性地分析在2015年03月至2016年12月期间于青岛大学附属医院肿瘤科治疗的非小细胞肺癌患者48例,所有患者均经病理学或细胞学诊断为腺癌,临床分期为IV期,采用培美曲塞或吉西他滨或多西他赛或力扑素或长春瑞滨联合贝伐珠单抗±铂类(卡铂或顺铂)方案治疗,观察患者的治疗疗效及治疗过程中出现的不良反应并进行随访。研究结果:所有患者完全缓解0例(0%),部分缓解10例(20.8%),稳定30例(62.5%),进展8例(16.7%),客观缓解率为20.8%,疾病控制率为83.3%。总体中位无进展生存期为6.4个月,中位总生存期为12.0个月。应用培美曲塞方案治疗的36名患者中,完全缓解0例(0%),部分缓解10例(27.8%),稳定22例(61.1%),进展4例(11.1%),客观缓解率27.8%,疾病控制率88.9%。总体中位无进展生存期7.3个月,中位总生存期13.1个月。亚组中一线治疗患者的中位无进展生存期为8.8个月,中位总生存期为13.9个月,二线及以上治疗患者的中位无进展生存期为4.3个月,中位生存期为10.3个月,两者间有统计学差异(P0.05);应用贝伐珠单抗4周期以上患者中位无进展生存期为9.2个月,中位总生存期为14.5个月,4周期及以下患者中位无进展生存期为4.4个月,中位总生存期为10.3个月,两者间差异有统计学意义(P0.05)。最常见的不良反应为化疗相关的,主要有血象减少、恶心呕吐、肝肾功异常,大部分为1-2级,给予对症治疗后好转。贝伐珠单抗相关不良反应有蛋白尿、出血、高血压、血栓,1例患者因肺出血死亡,该患者既往有咯血史,大部分副反应均经治疗后改善,严重不良反应(3级及以上)少见。结论及意义:贝伐珠单抗联合化疗可有效改善晚期非鳞非小细胞肺癌患者的生存,贝伐珠单抗参与的维持治疗可以明显延长患者的总生存期,持续应用贝伐珠单抗可改善患者生存,对贝伐珠单抗的临床应用有一定的指导意义。不良反应多可耐受但要高度重视既往有咯血史的患者的应用。
[Abstract]:The incidence of lung cancer is increasing year by year, especially non-small cell lung cancer (NSCLC). More than 3/4 of the patients are in advanced stage when the disease is diagnosed. At present, the curative effect of chemotherapy alone has reached the bottleneck state. It has been proved that vascular endothelial growth factor (VEGF) is one of the main mediators in the process of vascular dysplasia. Bevacizumab, as an anti-angiogenic drug, can bind to human vascular endothelial growth factor (VEGF) and block its biological activity, thus inhibit tumor angiogenesis, cut off tumor nutrition supply, and inhibit tumor cell proliferation and migration. It is the first anti-angiogenic drug approved by the Food and Drug Administration for first-line treatment for advanced non-small cell lung cancer. Many studies have proved that bevacizumab combined with chemotherapy can effectively prolong the survival time of patients with advanced non-small cell lung cancer, and the clinical value of beavazumab is worthy of further verification and analysis. Objective: to observe the efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced non-squamous non-small cell lung cancer (NSCLC). Methods: from March 2015 to December 2016, 48 patients with non-small cell lung cancer treated in the Department of Oncology, affiliated Hospital of Qingdao University were retrospectively analyzed. All patients were diagnosed as adenocarcinoma by pathology or cytology, and the clinical stage was IV stage. The patients were treated with pemetaxel or gemcitabine or docetaxel, or vinorelbine combined with bevacizumab 卤platinum (carboplatin or cisplatin). The therapeutic efficacy and adverse reactions in the course of treatment were observed and followed up. Results: all patients had complete remission in 0 cases (0%), partial remission in 10 cases (20.8%), stabilization in 30 cases (62.5%), progression in 8 cases (16.7%), objective remission rate of 20.8% and disease control rate of 83.3%. The overall median progression-free survival was 6.4months and the median overall survival was 12.0 months. Of the 36 patients treated with Pemetrexil regimen, complete remission (0%), partial remission (10 cases, 27.8%), stability (22 cases, 61.1%), progress (4 cases, 11.1%) and objective remission rate (27.8%) were observed. The disease control rate was 88.9%. The overall median progression-free survival time was 7.3 months and the median overall survival time was 13.1 months. In the subgroup, the median progression-free survival time was 8.8months, the median total survival time was 13.9 months, the median progression-free survival time was 4.3months and the median survival time was 10.3 months in the first-line treatment group, and the median survival time was 13.9 months in the first-line treatment group and 10.3 months in the second-line treatment group. There was statistical difference between them (P0.05); The median progression-free survival time was 9.2months, the median total survival time was 14.5 months, and the median progression-free survival time was 4.4months in patients with 4 cycles and less than 4 cycles of bevaczumab, and the median progression-free survival time was 9.2months, the median survival time was 14.5 months. The median overall survival time was 10.3 months, the difference was statistically significant (P0.05). The most common adverse reactions were chemotherapy-related, mainly hemogram reduction, nausea and vomiting, abnormal liver and kidney function, most of which were grade 1 / 2 and improved after symptomatic treatment. The adverse reactions associated with beavazumab included proteinuria, hemorrhage, hypertension, thrombus, and one patient died of pulmonary hemorrhage. The patient had a history of hemoptysis in the past. Most of the side effects were improved after treatment, and severe adverse reactions (grade 3 or above) were rare. Conclusion: bevacizumab combined with chemotherapy can effectively improve the survival of patients with advanced non-squamous non-small cell lung cancer, and the total survival time of patients with advanced non-squamous non-small cell lung cancer can be significantly prolonged by taking part in the maintenance therapy of bevacizumab. Continuous use of bevacizumab can improve the survival of patients, and has some guiding significance for the clinical application of beavazumab. Adverse reactions are tolerable but should attach great importance to the use of patients with previous history of hemoptysis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2449994
[Abstract]:The incidence of lung cancer is increasing year by year, especially non-small cell lung cancer (NSCLC). More than 3/4 of the patients are in advanced stage when the disease is diagnosed. At present, the curative effect of chemotherapy alone has reached the bottleneck state. It has been proved that vascular endothelial growth factor (VEGF) is one of the main mediators in the process of vascular dysplasia. Bevacizumab, as an anti-angiogenic drug, can bind to human vascular endothelial growth factor (VEGF) and block its biological activity, thus inhibit tumor angiogenesis, cut off tumor nutrition supply, and inhibit tumor cell proliferation and migration. It is the first anti-angiogenic drug approved by the Food and Drug Administration for first-line treatment for advanced non-small cell lung cancer. Many studies have proved that bevacizumab combined with chemotherapy can effectively prolong the survival time of patients with advanced non-small cell lung cancer, and the clinical value of beavazumab is worthy of further verification and analysis. Objective: to observe the efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced non-squamous non-small cell lung cancer (NSCLC). Methods: from March 2015 to December 2016, 48 patients with non-small cell lung cancer treated in the Department of Oncology, affiliated Hospital of Qingdao University were retrospectively analyzed. All patients were diagnosed as adenocarcinoma by pathology or cytology, and the clinical stage was IV stage. The patients were treated with pemetaxel or gemcitabine or docetaxel, or vinorelbine combined with bevacizumab 卤platinum (carboplatin or cisplatin). The therapeutic efficacy and adverse reactions in the course of treatment were observed and followed up. Results: all patients had complete remission in 0 cases (0%), partial remission in 10 cases (20.8%), stabilization in 30 cases (62.5%), progression in 8 cases (16.7%), objective remission rate of 20.8% and disease control rate of 83.3%. The overall median progression-free survival was 6.4months and the median overall survival was 12.0 months. Of the 36 patients treated with Pemetrexil regimen, complete remission (0%), partial remission (10 cases, 27.8%), stability (22 cases, 61.1%), progress (4 cases, 11.1%) and objective remission rate (27.8%) were observed. The disease control rate was 88.9%. The overall median progression-free survival time was 7.3 months and the median overall survival time was 13.1 months. In the subgroup, the median progression-free survival time was 8.8months, the median total survival time was 13.9 months, the median progression-free survival time was 4.3months and the median survival time was 10.3 months in the first-line treatment group, and the median survival time was 13.9 months in the first-line treatment group and 10.3 months in the second-line treatment group. There was statistical difference between them (P0.05); The median progression-free survival time was 9.2months, the median total survival time was 14.5 months, and the median progression-free survival time was 4.4months in patients with 4 cycles and less than 4 cycles of bevaczumab, and the median progression-free survival time was 9.2months, the median survival time was 14.5 months. The median overall survival time was 10.3 months, the difference was statistically significant (P0.05). The most common adverse reactions were chemotherapy-related, mainly hemogram reduction, nausea and vomiting, abnormal liver and kidney function, most of which were grade 1 / 2 and improved after symptomatic treatment. The adverse reactions associated with beavazumab included proteinuria, hemorrhage, hypertension, thrombus, and one patient died of pulmonary hemorrhage. The patient had a history of hemoptysis in the past. Most of the side effects were improved after treatment, and severe adverse reactions (grade 3 or above) were rare. Conclusion: bevacizumab combined with chemotherapy can effectively improve the survival of patients with advanced non-squamous non-small cell lung cancer, and the total survival time of patients with advanced non-squamous non-small cell lung cancer can be significantly prolonged by taking part in the maintenance therapy of bevacizumab. Continuous use of bevacizumab can improve the survival of patients, and has some guiding significance for the clinical application of beavazumab. Adverse reactions are tolerable but should attach great importance to the use of patients with previous history of hemoptysis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
【参考文献】
相关期刊论文 前2条
1 阳秋香;张欢欢;袁太泽;梁颖;余锦秀;王文金;张秀萍;;贝伐单抗联合放疗对肺癌裸鼠移植瘤作用的研究[J];中国医药导报;2015年14期
2 赵静;李航;张力;钟巍;李龙芸;文煜冰;王孟昭;;四例贝伐单抗所致肾损害临床和病理特征分析[J];中国医学科学院学报;2012年02期
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