NP方案与TP方案治疗晚期非小细胞肺癌临床分析  

Clinical study of paclitaxel plus cisplatin versus vinorelbine plus cisplatin in treatment of patients with advanced non-small-cell lung cancer

作　　者：林蓉燕[1] 赵玉亮[1] 于晶琳[1] 白羽[1] 方红[1] 孙明霞[1] 徐玲[1] 

机构地区：[1]北京大学第一医院肿瘤诊治中心化疗科,100009

出　　处：《中国肿瘤临床与康复》2004年第5期409-412,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的 评价NP方案、TP方案治疗晚期非小细胞肺癌的疗效和毒副反应。方法 NP方案:长春瑞滨(NVB)25-mg/m2,快速静脉滴注,第1、8天;顺铂(PDD)45 mg/m2,静脉点滴,第1-2天。TP方案:紫杉醇(PTX)135 mg/m2,静脉点滴,第1天,持续3 h;PDD 80 mg/m2,静脉点滴,第2天。21 d为一周期。结果 NP组30例,CR 2例(6.7％).PR 12例(40.0％),SD 12例(40.0％),总有效率46.7％;TP组29例,CR 1例(3.4％),PR 12例(41.4％),SD 11例(37.9％),总有效率44.8％。NP组和TP组中位缓解时间分别为5.5个月和4.5个月。初治优于复治(NP组为72.7％对31.6％,P=0.0308;TP组为75.0％对33.3％,P=0.0480);Ⅲb期优于Ⅳ期(NP组为77.8％对33.3％,P=0.0288;TP组为85.7％对31.8％,P=0.0176)。剂量限制性毒性主要为骨髓抑制,NP组较TP组稍重,白细胞、血小板减少发生率分别为66.7％、51.7％和33.3％、31.0％。TP组脱发、周围神经毒性/疼痛较NP组重,而NP组静脉炎及胃肠道反应较TP组重。无Ⅳ度反应出现,患者均能够较好地耐受,不影响化疗继续进行。结论 NP方案、TP方案治疗晚期非小细胞肺癌安全有效,既可用作一线方案,也可用作二线方案,且二者无明显交叉耐药性,可互为挽救方案。Objective To compare the efficacy and toxicity of vinorelbine plus cisplatin(NP) and paclita-xel plus cisplatin(TP) combinations in the treatment of advanced non-small-cell lung cancer(NSCLC) .Methods From December 1997 to April 2002, a total of 59 patients with advanced NSCLC were randomized to receive vinorelbine 25 mg/m2 on days 1,8 by twenty-minute infusion and cisplatin 45 mg/m2 on day 1 (group NP) , or paclita-xel 135 mg/m2 by 3-hour infusion and cisplatin 80 mg/m2 on day 1(group TP). Both regimens were repeated every 3 weeks. Results A total of 59 patients (30 patients in group TP, 29 patients in group TP) were enrolled. All characteristics were well matched between the two groups. In total, 188 cycles of NP and 93 cycles of TP were given. The median duration of response was 5.5 months for group NP and 4.5 months for group TP.The overall response rate for group NP was 46.7% , with 6.6% complete response(CR) ,40.0% partial response(PR) ,40.0% stable disease(SD) and 13. 3% progression of disease(PD), and in group TP, the overall response rate was 44. 8% (3.4% CR,41.4% PR,37.9% SD,and 17.2% PD)(P>0.75).The response rate was higher in grade Ⅲb cases than in grade Ⅳ cases(77.8% vs 33.3% in group NP,P = 0.0288,and 85.7% vs 31.8% in group TP, P = 0.0176),higher in previously untreated cases than in treated cases(72.7% vs 31.6% in group NP, P = 0.0308,and 75.0% vs 33.3% in group TP, P = 0.0480).The incidence of neutropenia and thrombocytopenia were 66.7% and 51.7% in group NP,and 33.3% and 31.0% in group TP,respectively.Phlebitis(63.3% vs 3.4%)and nausea/vomiting(55.3% vs 41.4%)were more severe in group NP.By contrast,alopecia(93.1% vs 23.3%)and peripheral neurotoxicity/myalgia(72.4% vs 36.7%)were more frequent in group TP.The frequency and severity of other toxic reactions were comparable between the two groups. No WHO grade Ⅳ toxicity occurred. Conclusion Both NP and TP combined chemotherapy produce similar efficacy and are well tolerated in patients with advanced non-small-cell lung cancer.

关 键 词：肺肿瘤/化学疗法 长春瑞滨 紫杉醇 顺铂 

分 类 号：R734.2[医药卫生—肿瘤] R730.53[医药卫生—临床医学]