小剂量阿帕替尼联合紫杉醇脂质体与雷替曲塞二线治疗晚期胃癌的疗效及安全性  

Efficacy and safety of low dosage of apatinib combined with liposomal paclitaxel and ralritrexed as second-line therapy in the treatment of advanced gastric cancer

作　　者：毕延智[1] 李小倩[1] 肖敏[1] 杨全良[1] 曾冬香[1] BI Yan-zhi;LI Xiao-qian;XIAO Min;YANG Quan-liang;ZENG Dong-xiang(Department of Medical Oncology,Changzhou Tumor Hospital,Changzhou 213000,China)

机构地区：[1]江苏省常州市肿瘤医院肿瘤内科,常州213000

出　　处：《中国肿瘤临床与康复》2019年第1期30-33,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨小剂量阿帕替尼联合紫杉醇脂质体与雷替曲塞二线治疗晚期胃癌的疗效及安全性。方法选取2015年3月至2017年10月间常州市肿瘤医院收治的18例一线化疗后进展或病灶缓解后再进展的胃腺癌或胃食管结合部腺癌患者,均接受甲磺酸阿帕替尼片抗血管生成治疗联合紫杉醇脂质体与雷替曲塞化疗。2个周期后,评价患者的临床疗效及治疗相关不良反应。结果患者共完成治疗69个周期(1～6个周期),平均3. 8个周期。其中部分缓解4例,稳定6例,进展8例,有效率为22. 2%,疾病控制率为55. 6%,患者中位无进展生存时间为92. 9d(52～306d)。患者无治疗相关死亡。常见不良反应为中性粒细胞减少、恶心、呕吐、乏力、药物性高血压或原有高血压加重及手足综合征。其中Ⅲ级高血压3例,经缬沙坦氨氯噻嗪片口服后血压控制良好,疗效均为部分缓解。Ⅲ级手足综合征及口腔黏膜炎出现于同1例稳定患者,经短时停药及促黏膜修复治疗后好转。Ⅰ～Ⅱ级乏力患者8例,经每日静脉或口服使用小剂量糖皮质激素治疗后症状好转;Ⅲ级乏力患者用药后一月余渐出现淡漠症状,甲状腺功能减退,口服补充甲状腺素后症状好转。结论小剂量阿帕替尼联合紫杉醇脂质体与雷替曲塞二线治疗晚期胃癌有一定疗效,耐受性好。Objective To observe the low dosage of apatinib combined with liposomal paclitaxel and ralritrexed as second-line therapy in the treatment of advanced gastric cancer. Methods Eighteen patients with gastric adenocarcinoma or adenocarcinoma of esophagogastric junction who progressed after firstline chemotherapy or after lesion remission were selected. They were given apatinib mesylate tablets as antiangiogenic therapy combined with liposomal paclitaxel and ralritrexed as chemotherapy. After 2 cycles,the efficacy and adverse reactions were evaluated. Results In total,patients completed 69 cycles( 1 -6 cycles) with average cycles of 3. 8. Partial response( PR) occurred in 4 patients. Steady disease( SD) occurred in 6 patients. Progressive disease( PD) occurred in 8 patients. No patient achieved complete response( CR). Response rate( RR) was 22. 2%. Disease control rate( DCR) was 55. 6%. Median progression-free survival( PFS) was 92. 9( 52-306) d. No treatment associated mortality occurred. The common adverse reactions were neutropenia,nausea,vomiting,fatigue,drug-induced hypertension,deteriorated primay hypertension,and hand-foot syndrome. Grade Ⅲ hypertension occurred in 3 patients and the blood pressure was well controlled after the administration of valsartan and hydrochlorothiazide tablets and PR was achieved. Grade Ⅲ hand-foot syndrome and stomatitis occurred in 1 SD patient whose condition was improved after temporary suspension of the drug and mucosal repair treatment. GradeⅠ-Ⅱ fatigue occurred in 8 patients whose condition was improved after daily intravenous or oral glucocorticoid. Indifferent symptoms and hypothyroidism occurred in patients with grade Ⅲ fatigue and the condition was improved with oral supplemental thyroid hormone. Conclusion The regimen of low dosage of apatinib combined with liposomal paclitaxel and raltitrexed as second line treatment has good efficacy and tolerance in patients with advanced gastric cancer.

关 键 词：胃肿瘤 阿帕替尼 紫杉醇脂质体 雷替曲塞 药物疗法 

分 类 号：R735.2[医药卫生—肿瘤]