大剂量三苯氧胺逆转对EP方案耐药的非小细胞肺癌  

High dose tamoxifen in the reversal treatment of multidrug resistance to EP regimen in patients with non-small cell lung cancer

作　　者：洪专[1] 郑秀立[1] 孙晓峰[1] 许红霞[1] 周兆飞[1] 王丽[1] 徐霞[1] 潘良熹[1] 冯继锋[1] 黄富麟[1] 

机构地区：[1]江苏省肿瘤医院内科,南京210009

出　　处：《中国肺癌杂志》2002年第3期201-203,共3页Chinese Journal of Lung Cancer

摘　　要：目的　研究大剂量三苯氧胺 (tamoxifen ,TAM)逆转治疗对鬼臼乙叉甙 顺铂 (EP)方案耐药 ,且P gp表达阳性的非小细胞肺癌。方法　 41例对EP方案耐药 ,且P gp阳性的NSCLC患者随机分为二组 ,逆转组应用TAM 10 0mg ,2次 /日 ,第 1～ 5天 ,然后采用EP方案 ;对照组仅采用EP方案治疗。结果　逆转组CR 1例 ,PR 5例 ,NC 11例 ,PD 4例 ,有效率为 2 8.6% (6/2 1) ,中位生存期为 8.4月 ,1年生存率为 3 8.1% ;对照组NC 9例 ,PD 11例 ,有效率为 0 ,中位生存期为 4.6月 ,1年生存率为 3 5 .0 %。逆转组有效率明显高于对照组 (P =0 .0 12 1) ,中位生存期明显长于对照组 (P <0 .0 1)。逆转组P gp阴转率为 3 3 .3 % (7/2 1) ,对照组无阴转者。主要毒副反应为Ⅱ～Ⅲ度血液学毒性 ,Ⅳ度少见。消化道反应均为Ⅰ～Ⅱ度。两组间毒副反应比较均无显著差异 (P >0 .0 5 )。结论　大剂量三苯氧胺能逆转对EP方案耐药 ,且P gp表达阳性的非小细胞肺癌。Objective To evaluate the reversal effect of high dose tamoxifen on multidrug resistance to EP regimen in patients with non small cell lung cancer. Methods A total of 41 patients with NSCLC were studied, who were resistant to EP regimen and were proved to have P gp protein overexpression. All patients were randomizedly divided into two arms. Reversal group (n=21) received oral tamoxifen 100?mg, 2 times everyday on D1 5, together with EP regimen. Control group (n=20) were only given EP regimen. Results In reversal group, complete response occurred in 1 patient, and partial response in 5; disease remained stable in 11 patients, and tumor progression occurred in 4 patients. The response rate was 28.6%(6/21). In control group, no response occurred; 9 patients had stable diseases, and the other 11 progressed. There was a significant difference in response rate between the two groups (P=0.012?1). In reversal and control groups, the median survivals were 8.4 and 4.6 months respectively (P<0.01), and 1 year survial rates were 38.1% and 35.0% respectively. Reversal of P gp occurred in 7 cases of reversal group (33.3%),and none in control group (P= 0.005?2) . There was no significant difference in toxicities between the two groups (P>0.05). Conclusion High dose tamoxifen can remarkably downregulate the expression of P gp and partially reverse the multidrug resistance to EP regimen for non small cell lung cancer.

关 键 词：三苯氧胺 EP方案 非小细胞肺癌 多药耐药性 化学治疗 逆转治疗 NSCLC 

分 类 号：R734.2[医药卫生—肿瘤]