吉西他滨联合异环磷酰胺对铂类方案化疗失败的晚期鼻咽癌患者的疗效及安全性评价  

Efficacy and safety evaluation of gemcitabine combined with ifosfamide in patients with advanced nasopharyngeal carcinoma after failure of platinum-based chemotherapy

作　　者：胡少轩[1] 何小慧[1] 董梅[1] 郏博[1] 周生余[1] 杨建良[1] 杨晟[1] 张长弓[1] 刘鹏[1] 秦燕[1] 桂琳[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院内科,100021

出　　处：《中华肿瘤杂志》2015年第8期632-636,共5页Chinese Journal of Oncology

摘　　要：目的评价吉西他滨联合异环磷酰胺（GI）方案治疗铂类方案化疗失败后复发或转移性鼻咽癌患者的疗效和安全性。方法回顾性分析2005年4月至2014年3月间接受GI方案治疗的27例铂类方案化疗失败后复发或转移性鼻咽癌患者的临床病理资料及其预后相关的影响因素。结果27例患者均可评价疗效和毒副反应。其中部分缓解（PR）10例（37．0％），稳定（SD）13例（48．1％），进展（PD）4例（14.8％），有效率为37．0％，疾病控制率为85．2％。27例患者的中位无进展生存时间（PFS）为6．7个月，其中10例PR患者的中位PFS为10．6个月，中位缓解时间为5．5个月。27例患者的中位总生存时间（OS）为17．4个月，1年生存率为72．6％。毒副反应主要为血液学毒性，其中Ⅲ～Ⅳ度中性粒细胞减少发生率为37．0％，Ⅲ～Ⅳ度血小板减少发生率为18．5％，Ⅲ～Ⅳ度血红蛋白降低发生率为3．7％。多因素分析显示，吉西他滨剂量强度是影响患者PFS的主要因素，是否接受后续治疗是影响患者OS的主要因素（均P〈0．05）。结论GI方案治疗铂类方案化疗失败后的晚期鼻咽癌患者疗效确切，患者耐受性好，值得进一步临床研究。Objective To evaluate the efficacy and safety of gemcitabine combined with ifosfamide （GI regimen ） in patients with recurrent or metastatic nasopharyngeal carcinoma after failure of platinum- based chemotherapy. Methods The clinical data of 27 nasopharyngeal carcinoma patients, who received GI regimen between April 2005 and March 2014 after failure of prior platinum-based chemotherapy, were retrospectively reviewed, and relevant prognostic factors were explored. Results All patients were evaluable for efficacy and toxicity. No patient achieved complete response （CR）. Partial response （PR） was achieved in ten patients, stable disease （SD） in thirteen patients, progressive disease （PD） in four patients, with a response rate of 37.0% and an overall disease control rate （PR＋SD） of 85.2%. For ten PR patients, the median duration of response was 5.5 months. The median progression-free survival of the whole group was 6.7 months, and the Kaplan-Meier estimate of median overall survival was 17.4 months. The 1-year survival rate was 72.6%. Toxicity was mainly hematological： Grade ⅢorⅣ anemia, neutropenia and thrombocytopenia were found in 3.7%, 37.0% and 18.5% of all patients, respectively. Univariate and multivariate analyses indicated that dose intensity of gemcitabine was a significant prognostic factor for PFS, whereas salvage treatment after failure of GI regimen was a significant prognostic factor for OS. Conclusions Gemcitabine and ifosfamide combination is effective and well tolerated by patients with advanced nasopharyngeal carcinoma pretreated with platinum-based chemotherapy. Further clinical study is warranted.

关 键 词：鼻咽肿瘤 药物疗法 吉西他滨 异环磷酰胺 治疗效果 预后 

分 类 号：R739.63[医药卫生—肿瘤]