贝伐珠单抗联合化疗治疗晚期非鳞非小细胞肺癌的临床观察  

Clinical Observation of Bevacizumab Combined with Chemotherapy in Advanced Non-squamous Non-small Cell Lung Cancer Patients

作　　者：陶虹[1] 唐俊舫[1] 朱允中[1] 李明智[1] 史亮[1] 武玮[1] 吴羽华[1] 徐丽艳[1] 孟弃逸[1] 吴卫华[1] 郭丽丽[1] 仝丽[1] 吴洪波[1] 刘喆[1] 

机构地区：[1]首都医科大学附属北京胸科医院肿瘤内科,101149

出　　处：《结核病与胸部肿瘤》2016年第3期179-185,共7页Tuberculosis and Thoracic Tumor

摘　　要：目的观察贝伐珠单抗联合化疗对晚期非小细胞肺癌患者的疗效、安全性及影像学改变。方法对2007年至2014年于我院治疗的晚期NSNSCLC（非鳞非小细胞肺癌non-squamous non-small cell lung cancer）患者，给予贝伐珠单抗（15mg／kg或7．5mg／kg）联合化疗（紫杉醇175mg／m^2，d1，卡铂AUC=5或6，d1，q3w）6周期及贝伐珠单抗维持治疗（15mg／kg或7．5mg／kg，d1，q3w）。观察疗效、不良反应、肺部病灶空洞改变的情况、恶性胸腔积液的治疗效果及部分患者EGFR、KRAS基因突变状况。结果共观察26例患者，均接受贝伐珠单抗联合化疗，17例行贝伐珠单抗维持治疗。部分缓解（partialresponse，PR）、疾病稳定（stabledisease，SD）、疾病进展（disease progression，PD）率分别为53．8％、42．3％、3．8％。中位无进展生存期（progression free survival，PFS）为11．0个月，中位总生存期（overall survival，OS）达25．8个月。26例患者中15．4％治疗后病变发生空洞改变，空洞组的2年、3年生存率略高于无空洞组，但无统计学差异（P值分别为0．586、0．509）。13例患者伴有恶性胸腔积液，胸腔积液的疾病控制率为100％。11例患者标本可进行EGFR基因检测，敏感突变占36．4％，未突变占63．6％。对10例患者标本行KRAS基因检测，均为突变阴性。不良反应包括骨髓抑制、消化道反应、鼻衄、咯血、高血压、蛋白尿等。大多数不良反应程度较轻，可控制。结论贝伐珠单抗联合化疗治疗晚期NSNSCLC患者疗效确切，副反应可耐受，控制恶性胸腔积液效果较好。肺部病灶空洞改变的临床意义有待进一步研究。Objective To evaluate the efficacy, safety and imaging findings of bevacizumab plus chemotherapy in patients with advanced non- squamous non-small cell lung cancer （NSNSCLC）. Methods Patients admitted in the hospital from 2007 to 2014 were treated with bevacizumab （15 mg/ kg or 7.5 mg/kg, dl） plus chemotherapy （paclitaxel 175 mg/m^2, dl, carhoplatin AUC=5 or 6, dl） with 3 weeks in one cycle, up to 6 cycles, followed with maintenance therapy of bevacizumab （15 mg/kg or 7.5 mg/kg, dl） till disease progression. Efficacy, safety, tumoral cavitation, therapeutic outcome of malignant pleural effusion and EGFR, KRAS mutation status were analyzed. Results 26 Patients were collected. They were all treated with bevacizumab plus chemotherapy. 17 patients received maintenance therapy. Partial response （PR）, stable disease （SD） and progressive disease （PD） rates were 53.8 %, 42.3 % and 3.8 %, respectively. The median progression free survival （PFS） and overall survival （OS） were 11.0 months and 25.8 months respectively. Out of 26 patients, 15.4 % developed cavitation after treatment. 2 years and 3 years survival rate of cavitation group was slightly higher than those of non-cavitation group （75.0 % vs 44.4 %, P=0.586, 25.0 % vs 12.5 %, P=0.509, respectively）. Of the 13 patients with malignant pleural effusion, the disease control rate of malignant pleural effusion was 100 %. EGFR mutation was detected in 11 patients. 36.4 % patients showed mutation positive while 63.6 % showed mutation negative. KRAS mutation had not been found in all the 10 patients whose samples were detected. Adverse effects included myelosuppression, digestive symptoms, epistaxis, hemoptysis, hypertension, proteinuria, etc. Most of the adverse effects were mild and controllable. Conclusions Bevacizumab combined with chemotherapy is a promising and safe treatment for patients with NSNSCLC. It was also effective in controlling malignant pleural effusion. The clinical significance of tumoral cavitation is subject to fu

关 键 词：贝伐珠单抗 肺癌 疗效 不良反应 空洞形成 

分 类 号：R273.420.5[医药卫生—中西医结合]