贝伐珠单抗联合卡铂与贝伐珠单抗单药治疗恶性胸腔积液的疗效和安全性  

Efficacy and Safety of Combined Bevacizumab and Carboplatin Therapy and Bevacizumab Monotherapy for the Treatment of Malignant Pleural Effusion

作　　者：赵健竹[1] 汤隽[2] 马洁韬[1] 张树玲[1] 韩琤波[1] 邹华伟[1] ZHAO Jianzhu;TANG Jun;MA Jietao;ZHANG Shuling;HAN Chengbo;ZOU Huawei(Department of Oncology,Shengjing Hospital,China Medical University,Shenyang 110022,China;Department of Thoracic Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院第一肿瘤科,沈阳110022 [2]中国医科大学附属盛京医院第一胸外科,沈阳110004

出　　处：《中国医科大学学报》2018年第4期289-293,共5页Journal of China Medical University

基　　金：国家自然科学基金青年科学基金(81501990);辽宁省高等学校杰出青年学者成长计划(LJQ2014082)

摘　　要：目的 比较贝伐珠单抗联合卡铂与贝伐珠单抗单药通过胸腔灌注的方法治疗恶性胸腔积液的临床疗效及不良反应,为恶性胸腔积液治疗决策提供初步依据。方法 回顾性收集2015年1月至2016年11月我院收治的合并恶性胸腔积液的晚期肿瘤患者的临床资料,符合纳入标准的患者共48例,所有患者均经胸水细胞病理学或影像学证实为恶性胸腔积液,分为贝伐珠单抗联合卡铂组(30例)和贝伐珠单抗单药治疗组(18例),记录患者体力状况改善、影像学改变以及恶心呕吐、粒细胞减少等不良反应,比较2组治疗效果及不良反应的差异。结果 贝伐珠单抗联合卡铂治疗组和贝伐珠单抗单药治疗组中治疗有效率分别为83.3%和55.6%,3~4级不良反应发生率分别为40.0%和11.1%,差异均有统计学意义(P=0.039,P=0.033)。在生活质量改善方面,2组比较无统计学差异(P=0.113)。贝伐珠单抗联合卡铂治疗组和贝伐珠单抗单药治疗组中位疾病进展时间分别为3.9和3.5个月,差异无统计学意义(P=0.873),且在生活质量改善方面,2组比较无统计学差异(P=0.113)。结论 贝伐珠单抗联合卡铂治疗恶性胸腔积液有效率较高,但与贝伐珠单抗单药灌注治疗相比不良反应较大,二者在疾病进展时间及改善生活质量方面无统计学差异,在临床选择中需要根据患者具体情况选择适合的治疗策略。Objective To explore the efficacy and side effects of combined bevacizumab and carboplatin therapy and bevacizumab monotherapy for the treatment of malignant pleural effusion(MPE)through thoracic perfusion,and provide evidence for a clinical strategy.Methods We retrospectively collected 48 patients with malignant pleural effusion caused by advanced tumor effusion from January 2015 to November 2016 according to the inclusion criteria.All patients were diagnosed based on cell pathology or imaging.Patients received combined bevacizumab and carboplatin therapy(n=30)or bevacizumab monotherapy(n=18).The differences in clinical improvement,changes in images,symptoms of nausea and vomiting,neutrophil count reduction,and other side effects were compared between the two groups.Results There were significant differences in the efficacy(83.3%and 55.6%,respectively;P=0.039)and rates of grade 3 side effects(40.0%and 11.1%,respectively;P=0.033)between the combined therapy and monotherapy groups.No significant difference in quality of life improvement was found between the two groups(P=0.113).The median times to progression in combined therapy and monotherapy groups were 3.9 and 3.5 months,respectively,without statistical significance(P=0.873).Conclusion Compared with bevacizumab monotherapy,combined bevacizumab and carboplatin therapy is highly effective for the treatment of MPE with more severe side effects.There are no significant differences in the time to progression and quality of life improvement between these two therapies.We should choose appropriate therapeutic drugs according to specific patients in the clinic.

关 键 词：贝伐珠单抗 恶性胸腔积液 恶性肿瘤 胸腔灌注 

分 类 号：R730.53[医药卫生—肿瘤]