阿帕替尼联合替莫唑安序贯全脑放疗二线治疗小细胞肺癌脑转移  

Efficacy of Apatinib Combined with Temozolol Sequential Whole Brain Radiotherapy in Treatment of Brain Metastasis of Small Cell Lung Cancer

作　　者：张智显[1] 顾后[1] 林劼[1] 雷学芬 江利锋[1] 李楠[1] 路欣妍 余佳 ZHANG Zhi-xian;GU Hou;LIN Jie;LEI Xue-fen;JIANG Li-feng;LI Nan;LU Xin-yan;YU Jia(Dept. of Oncology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院肿瘤科

出　　处：《昆明医科大学学报》2019年第8期97-101,共5页Journal of Kunming Medical University

基　　金：CSCO-恒瑞肿瘤研究基金资助项目(Y-HR2015-218)

摘　　要：目的回顾性分析阿帕替尼(Apatinib)联合替莫唑安(TMZ)序贯全脑放疗二线治疗小细胞肺癌脑转移患者的临床疗效。方法2012 年10 月至2018 年12 月6 a间41 例小细胞肺癌患者随机分为对照组和实验组,均病理证实为小细胞肺癌,一线治疗方案均为EP(依托泊苷+顺铂)或者IP(伊立替康+顺铂)标准化疗方案6~8 疗程,胸部放疗采用适形调强放疗技术(IMRT),常规分割1.8~2.5 Gy/次,病灶PGTV 50.4~66 Gy,出现脑转移后判定为一线治疗失败。二线治疗对照组(拓扑替康单药) 20 例:拓扑替康(1.3~1.5) mg/m2 D1~5,3 周一疗程;实验组(阿帕替尼+替莫唑安) 21 例:阿帕替尼500~625 mg/d,替莫唑安(150~200) mg/m2D1~5,3 周一疗程,直至病情进展或无法耐受。2 组病例均序贯全脑放疗PCTV 30~36 Gy,转移灶PGTV 54~66Gy,常规分割1.8~2.5 Gy/次。比较2 组临床疗效、T细胞亚群、肿瘤标记物变化及不良反应情况。结果对照组和实验组6 个月客观有效率(ORR)分别为40.0%和71.4%,疾病控制率(DCR)分别为25.0%和57.1%,2 组无疾病进展生存期(PFS)分别为(5.6±1.1)个月和(3.3±2.8)个月,总生存时间(OS)分别为(7.5±3.2)个月和(10.2±3.9)个月;2 组ORR、DCR、PFS、OS 比较差异有统计学意义(P<0.05);实验组CD4、CD8 及CD4/CD8水平均高于对照组;2 组肿瘤标记物(NSE)比较有统计学差异;实验组高血压、出血、口腔黏膜炎发生率高于对照组,差异有统计学意义(P<0.05),其他副反应差异不大。结论阿帕替尼联合替莫唑安序贯全脑放疗二线治疗小细胞肺癌脑转移较单药拓扑替康临床疗效显著,值得临床推广。Objective To retrospectively analyze the clinical effects of Apatinib combined with Temozolol (TMZ) in the treatment of brain metastases of small cell lung cancer (SCLC). Methods 41 patients with small cell lung cancer from October 2012 to December 2018 were randomly divided into a control group and an experimental group. The first-line treatment for all of them was EP (Etoposide+Cisplatin)/ IP (Iriticam +Cisplatin),standard chemotherapy were 6~8 courses, chest radiotherapy with Intensity Modulated Radiotherapy Technique(IMRT), routine partitioning 1.8-2.5Gy/ times. The PGTV of the lesion was 50.4 -66 Gy, which was determined as a failure of first-line treatment after brain metastasis. In the second line treatment, the control group (topotecan alone) included 20 cases: Topotecan 1.3-1.5 mg/m2 D1~ 5,3 weeks one course;the experimental group(Apatinib+TMZ) included 21 cases: Apatinib 500 ~ 625 mg/d, TMZ 150-200 mg/m2 D1~ 5,3 weeks one course, until the disease progressed or patients felt intolerable. The two groups of patients received sequential whole brain radiotherapy PCTV 30 ~ 36Gy, metastatic focus PGTV 54- 66Gy,and routine segmentation 1.8-2.5 Gy/ times. The clinical efficacy, T cell subsets, tumor markers and adverse reactions were compared between the two groups. Results The objective effective rate (ORR) was 40.0% in the control group and 71.4% in the experimental group in 6 months. The DCR of the control group was 25.0% and 57.1% in the experimental group in 6 months, respectively. The progression free survival (PFS) was(5.6±1.1) months and(3.3±2.8) months, and the total survival time (OS) was(7.5±3.2) months and (10.2±3.9) months, respectively. There were significant differences in the ORR, DCR,PFS,OS between the two groups. The levels of CD4,CD8 and CD4/CD8 in the experimental group were higher than those in the control group (P< 0. 05), and there were significant differences in the tumor marker (NSE) between the two groups. The incidences of hypertension, bleeding and oral mucositis in the experimen

关 键 词：阿帕替尼 替莫唑安 拓扑替康 小细胞肺癌脑转移 全脑放疗 

分 类 号：R734.2[医药卫生—肿瘤]