敏感复发广泛期小细胞肺癌应用EP方案二线治疗的可行性,一项多中心、回顾性研究  

Feasibility of EP Regimen in Second-Line Treatment of Sensitive and Relapsed Extensive Small-Cell Lung Cancer:A Multicenter Retrospective Study

作　　者：曾梓洵 李东 王晓珊[3] 冯岗[4] 柯华[5] 胡瀚 贾蓉 陈孝磊 丁婧 谢华[7] 周进[7] Zeng Zixun;Li Dong;Wang Xiaoshan;Feng Gang;Ke Hua;Hu Han;Jia Rong;Chen Xiaolei;Ding Jing;Xie Hua;Zhou Jin(Department of Oncology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Oncology,the General Hospital of Western Theater Command,Chengdu 610036,Sichuan,China;Department of Oncology,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,Sichuan,China;Department of Oncology,Mianyang Central Hospital,Mianyang 621000,Sichuan,China;Departmentof Respiratory Medicine,Chengdu SeventhPeople's Hospital,Chengdu 610041,Sichuan,China;School of Clinical Medicine,Chengdu Medical College,Chengdu 610500,Sichuan,China;Department of Medical Oncology,Sichuan Cancer Hospital&Institute,(i.e.Sichuan Cancer Center,or Cancer Hospital Afiliated to University of Electronic Science and Technology of China),Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]中国人民解放军西部战区总医院肿瘤诊治中心,成都610036 [3]四川省人民医院肿瘤中心,成都610072 [4]绵阳市中心医院肿瘤科,四川绵阳621000 [5]成都市第七人民医院呼吸内科,成都610041 [6]成都医学院临床医学院,成都610500 [7]四川省肿瘤医院·研究所/四川省癌症防治中心/电子科技大学附属肿瘤医院肿瘤内科,成都610041

出　　处：《肿瘤预防与治疗》2023年第1期34-40,共7页Journal of Cancer Control And Treatment

基　　金：广东省临床试验协会/中国胸部肿瘤研究协作组和广东省肺癌转化医学重点实验室开放课题(编号:YC20210105);2022CSCO重点项目(编号:Y-2021AST/zd-0119)。

摘　　要：目的:广泛期小细胞肺癌(extensive-stage small-cell lung cancer,ES-SCLC)一线治疗主要采用以化疗为基础的联合方案,进展后多推荐拓扑替康等二线化疗。对于一线使用依托泊苷联合铂类(etoposide-platin,EP)有效的人群,复发后亦可选择同方案再次治疗。但目前并无二种方案的疗效和安全性比对数据。本研究旨在探讨EP方案再治疗敏感复发ES-SCLC患者的疗效和安全性。方法:纳入153例就诊于四川省肿瘤医院等5所医疗中心并接受EP方案二线治疗的ES-SCLC患者。所有患者均接受标准一线EP方案化疗且有效。根据治疗间歇期、不同铂类方案、有无吸烟史、放疗与否等进行分组,进行回顾性分析。主要观察指标包括客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、无进展生存时间(progression-free survival,PFS)以及药物不良反应。结果:153例患者中64例复发时间在3~6月间,89例复发时间>6个月。86例患者一线治疗中接受过胸部放疗,有长期吸烟史者占70.58%(108/153)。总体ORR为35.94%,DCR为57.51%,平均PFS为4.72个月。复发时间>6个月的患者PFS较复发时间3~6月者有明显延长趋势(5.24个月vs 4.0个月,P<0.001),客观缓解率为40.45%vs 29.68%(P=0.015)。是否有长期吸烟史、一线联合放疗与否、方案中铂类的选择与PFS无明显相关性(P>0.05)。结论:对于敏感复发的ES-SCLC,尤其是治疗间歇期长于6月者,EP方案再治疗是可选的临床策略之一。Objective:Chemotherapy-based combination regimens are generally adopted as first-line treatment for extensive-stage small-cell lung cancer(ES-SCLC),and topotecan for progressed ES-SCLC.Etoposide combined with platinum-based chemotherapy can be administered again upon those who responded to this regimen in first-line treatment,but the efficacy and safety of this approach is unknown.This study was designed to investigate the efficacy and safety of the etoposide-platin(EP)regimen for the retreatment of patients with sensitive relapsed ES-SCLC.Methods:This multicenter retrospective study included 153 ES-SCLC patients who received etoposide combined with platinum-based chemotherapy as second-line treatment.All patients underwent effective and standard first-line EP treatment.The patients were grouped according to treatment intermissions,platinum-based regimen,smoking history and radiotherapy,and were then retrospectively analyzed.Objective-response rate(ORR),disease-control rate(DCR),progression-free survival(PFS)and adverse reactions were recorded.Results:Among the 153 patients,64 relapsed at between 3-6 months and 89 patients relapsed at>6 months.86 patients underwent thoracic radiotherapy during first-line treatment,and 70.58%(108/153)of them had a history of long-term smoking.The overall ORR and DCR were 35.94%and 57.51%,respectively.The average PFS was 4.72 months.PFS were significantly longer in patients relapsing at>6 months than in those relapsing at between 3-6 months(5.24 months vs 4.0 months,P<0.001),and the ORR was 40.45%vs 29.68%(P=0.015).Smoking history,radiotherapy,and platinum-based regimen were not correlated to PFS(P>0.05).Conclusion:For ES-SCLC patients responsive to first-line EP treatment,particularly those with a treatment interval longer than 6 months,retreatment with the same regimen is one of the alternative clinical strategies.

关 键 词：广泛期小细胞肺癌 敏感复发 二线化疗 依托泊苷 有效性 

分 类 号：R734.2[医药卫生—肿瘤] R730.53[医药卫生—临床医学]