培美曲塞联合顺铂二线治疗复发转移性非小细胞肺癌23例临床报告

目的研究培美曲塞联合顺铂方案治疗复发转移性非小细胞肺癌的近期疗效和毒副反应。方法 23例晚期复治的非小细胞肺癌患者接受培美曲塞500mg/m2,d1,顺铂25mg/m2,d1-3,3周后重复,连用两个周期评价疗效。结果 23例患者有效率（CR＋PR）为30.4%。疾病控制率（CR＋PR＋SD）为78.2%。主要毒副反应为骨髓抑制、皮疹和胃肠道反应。结论培美曲塞联合顺铂治疗复发转移性非小细胞肺癌具有较好的疗效,毒副反应可以耐受。     

培美曲塞联合顺铂治疗初治失败的非小细胞肺癌的临床应用研究

目的：探讨培美曲塞联合顺铂方案治疗初治失败的非小细胞肺癌近期疗效及其不良反应。方法培美曲塞500mg/m2,第1天静脉滴注,第二天顺铂50mg/m2静脉滴注。每3-4周为1个周期。结果治疗组30例晚期肺癌患者,有效率达到71%（PR+CR）。主要不良反应为口腔炎、白细胞和血小板减少及轻度周围神经毒性,无化疗相关死亡。结论培美曲塞联合顺铂治疗初治失败的非小细胞肺癌有较好的疗效和安全性。     

培美曲塞联合顺铂治疗晚期非小细胞肺癌的临床观察

目的：评价培美曲塞联合顺铂治疗晚期非小细胞肺癌（ NSCLC）的临床疗效和毒副反应。方法44例晚期NSCLC接受培美曲塞联合顺铂化疗,2周期后评价临床疗效和毒副反应。结果44例中,CR0例,PR12例,SD14例,PD18例,有效率27．3％,临床获益率59．1％。主要毒副反应为骨髓抑制、胃肠道反应和皮肤过敏。结论培美曲塞联合顺铂治疗晚期NSCLC疗效可靠,毒副反应轻。     

培美曲塞联合卡铂治疗晚期非小细胞肺癌的近期疗效观察

目的观察培美曲塞联合卡铂治疗晚期非小细胞肺癌的近期疗效及毒副作用。方法晚期非小细胞肺癌患者共45例,培美曲塞500mg／m^2,第1天,卡铂300mg／m^2第1天静脉滴注,21d为一周期,每例患者至少接受2个周期的治疗。结果45例患者均可评价疗效,无完全缓解（CR）,19例获部分缓解（PR）,12例稳定（SD）,14例疾病进展（PD）,总有效率为42．2％,其中位疾病进展时间为5．2个月,中位生存时间为10．3个月,1年生存率为55．6％。毒副作用主要有骨髓抑制、恶心、呕吐和腹泻以及白细胞下降导致的发热等,但患者多为Ⅰ、Ⅱ度反应,耐受性良好。结论培美曲塞联合卡铂是一种对晚期非小细胞肺癌有效的化疗方法,不良反应发生率低,耐受性良好。     

培美曲塞联合奥沙利铂治疗晚期复发性非小细胞肺癌的临床观察

目的探讨培美曲塞联合奥沙利铂方案治疗晚期复发性非小细胞肺癌的疗效及不良反应。方法经病理学或细胞学确诊的复发性晚期非小细胞肺癌患者36例。化疗方案:培美曲塞500mg/m2第1天+奥沙利铂120mg/m2第1天静脉滴注,每3周重复。至少完成2周期后评价疗效及毒性。结果 36例中无完全缓解病例,部分缓解1例,稳定22例,进展13例,疾病控制率64%。中位无疾病进展时间3.2个月。主要不良反应为疲乏、骨髓抑制。结论培美曲塞联合奥沙利铂的联合方案对晚期复发性非小细胞肺癌疗效确切,毒性反应轻,值得推广使用。     

晚期肺腺癌应用培美曲塞+顺铂治疗的临床疗效观察

目的 探讨培美曲塞+顺铂治疗晚期肺腺癌的临床疗效和不良反应.方法 对近年我院收治的28例晚期肺腺癌患者采用培美曲塞联合顺铂治疗方案,并分析评价其疗效和不良反应.结果 28例患者中,CR0例,PR10例,SD11例,总有效率为35.7%,疾病控制为75%.不良反应主要为骨髓抑制、胃肠道反应.结论 培美曲塞联合顺铂方案治疗晚期肺腺癌有较好的临床效果,不良反应较轻,患者多可耐受,对延长患者生存期,提高生存质量具有重要意义.     

培美曲塞单药化疗二线治疗老年晚期非小细胞肺癌近期疗效观察

目的 观察培美曲塞单药化疗二线治疗老年晚期非小细胞肺癌的近期疗效及不良反应.方法 38例经病理学检查确诊的老年晚期非小细胞肺癌患者,一线化疗后复发或进展.随机分为单药组和联合组各19例,单药组给予培美曲塞单药治疗:培美曲塞500 mg/m2,21 d为1个周期,联合组给予美曲塞联合顺铂治疗:培美曲塞500 mg/m2+顺铂75 mg/m2,d1～d3,21 d为1个周期.完成2个周期后评价临床疗效,每个周期评价不良反应.结果 单药组和联合组的有效率(21.05％,26.31％)及疾病控制率(57.89％,52.63％)差异无统计学意义(P＞0.05);单药组的粒细胞减少(36.84％)和血小板减少发生率(5.26％)明显低于联合组(分别为84.21％,15.79％),差异有统计学意义(P＜0.05).结论 单用培美曲赛二线治疗老年晚期非小细胞肺癌与培美曲塞联合顺铂化疗疗效相似,且使用培美曲塞单药不良反应更低,值得在临床推广.     

顺铂联合培美曲塞治疗肺癌患者的效果评价

目的:探讨顺铂联合培美曲塞治疗肺癌患者的效果。方法:选取2016年1月～2018年12月在我院药物试验机构的92例肺癌患者,随机分为两组。对照组采取顺铂联合长春瑞滨疗法,观察组采取顺铂联合培美曲塞疗法。结果:观察组CR0例,PR22例,SD14例,PD10例,有效率为47.83%(22/46),明显高于对照组的30.43%(15/46)(P0.05);观察组治疗后的角色功能、躯体功能、整体功能和情绪功能评分均明显高于对照组和治疗前(P0.05)。结论:顺铂联合培美曲塞对于肺癌患者具有较佳的效果。     

培美曲塞联合顺铂对晚期非小细胞肺癌的化疗效果和血清肿瘤标志物的影响

目的探讨培美曲塞联合顺铂治疗晚期非小细胞肺癌的临床疗效和对血清肿瘤标志物的影响。方法选择178例非小细胞肺癌患者随机分为观察组和对照组各89例,对照组采用吉西他滨+顺铂化疗方案,观察组采用培美曲塞+顺铂化疗方案,比较2组患者的化疗效果、不良反应发生率及血清肿瘤标志物水平。结果 2组的临床缓解率和疾病控制率差异均无统计学意义(P0.05);观察组贫血、血小板减少、皮疹、肝功能损害及放射性肺炎的发生率明显低于对照组,差异均有统计学意义(P0.05);与化疗前相比,2组化疗2个周期后CEA、CA125、NSE及CYFRA21-1水平均明显降低,差异均有统计学意义(P0.05)。结论培美曲塞联合顺铂治疗晚期非小细胞肺癌的化疗疗效与吉西他滨联合顺铂相当,但不良反应明显减少,且可明显降低患者血清肿瘤标志物水平,值得推广。     

培美曲塞方案用于晚期肺癌的疗效及毒副反应研究

目的:探究对晚期肺癌应用培美曲塞方案治疗的疗效和毒副反应情况。方法:将我院56例晚期肺癌患者作为研究对象,将其分为培美曲塞联合顺铂(观察组25例)和紫杉醇联合顺铂(对照组31例),所有患者完成2个周期及以上的化疗,对比两组疗效及毒副反应发生情况。结果:观察组和对照组的有效率分别为36.0%和35.4%,疾病控制率分别为76.0%和67.7%,差异不具有统计学意义(P0.05);观察组不良反应:白细胞降低、血小板降低、脱发、关节肌肉痛均低于对照组,P0.05具有统计学意义。结论:对晚期非鳞NSCLC肺癌应用培美曲塞或紫杉醇联合顺铂疗效相似,培美曲塞组不良反应的发生率较低,耐受性较好。     

吉非替尼联合择期放疗治疗晚期非小细胞肺癌的临床研究

目的 观察吉非替尼联合择期放疗治疗晚期非小细胞肺癌(NSCLC)的疗效和不良反应.方法 13例晚期NSCLC,应用吉非替尼治疗,对10例吉非替尼治疗获益的患者,根据患者及家属意愿分为联合组和对照组,每组5例,联合组联合放疗,对照组继续单独应用吉非替尼治疗直至病情进展.结果 到随访截止日期,全部患者1年生存率达53.8%(7/13),2年生存率达46.2%(6/13).联合组和对照组的中位无进展生存期(PFS)分别为24个月和8个月(P=0.0019),中位总生存期(OS)分别为32个月和10个月(P=0.0062).不良反应主要为皮疹和腹泻.无症状性肺纤维化3例.结论 吉非替尼联合择期放疗治疗晚期NSCLC可以显著延长PFS和OS,不良反应可以耐受,是NSCLC规范化治疗和个体化治疗的合理选择.

Abstract：

Objective To study the effect and toxicity ofgefitinib combined with selected radiotherapy in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Methods From March 2006 to February 2009,10 of 13 advanced NSCLC patients who got benefit from gefitinib were enrolled to treatment group (gefitinib concurrent selected radiotherapy) and control group (gefitinib only), with 5 cases in each group. The response was evaluated as progression free survival (PFS) and overall survival (OS).Results No patient got complete remission (CR). Ten of 13 patients got partial remission (PR) and stable disease (SD). The 1 year and 2 years survival rate was 53.8%(7/13) and 46.2%(6/13) respectively. The median PFS in treatment group and control group was 24 months and 8 months respectively(P= 0.0019). The median OS was 32 months and 10 months respectively (P= 0.0062). The main toxicities were reversible skin rash and diarrhea,and 3 patients developed asymptomatic radiation pulmonary fibrosis. Conclusions Gefitinib combining with selected radiotherapy is effective and tolerated in patients with advanced NSCLC. It may prolong PFS and OS. It may be a rational choice for the standard and individualized treatment of NSCLC.     

Estimating quality adjusted progression free survival of first-line treatments for EGFR mutation positive non small cell lung cancer patients in The Netherlands

ABSTRACT: BACKGROUND: Gefitinib, a tyrosine kinase inhibitor, is an effective treatment in advanced non-small cell lung cancer (NSCLC) patients with an activating mutation in the epidermal growth factor receptor (EGFR). Randomised clinical trials showed a benefit in progression free survival for gefitinib versus doublet chemotherapy regimens in patients with an activated EGFR mutation (EGFR M+). From a patient perspective, progression free survival is important, but so is health-related quality of life. Therefore, this analysis evaluates the Quality Adjusted progression free survival of gefitinib versus three relevant doublet chemotherapies (gemcitabine/cisplatin (Gem/Cis); pemetrexed/cisplatin (Pem/Cis); paclitaxel/carboplatin (Pac/Carb)) in a Dutch health care setting in patients with EGFR M + stage IIIB/IV NSCLC. This study uses progression free survival rather than overall survival for its time frame in order to better compare the treatments and to account for the influence that subsequent treatment lines would have on overall survival analysis. METHODS: Mean progression free survival for Pac/Carb was obtained by extrapolating the median progression free survival as reported in the Iressa-Pan-Asia Study (IPASS). Data from a network meta-analysis was used to estimate the mean progression free survival for therapies of interest relative to Pac/Carb. Adjustment for health-related quality of life was done by incorporating utilities for the Dutch population, obtained by converting FACT-L data (from IPASS) to utility values and multiplying these with the mean progression free survival for each treatment arm to determine the Quality Adjusted progression free survival. Probabilistic sensitivity analysis was carried out to determine 95% credibility intervals. RESULTS: The Quality Adjusted progression free survival (PFS) (mean, (95% credibility interval)) was 5.2 months (4.5; 5.8) for Gem/Cis, 5.3 months (4.6; 6.1) for Pem/Cis; 4.9 months (4.4; 5.5) for Pac/Carb and 8.3 (7.0; 9.9) for gefitinib. CONCLUSIONS: In the Dutch health care setting, the previously established progression free survival benefit of first-line gefitinib in advanced NSCLC EGFR M + patients in comparison to standard doublet chemotherapy is further supported by the Quality Adjusted PFS, which takes into account the additional health-related quality of life benefits of gefitinib over doublet chemotherapy.     

多西紫杉醇单药化疗在老年中晚期非小细胞肺癌的近期疗效分析

目的 观察了解多西紫杉醇单药化疗在老年晚期非小细胞肺癌（NSCLC）的临床疗效和毒性反应.方法 29例Ⅲ～Ⅳ期NSCLC老年患者均经病理组织学和（或）细胞学检查确诊.多西紫杉醇单药治疗后评价疗效.结果 29例患者均可评价,获得CR 2例,PR 10例,有效率41.4%（12/29）.1年生存率为48.3%（14/29）.最主要的毒副反应为白细胞及血小板降低,但均可耐受.结论 多西紫杉醇单药化疗治疗老年晚期NSCLC有较好疗效,可明显改善患者生存质量,毒副反应轻,易于耐受.     

晚期非小细胞肺癌两种含铂新方案的临床近期疗效比较

目的　观察NP(长春瑞宾加顺铂 )方案和GP(吉西他宾加顺铂 )方案两种含铂方案治疗晚期非小细胞肺癌 (non -smallcelllungcancer,NSCLC)的近期疗效和毒副反应。方法　采用NP方案治疗晚期NSCLC2 5例 ,GP方案治疗 2 3例。结果　临床疗效 :GP组完全缓解 0例 ,部分缓解 8例 ,稳定 12例 ,进展 3例 ,有效率为 3 4 8% ;NP组完全缓解 0例 ,部分缓解 8例 ,稳定 13例 ,进展 4例 ,有效率为 3 2 0 %。两组有效率差异无统计学意义 (P =0 776 )。毒副反应 :GP组血小板减少明显 (P =0 0 0 9) ,NP组白细胞减少明显 (P =0 0 0 6 )。结论　NP方案和GP两种方案治疗晚期NSCLC均有效 ,两种方案疗效相似。两组均有血液毒性 ,GP方案以血小板减少为主 ,且有过敏现象 ;NP方案以白细胞减少为主 ,并有静脉炎和周围神经毒性。     

重组人血管内皮抑素联合放化疗在非小细胞肺癌的临床观察

目的观察重组人血管内皮抑素（恩度）联合放化疗和恩度联合化疗对非小细胞肺癌（NSCLC）的疗效及毒副反应。方法经病理证实43例NSCLC（Ⅱa~Ⅲb）,按随机原则并参考病人意愿分为实验组（恩度＋放化疗）24例和对照组（恩度＋化疗）19例,化疗方案吉西他滨1 000 mg/m2,第1、8 d,顺铂20 mg/m2,第1~5 d,28 d 1周期,共3~4周期;恩度15 mg/d,同步每化疗周期的第1~14 d。放疗采用常规剂量分割2 Gy/d,总剂量60~66 Gy,与第一周期化疗同时进行。结果有2例出现明显心脏毒性或骨髓抑制,未完成治疗,只作毒性分析。实验组的完全缓解率高于对照组（P〈0.05）,中位无疾病进展时间分别为8.3月和4.7月,1年生存率分别为78.3%和55.6%（P〈0.05）,完全缓解病例主要集中在Ⅱa期鳞癌,实验组未明显增加治疗的毒副反应。结论恩度联合放化疗治疗非晚期肺鳞癌有较好近期疗效,延长无疾病生存时间及1年生存率,安全性好。     

培美曲赛联合奥沙利铂二线治疗晚期非小细胞肺癌的回顾性研究

[目的]评价培美曲赛联合奥沙利铂用于晚期非小细胞肺癌二线治疗时的安全性和有效性。[方法2007年1月～2009年1月,一线治疗失败的晚期非小细胞肺癌患者中,一部分采用了培美曲赛单药或培美曲赛联合奥沙利铂化疗作为二线治疗,回顾他们的病历,并比较两组患者的临床特征,使用Kaplan-Meier法和时间等级检验分析两组之间生存期的差别。[结果]共79人纳入分析,34人使用PO方案(培美曲赛500mg/ml2d1+奥沙利铂125mg/m21,每21d重复),45人使用培美曲赛单药化疗。两组耐受性都较好,没有治疗相关性死亡发生,粒细胞减少是最常见的毒性反应。PO组的缓解率和肿瘤控制率分别为15.2%和63.6%,单药组则分别为11.1%、47.5%。PO组中位进展时间和中位生存期分别是18周(95%可信区间:13.72～22.28周)和31周(95%可信区间:15.56～46.44周),明显好于单药组(P值分别为0.002、0.006)。[结论]在晚期非小细胞肺癌的二线治疗中培美曲赛联合奥沙利铂化疗方案表现出与培美曲塞单药化疗方案相似的安全性和缓解率,生存期显著延长。     

多西他赛单药一线治疗老年晚期非小细胞肺癌的临床观察

目的观察多西他赛单药一线治疗老年晚期非小细胞肺癌患者的临床疗效。方法 30例晚期非小细胞肺癌初治老年患者予以多西他赛70mg/m~2治疗,21d为1周期,完成2周期后评价疗效,有效及稳定病例治疗4个周期,随访至疾病进展和死亡。结果 26名可评价病例中,总有效率26.9%,疾病控制率57.6%,中位无进展生存期3.6个月。中位生存期8.5个月,1年生存率为35.6%,主要毒副反应为细胞减少,乏力,脱发为主,分别为61%,64%,57%。结论国产多西他赛单药一线治疗老年晚期非小细胞肺癌有效且耐受性好。     

鸦胆子油乳联合GP方案治疗晚期非小细胞肺癌的临床观察

目的观察鸦胆子油乳注射液联合GP(吉西他滨+顺铂)方案治疗晚期非小细胞肺癌(NSCLC)患者的疗效、毒副反应及生活质量改善情况。方法将我院2007年6月至2011年10月期间80例晚期NSCLC患者随机分对照组和治疗组,对照组40例用GP方案治疗,治疗组40例用鸦胆子油乳+GP方案治疗,对比分析两组患者临床疗效、毒副反应以及生活质量情况。结果治疗组近期有效率47.5%与对照组45%比较,P>0.05,无统计学意义;两组患者白细胞减少、胃肠道反应,疼痛发生率比较,P<0.05,有统计学意义;两组患者血红蛋白减少、肝功能损害、肾功能损害发生率比较,P>0.05,无统计学意义;治疗组在生活质量改善方面72.5%明显优于对照组40%,P<0.01,有显著统计学意义。结论鸦胆子油乳注射液与GP方案联合治疗晚期NSCLC可明显提高患者生活质量,改善症状,减轻化疗毒副反应。     

Spotlight on Paclitaxel in Non-Small Cell Lung Cancer

A number of first-line chemotherapy options for patients with advanced non-small cell lung cancer (NSCLC) are advocated in treatment guidelines and/or by various clinical investigators. Platinum-based chemotherapy has clearly demonstrated efficacy in patients with advanced NSCLC and is generally recommended as first-line therapy, although there is increasing interest in the use of non-platinum chemotherapy regimens. Among the platinum-based combinations currently used in clinical practice are regimens such as cisplatin or carboplatin combined with paclitaxel, vinorelbine, gemcitabine, docetaxel or irinotecan. The particular combinations employed may vary between institutions and geographic regions.Several pharmacoeconomic analyses have been conducted on paclitaxel in NSCLC and most have focused on its use in combination with cisplatin. In terms of clinical efficacy, paclitaxel-cisplatin combinations achieved significantly higher response rates than teniposide plus cisplatin or etoposide plus cisplatin (previously thought to be among the more effective regimens available) in two large randomized trials. One of these studies showed a survival advantage for paclitaxel plus cisplatin [with or without a granulocyte colony-stimulating factor (G-CSF)] compared with etoposide plus cisplatin.A Canadian cost-effectiveness analysis incorporated data from one of the large randomized comparative trials and showed that the incremental cost per life-year saved for outpatient administration of paclitaxel plus cisplatin versus etoposide plus cisplatin was $US22 181 (30 619 Canadian dollars; $Can) [1997 costs]. A European analysis incorporated data from the other large randomized study and showed slightly higher costs per responder for paclitaxel plus cisplatin than for teniposide plus cisplatin in The Netherlands ($US30 769 vs $US29 592) and Spain ($US19 923 vs $US19 724) but lower costs per responder in Belgium ($US22 852 vs $US25 000) and France ($US28 080 vs $US34 747) [1995/96 costs].In other cost-effectiveness analyses, paclitaxel plus cisplatin was associated with a cost per life-year saved relative to best supportive care of approximately $US10 000 in a US study (year of costing not reported) or $US11 200 in a Canadian analysis ($Can15 400; 1995 costs). Results were less favorable when combining paclitaxel with carboplatin instead of cisplatin and particularly when G-CSF was added to paclitaxel plus cisplatin. The Canadian study incorporated the concept of extended dominance in a threshold analysis and ranked paclitaxel plus cisplatin first among several comparator regimens (including vinorelbine plus cisplatin) when the threshold level was $Can75 000 ($US54 526) per life-year saved or per quality-adjusted life-year gained (1995 values). Conclusions: Current treatment guidelines for advanced NSCLC recognize paclitaxel-platinum combinations as one of the first-line chemotherapy treatment options. In two large head-to-head comparative clinical trials, paclitaxel plus cisplatin was associated with significantly greater response rates than cisplatin in combination with either teniposide or etoposide, and a survival advantage was shown for paclitaxel plus cisplatin (with or without G-CSF) over etoposide plus cisplatin. There are limitations to the currently available pharmacoeconomic data and further economic analyses of paclitaxel-carboplatin regimens are warranted, as this combination is widely used in NSCLC and appears to have some clinical advantages over paclitaxel plus cisplatin in terms of ease of administration and effects on platelets. Nevertheless, results of various cost-effectiveness studies support the use of paclitaxel-platinum combinations, particularly paclitaxel plus cisplatin, as a first-line chemotherapy treatment option in patients with advanced NSCLC.     

Impact of early radiological response evaluation on radiotherapeutic outcomes in the patients with nasal cavity and paranasal sinus malignancies

We analyzed the correlation between primary tumor response within 6 months after radiation therapy (RT) including proton beam therapy (PBT) and progression free survival rate (PFS) in patients with nasal cavity and paranasal sinus malignancies to clarify the impact of early radiological evaluation of treatment response on prognosis. Sixty-five patients treated between January 1998 and December 2008, and whose follow-up duration was more than 2 years were included. The Response Evaluation Criteria in Solid Tumors (version 1.1) was used for the evaluation of treatment. Median age was 59 years (range 21–83 years). Olfactory neuroblastoma (n = 20, 30%) and squamous cell carcinoma (n = 15, 23%) were the major pathological tumor types. The median follow-up duration was 51.6 months. Radiological response evaluation within 6 months after treatment demonstrated that 15% of the patients achieved complete response (CR), and 3-year progression free survival rates of all patients was 49.2%. The 3-year PFS rates according to response for the treatment were 55.6% in the patients with CR and 46.4% in those with non-CR, respectively (P = 0.643). However, the 3-year PFS rates were 80.% in the patients with CR and 10.% in those with non-CR (P = 0.051) in the patients with squamous cell carcinoma (SCC) histology. Radiological response evaluation within 6 months did not have a significant impact on prognosis when analysis included all histology, although early radiological response within 6 months after RT had a borderline significant impact on treatment outcomes for the patients with nasal and paranasal SCC.