分子靶向治疗在Ⅲb/Ⅳ期非小细胞肺癌一线治疗中的应用

Ⅲb/Ⅳ期非小细胞肺癌一线化疗的疗效已进入瓶颈期.分子靶向药物的出现,给晚期非小细胞肺癌的一线治疗带来了划时代的变革,极大地改善了晚期非小细胞肺癌患者的生活质量、提高了生存期.全文就分子靶向治疗在晚期非小细胞肺癌一线治疗中的应用作一综述.     

化疗联合局部热疗治疗晚期非小细胞肺癌

[目的]探讨化疗联合局部射频热疗治疗晚期非小细胞肺癌的治疗效果。[方法]89例ⅢB期或Ⅳ期非小细胞肺癌病人分为热化疗联合治疗组和单纯化疗组,观察近期疗效和生存情况。[结果]热化疗组有效率26.8%,单纯化疗组为25.0%(P=0.844);热化疗组肿瘤控制率为78.0%,明显高于单纯化疗组的45.8%(P=0.002)。两组病人的中位生存期均为9个月。[结论]热化疗联合治疗晚期非小细胞肺癌可以明显提高肿瘤控制率,但在生存期方面较单纯化疗没有明显优势。     

非小细胞肺癌的治疗:40年回眸与七个进展点

早期,非小细胞肺癌术后5年生存率只有30%左右,肺癌化疗主要药物是盐酸氮芥和氧化氮芥,晚期非小细胞肺癌的1年生存率只有10%左右,放射治疗是用深部X线或60钴。现在,有七个进展点:①手术治疗进展包括:系统淋巴结清扫术,气管隆凸或血管重建术及支气管成形术,电视胸镜技术(VATS)以及某些特定条件下Ⅳ期非小细胞肺癌的手术治疗(例如周围型肺癌脑转移,如果两者都是单个病灶可以手术完全切除);②放射治疗进展,三维适形放疗(3DCRT)和调强适形放疗(IMRT)提高了疗效且减少对周围肺组织的损伤;③化学治疗的进步:第3代化疗新药与铂类药物结合可把总有效率提高至40%左右,化疗类别进一步分为:新辅助化疗,术后辅助化疗,姑息性化疗和补救性化疗,其中,辅助性化疗和姑息性化疗近年来已得到确认;④放射治疗与化疗结合是局部晚期非小细胞肺癌的治疗模式;⑤生物治疗的进步,EGFR-TKIs(Iressa或Tarceva)已分别在东方和西方作为非小细胞肺癌二线或三线治疗药物;⑥Avastin与化疗药物相结合的生物化疗在非鳞性非小细胞肺癌的治疗中开创了新模式;⑦中医药治疗非小细胞肺癌具有改善生活质量和延长生存期的作用。     

吉非替尼治疗老年晚期非小细胞肺癌55例

老年局部晚期(Ⅲb期)和转移性(Ⅳ期)非小细胞肺癌(NSCLC)患者在肺癌人数中约占70%左右 [1],目前推荐的治疗标准是第3代化疗药物的单药治疗,部分体能评分较好的老年患者可接受标准的以铂类为基础的两药联合化疗.但是老年患者在一线化疗失败后大多不能耐受继续化疗,甚至很多患者因为体能评分差、化疗反应或不愿接受细胞毒药物治疗等而不能化疗 [2].吉非替尼是治疗晚期非小细胞肺癌(NSCLC)分子靶向药物,其有效性和良好的耐受性为此类患者带来了希望 [3].本文回顾总结我院于2007年1月至2009年1月用吉非替尼治疗的老年局部晚期和转移性非小细胞肺癌(NSCLC)患者的疗效、不良反应,旨在更好地认识吉非替尼对老年非小细胞肺癌患者的有效性与安全性.     

盖诺联合顺铂治疗晚期非小细胞肺癌临床观察

肺癌已日益成为威胁人类生命健康的罪魁祸首,在我国乃至世界范围内,其发病率和死亡率均居恶性肿瘤之首。只有不足30%的患者可以接受手术治疗,而70%以上的患者在诊断时已为晚期,其中近80%为非小细胞肺癌。所以化疗成为晚期非小细胞肺癌的主要治疗手段,化疗可使不能接受手术的Ⅲ、Ⅳ期患者生存期显著延长,生存质量显著改善。     

3D-CRT放疗联合同步化疗治疗局部晚期非小细胞肺癌疗效观察

非小细胞肺癌占肺癌总数的75%左右,其中近70%患者确诊时已属于晚期,丧失手术治疗机会[1]。近来,同步放化疗是不能手术Ⅲ期非小细胞肺癌患者的标准治疗[2]。我科自2009年3月至2010年12月,采用三维适形放疗、同步采用含铂两药方案化疗,治疗局部晚期非小细胞肺癌患者,现报告如下。     

130例晚期非小细胞肺癌的预后分析

目的:回顾分析130例晚期非小细胞肺癌(NSCLC)的预后因素,探讨化疗方案、疗程数、转移情况、治疗效果等因素对晚期非小细胞肺癌预后的影响,从而指导临床的个体化规范化治疗.方法:1996年1月至2003年12月130例经组织学或细胞学确诊的晚期非小细胞肺癌患者(Ⅲ期55例占42.3%,Ⅳ期75例占57.7%),至少接受1个周期化疗,观察生存期,分析影响预后的因素.结果:COX比例风险模型分析显示化疗疗程数和化疗效果有独立预后作用.单因素分析显示,不同方案、不同的化疗疗程数直接影响疗效及生存时间.结论:晚期非小细胞肺癌的治疗应根据循证医学的原则给予有效的化疗方案和合适的疗程数.     

热、化疗联合治疗晚期非小细胞肺癌初探

背景与目的晚期非小细胞肺癌化疗有效率低,而热、化疗联合已在多种实体瘤的治疗中取得良好效果。本研究旨在探讨热疗与化疗联合治疗晚期非小细胞肺癌的可行性及近期疗效。方法51例晚期非小细胞肺癌患者入选,其中热化疗组(HC组)22例,单纯化疗组(C组)29例,均给予NP(长春瑞滨 顺铂)或GP(吉西他滨 顺铂)方案化疗2个周期。热化疗组使用13.8MHz局部射频热疗机同步进行热疗,每周2次,共12次。结果热化疗组有效率为22.7%,单纯化疗组为13.8%(P>0.05);热化疗组临床受益率为68.2%,而单纯化疗组为34.5%(P<0.05)。两组患者治疗前后KPS评分的变化无统计学意义。结论初步观察到热、化疗联合治疗晚期非小细胞肺癌有良好的耐受性和较好的近期疗效,值得进一步研究。     

复方苦参注射液联合长春瑞宾治疗老年性肺癌的临床观察

肺癌是全球肿瘤死亡的首要病因,老年患者发病高峰年龄为70~80岁。其中非小细胞肺癌占肺癌发生率的80%以上,而且超过50%的非小细胞肺癌患者在诊断时已处于晚期。目前老年晚期非小细胞肺癌的治疗主要是以全身化疗为主的综合治疗。长春瑞宾是目前单药治疗非小细胞肺癌     

健择联合顺铂治疗Ⅳ期非小细胞肺癌的疗效

肺癌中75%～80%为非小细胞肺癌(NSCLC),而且2/3患者确诊时已属晚期不能手术,一般给予姑息性化疗.以DDP为基础的联合化疗被认为是对晚期NSCLC有效的方案之一,我院近来采用健择联合顺铂治疗非小细胞肺癌患者24例,经临床观察现报告如下.     

Murine strain differences in ovotoxicity following intraovarian injection with benzo(a)pyrene, (+)-(7R,8S)-oxide, (-)-(7R,8R)-dihydrodiol, or (+)-(7R,8S)-diol-(9S,10R)-epoxide-2

Murine ovarian tumors produced by polycyclic aromatic hydrocarbons like benzo(a)pyrene (BP) require small oocyte destruction. Small oocyte destruction was evaluated in C57BL/6N (B6), DBA/2N (D2), and C57BL/6J X DBA/ 2JF1 (B6D2F1) mice following intraovarian injection with BP, (+)-( 7R ,8S)-oxide, (-)-( 7R , 8R )-dihydrodiol [(-)-DHD], or (+)-( 7R ,8S)-diol-(9S, 10R )-epoxide-2 [(+)- DE2 ] at doses ranging from 0.01 to 30 micrograms/ovary. BP, (-)-DHD, and (+)- DE2 produced small oocyte destruction in a dose-dependent fashion. The (+)-( 7R ,8S)-oxide did not destroy small oocytes at the highest dose tested (10 micrograms/ovary). The rank orders of the calculated doses which resulted in the destruction of 50% of the small oocytes (ED50S) for small oocyte destruction were BP approximately equal to (-)-DHD greater than (+)- DE2 in all three groups of mice. However, the ED50S for BP and (-)-DHD differed considerably among B6, D2, B6D2F1 mice; ED50S were smallest in B6 mice and largest in D2 mice. The ED50S for oocyte destruction in B6D2F1 mice were intermediate or similar to ED50S for B6 mice, depending on the method used for calculation. In spite of large strain differences in ED50S for BP and (-)-DHD, the ED50S for (+)- DE2 were similar in B6, D2, and B6D2F1 mice. The similar ED50 for (+)- DE2 suggests that it is an ultimate ovotoxin and ovarian carcinogen and that the target molecule(s) and mechanism(s) of detoxification are similar in B6, D2, and B6D2F1 mice.     

A new orally active antitumor 1R,2R-cyclohexanediamine-platinum(IV) complex: trans-(n-valerato)chloro(1R,2R-cyclohexanediamine) (oxalato)platinum(IV)

Purpose: The authors have previously reported that trans-bis(n-valerato)(1R,2R-cyclohexanediamine) (oxalato)platinum(IV) (C5-OHP), an oxaliplatin derivative, is an orally active antitumor agent in an intraperitoneal (i.p.) L1210 murine leukemia model. In this study, several oxaliplatin derivatives of the general formula trans-(carboxylato)chloro(1R,2R-cyclohexanediamine)(oxalato)platinum(IV) were synthesized in order to find new derivatives with greater oral activity than C5-OHP in a clinically predictive tumor model. In the formula, the carboxylate and chloride ligands are situated in axial positions. Methods: Four complexes with the axial carboxylate ligands n-butyrate, n-valerate, n-caproate or n-heptanoate were synthesized and designated C4-OHP-Cl, C5-OHP-Cl, C6-OHP-Cl and C7- OHP-Cl, respectively. The oral antitumor activity of the complexes was evaluated against the murine reticulosarcoma M5076 implanted subcutaneoulsy (s.c.) in to male BDF₁ mice. The complexes were administered orally daily for 5 days in two cycles initiated on days 5 and 12 postimplantation. The physicochemical properties were examined by measuring the concentrations of the complexes in test solutions at intervals by HPLC. The pharmacokinetic behaviors of C5-OHP-Cl, C6-OHP-Cl and C5-OHP following a single oral administration were studied in non-tumor-bearing male BDF₁ mice. Results: Of the complexes synthesized in this study, C5-OHP-Cl, which exhibited high activity in the i.p. L1210 model, was found to be orally active in the s.c. M5076 model while C5-OHP was not. The in vitro reduction of the complexes by ascorbate was much more rapid than that of C5-OHP, while the complexes were more stable than C5-OHP in HCl-acidic and alkaline solutions. Pharmacokinetic study showed that C_max and AUC_0–24h values of plasma total and filterable platinum of C5-OHP-Cl were four to six times greater than those of C5-OHP, indicating that C5-OHP-Cl was absorbed more than C5-OHP. Conclusion: C5-OHP-Cl was found to be a superior l-OHP derivative C5-OHP, exhibiting significant oral antitumor activity in the s.c. M5076 model. The enhanced activity of C5-OHP-Cl was considered to be due in part to increased susceptibility to reduction and increased gastrointestinal absorption. C5-OHP-Cl is a suitable candidate for further study as an oral cancer chemotherapy agent. Received: 22 January 1998 / Accepted: 20 May 1998