阿帕替尼治疗晚期非小细胞肺癌的疗效观察

目的探讨阿帕替尼治疗晚期非小细胞肺癌患者的临床疗效及用药安全。方法选取2016年1月至2017年12月间淮安市淮阴医院收治的60例晚期非小细胞肺癌患者,采用随机数表法分为对照组和阿帕替尼组,每组30例。对照组患者采用培美曲塞联合卡铂治疗,阿帕替尼组患者在对照组基础上辅以阿帕替尼,两组均治疗8周,比较两组患者治疗前后血清肿瘤标志物水平、临床治疗效果和不良反应发生情况。结果阿帕替尼组患者临床总有效率为70. 0%,对照组为46. 7%,两组比较,差异有统计学意义(P <0. 05)。治疗后,阿帕替尼组患者糖类蛋白50 (CA50)、CA199、CA125和癌胚抗原(CEA)水平均低于对照组患者,差异均有统计学意义(均P <0. 05)。阿帕替尼组患者不良反应发生率为23. 3%,对照组为53. 3%,两组比较,差异有统计学意义(P <0. 05)。结论常规培美曲塞联合卡铂辅以阿帕替尼治疗晚期非小细胞肺癌,可有效降低患者血清肿瘤标志物水平,提高临床疗效,且临床用药安全性良好,有良好的临床应用价值。     

多西他赛联合阿帕替尼二线治疗非鳞癌非小细胞肺癌的有效性及安全性分析

  目的   观察多西他赛联合阿帕替尼二线治疗晚期非鳞癌非小细胞肺癌的疗效及安全性。   方法   选取2015年2月至2016年8月平顶山市第一人民医院收治的符合标准的晚期非小细胞肺癌患者39例,随机进入研究组和对照组。研究组接受多西他赛60 mg/m2,d1,甲磺酸阿帕替尼500 mg/d,d1~21,21 d为1个周期。对照组接受多西他赛单药化疗,直到疾病进展（progressive disease,PD）或不良反应不可耐受。分析两组患者的疾病控制率（disease control rate,DCR）、不良事件发生率、无进展生存时间（progression-freesurvival,PFS）。   结果   中位随访时间4.6个月,研究组和对照组的DCR率分别为63.2%和30.0%,两组比较具有统计学意义（P=0.039）;研究组最常见的3~4级不良事件为血液学毒性（47.3%）,与对照组（15%）比较差异具有统计学意义（P=0.032）。研究组和对照组的中位PFS分别为5.6个月（95%CI:4.8~6.3）和3.0个月（95%CI:1.8~4.1）,两者比较差异有统计学意（χ2=4.17,P=0.04）。   结论   多西他赛联合阿帕替尼二线治疗晚期非鳞癌非小细胞肺癌不良反应可控,可显著提高DCR及PFS。      

阿帕替尼联合雷替曲塞三线治疗晚期结直肠癌患者的临床疗效观察

目的探讨阿帕替尼联合雷替曲塞三线治疗晚期结直肠癌临床疗效观察。方法选取2014年5月至2017年5月间山东省淄博市第四人民医院收治的60例晚期结直肠癌患者进行回顾性分析,将采用静脉注射雷替曲塞联合阿帕替尼治疗的30例患者纳入研究组,采用静脉注射雷替曲塞治疗的30例患者纳入对照组。比较两组患者的治疗效果、不良反应及生活质量。结果治疗后研究组患者治疗总有效率为36. 7%,优于对照组患者的20. 0%,差异有统计学意义(P <0. 05)。研究组患者总生存时间和无进展生存时间均长于对照组,差异均有统计学意义(均P <0. 05)。两组患者生活质量评分比较,差异无统计学意义(P> 0. 05)。治疗后,两组患者主要的不良反应均为感觉神经毒性、肝肾功能损伤、消化道反应及血液学毒性。不良反应主要为Ⅰ～Ⅱ度,研究组患者白细胞减低发生率高于对照组,秃头发生率低于对照组,其他不良反应发生率无明显差异。结论雷替曲塞联合阿帕替尼治疗结直肠癌患者疗效较显著,可延长患者的生存时间,安全性较高。     

胸腺五肽注射液联合阿帕替尼治疗晚期胃癌的疗效观察

目的探讨胸腺五肽注射液联合阿帕替尼治疗晚期胃癌的疗效。方法选取2017年9月至2018年9月间山东省立第三医院收治的68例晚期胃癌患者。采用随机数表法分为观察组和对照组,每组34例。对照组患者采用阿帕替尼治疗,观察组患者采用胸腺五肽注射液联合阿帕替尼治疗,观察两组患者胃癌临床疗效,比较两组患者血常规各项指标、免疫学指标以及远期疗效。结果治疗前,两组患者血常规各项指标比较,差异无统计学意义(P> 0. 05);治疗后,观察组患者血红蛋白、血小板以及白细胞等指标均高于对照组患者,差异均有统计学意义(均P <0. 05)。治疗前,两组患者免疫学各项指标比较,差异无统计学意义(P>0. 05);治疗后,观察组患者CD3+和CD4+均高于对照组患者,CD8+低于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者治疗有效率为76. 5%,高于对照组的55. 9%,差异有统计学意义(P <0. 05)。结论采用胸腺五肽注射液联合阿帕替尼治疗晚期胃癌,能够有效提高患者血常规水平,恢复机体免疫功能指标水平,适合临床推广应用。     

安罗替尼三线治疗晚期非小细胞肺癌的临床研究

目的探讨安罗替尼三线治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法选取2018年6月至2019年6月间盐城市第二人民医院收治的46例晚期非小细胞肺癌患者,依据临床治疗方案不同分为研究组和对照组,每组23例。采用吉西他滨联合顺铂方案治疗的纳入对照组,采用盐酸安罗替尼胶囊治疗的纳入研究组,比较两组患者的临床疗效、不良反应及血气指标变化情况。结果研究组患者的有效率为73. 9%,高于对照组的43. 5%,差异有统计学意义(P <0. 05)。研究组患者不良反应发生率的13. 0%,低于对照组的39. 1%,差异有统计学意义(P <0. 05)。研究组患者治疗后的Pa CO2低于对照组,Pa O2和Sa O2高于对照组,差异均有统计学意义(均P <0. 05)。结论采用安罗替尼对晚期NSCLC患者行三线治疗,临床疗效甚佳,不良反应较低,可有效改善患者血气指标,值得在临床中普及应用及深层次多中心研究。     

复方苦参注射液联合阿帕替尼治疗非小细胞肺癌的疗效观察

目的探讨复方苦参注射液联合阿帕替尼治疗非小细胞肺癌患者的临床疗效。方法选取2016年1月至2020年1月间重庆市合川区人民医院收治的102例非小细胞肺癌患者,采用随机抽签法分为观察组和对照组,每组51例。对照组患者采用阿帕替尼治疗,观察组患者采用复方苦参注射液联合阿帕替尼治疗,比较两组患者治疗效果、不良反应及肿瘤标志物。结果观察组患者近期治疗有效率为35.3%,对照组为17.6%,两组比较,差异有统计学意义(P <0.05)。观察组患者骨髓抑制、血红蛋白减少和肝肾功能损伤不良反应率均低于对照组,差异均有统计学意义(均P <0.05)。治疗前,两组患者癌胚抗原(CEA)、糖蛋白抗原125 (CA125)和细胞角单白-19片段(CYFRA21-1)比较,差异无统计学意义(P> 0.05)。治疗后,观察组患者CEA、CA125和CYFRA21-1均低于对照组患者,差异均有统计学意义(均P <0.05)。结论非小细胞肺癌患者采用复方苦参注射液联合阿帕替尼治疗,可获得良好的疗效,确保瘤体缩小或消失,且减轻药物不良反应,值得推广。     

白介素-2联合胸腺五肽在晚期非小细胞肺癌化疗中的疗效观察

目的探讨白介素-2联合胸腺五肽对晚期非小细胞肺癌化疗患者的影响。方法选取2016年9月至2018年9月间广东省陆丰市人民医院收治的72例晚期非小细胞肺癌患者,采用随机数表法分为研究组和对照组,每组36例。对照组患者采用常规多西他塞+卡铂(TC方案)化疗,研究组患者在对照组治疗基础上采用白介素-2联合胸腺五肽治疗,比较两组患者的近期疗效及不良反应发生情况,于治疗前后检测两组患者免疫功能指标的变化。结果研究组患者近期疗效有效率为66. 7%,高于对照组患者的41. 7%,差异有统计学意义(P <0. 05)。治疗前,两组患者Ig A、Ig G和Ig M水平比较,差异无统计学意义(P> 0. 05)。治疗后,研究组患者Ig A、Ig G和Ig M水平高于对照组,差异均有统计学意义(均P <0. 05)。对照组患者治疗后Ig A、Ig G和Ig M水平低于治疗前,差异均有统计学意义(均P <0. 05)。研究组患者治疗前后Ig A、Ig G和Ig M水平组内比较,差异无统计学意义(P> 0. 05)。研究组患者的生活质量优于对照组,差异有统计学意义(Z=2. 75,P <0. 05)。研究组患者恶心呕吐、白细胞减少和感染的发生率均低于对照组患者,差异均有统计学意义(均P <0. 05)。结论白介素-2联合胸腺五肽能提高晚期非小细胞肺癌化疗患者的免疫功能,降低不良反应发生情况。     

阿帕替尼联合多西他赛与多西他赛二线治疗晚期非鳞非小细胞肺癌的疗效、安全性及预后对比

目的:对比阿帕替尼联合多西他赛与单纯多西他赛在晚期非鳞非小细胞肺癌(NSCLC)二线治疗中的疗效及安全性,并对预后影响因素进行分析。方法:纳入98例晚期非鳞NSCLC,随机分为治疗组（阿帕替尼联合多西他赛）48例以及对照组（多西他赛）50例,观察客观缓解率（ORR)、疾病控制率（DCR)、无进展生存期（PFS)、总生存期（OS）及不良反应,并将治疗组的临床病理因素纳入单因素及多因素分析。结果:两组患者近期疗效无明显差异;中位PFS分别为4.1个月与3.1个月（P=0.045）;中位OS分别为10.4个月与8.8个月（P=0.023）。两组患者3-4级不良反应发生例数未见明显差异。单因素分析显示中高分化、转移灶≤1个预后较好,多因素分析提示肿瘤分化程度是阿帕替尼联合多西他赛治疗晚期非鳞NSCLC的独立预后因素。结论:在晚期非鳞NSCLC二线治疗中,阿帕替尼联合多西他赛与多西他赛对比有生存获益,且耐受性好,肿瘤分化程度是独立的预后因素。     

奥沙利铂和替吉奥联合多西他赛治疗胃癌根治术后患者的疗效观察

目的探讨奥沙利铂+替吉奥(SOX方案)化疗辅助胃癌根治术对进展期胃癌患者临床疗效的影响。方法选取2011年6月至2012年6月间西安交通大学第一附属医院收治的120例进展期胃癌患者,采用随机数字表分为观察组和对照组,每组60例。两组患者均行胃癌D2根治术,术后1个月,两组患者均采用SOX方案治疗,观察组患者联合多西他赛治疗,比较两组患者的治疗效果、围手术期指标、不良反应及生存时间。结果治疗后,两组患者的卡氏评分均升高,且观察组高于对照组,差异有统计学意义(P <0. 05)。两组患者的癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA72-4、血管内皮生长因子(VEGF)和胰岛素样生长因子-1 (IGF-1)均较治疗前下降,且观察组患者均低于对照组,差异均有统计学意义(均P <0. 05)。观察组患者术后活检组织基质金属蛋白酶(MMP2)、MMP7和MMP9阳性表达均低于对照组,差异均有统计学意义(均P <0. 05)。观察组患者总生存时间和无瘤生存时间均低于对照组,差异均有统计学意义(均P <0. 05)。两组患者均发生骨髓抑制、消化道反应、静脉炎和肝功能异常,但各发生率比较,差异均无统计学意义(P>0. 05)。结论SOX方案联合多西他赛治疗胃癌患者,患者的治疗效果显著,安全性较好。     

多西他赛、雷替曲塞治疗无法手术胃癌患者的疗效及作用机制

目的 探讨多西他赛联合雷替曲塞治疗无法手术的晚期胃癌患者的疗效及对血清dickkopf WNT信号通路抑制剂1(DKK1)、三叶因子3(TFF3)和内皮抑制蛋白(endostatin)水平的影响.方法 采用随机数字表法将92例晚期无法接受手术治疗的胃癌患者分为研究组和对照组,每组46例.研究组采用多西他赛联合雷替曲塞治疗,对照组采用多西他赛联合5-氟尿嘧啶治疗.比较两组患者的疗效,化疗前后血清endostatin、DKK1、TFF3水平,不良反应发生情况及生存情况.结果 化疗后,研究组患者总有效率为75.56％,高于对照组的52.27％,差异有统计学意义(P﹤0.05).化疗前,两组患者血清endostatin、DKK1、TFF3水平比较,差异均无统计学意义(P﹥0.05);化疗后,研究组患者血清DKK1、TFF3水平均低于对照组,endostatin水平高于对照组,差异均有统计学意义(P﹤0.05).研究组患者恶心呕吐、骨髓抑制发生率均低于对照组,差异均有统计学意义(P﹤0.05).研究组患者中位生存时间为22.0个月,长于对照组的17.0个月,差异有统计学意义(P﹤0.05).结论 多西他赛联合雷替曲塞治疗无法手术的晚期胃癌患者较多西他赛联合5-氟尿嘧啶更具有优势.     

非鳞非小细胞肺癌基因检测技术研究进展

随着分子生物学技术的日益发展,基于基因检测指导下的精准医疗已成为非鳞非小细胞肺癌的主要诊治模式。目前临床应用较广的基因检测技术大致分为:基因芯片(gene chip)技术、二代测序技术（next generation sequencing technologies,NGS）、扩增阻滞突变系统（amplification refractory mutation system,ARMS）、Cobas、数字聚合酶链反应（digital polymerase chain reaction,dPCR）和荧光原位杂交技术（fluorescence in situ hybridization,FISH）等,这些技术各有独特的优势与不足,本文综述不同基因检测技术在非鳞非小细胞肺癌临床应用中的研究进展。     

Assessment of molecular events in squamous and non-squamous cell lung carcinoma

Although considerable knowledge exists on the tumor biology of lung cancer, there is still a need to assess molecular events for the clinical management of the disease. We studied the pattern of chromosomal imbalances in 45 non-small cell lung carcinomas (NSCLC) by comparative genomic hybridization (CGH) and correlated the results with clinicopathological features including immunohistochemical (IHC) expression of the epidermal growth factor receptor (EGFR). Twenty-one tumors were squamous cell carcinomas (SCC) and 24 non-squamous cell lung carcinomas (NSCC) comprising 9 adenocarcinomas (ADC), 9 large cell carcinomas (LCC), 4 sarcomatoid carcinomas and 2 adenosquamous carcinomas. The mean number of individual imbalances was 7.1 for SCC (mean gains, 3.8; mean losses, 3.4) and 6.4 for NSCC (mean gains, 4.5; mean losses, 1.9). Several individual imbalances correlated significantly with increasing number of imbalances, that were +1q, -3p, +3q, -5q, -8p, +8q, +7p, +12p, and +14q. Altogether, the most frequent imbalances were +3q (49%), +5p (49%), -5q (36%), +8q (29%), -8p (24%), -3p (22%), +7p (22%), +12p (22%), +14q (20%), +18p (20%), +1q (18%), and +7q (18%). Among these, +3q and +18p correlated significantly with SCC, and +5p and +14q with NSCC. Remarkably, overlapping imbalances included +3q26, +7p11 in SCC and +1q21, +3q24, +12p11, and +14q12 in NSCC. EGFR expression was higher in SCC than in NSCC and correlated with +3q in the entire series. In addition, +12p correlated significantly with disease progress with the exception of nodal involvement in NSCC as well as with disease progress, regardless of nodal involvement, in the entire series. In conclusion, the present study contributes to the molecular biological characterization of NSCLC histological subtypes and through evaluation of molecular events to the recently emergent focus on novel markers for lung cancer treatment.     

Clinical characteristics and outcome of non-squamous cell malignancies of the maxillary sinus

BACKGROUND AND OBJECTIVES: A significant paucity of data exists on non-squamous cancers of the maxillary sinus. The purpose of this study was to assess the clinical characteristics and outcomes of these tumors. METHODS: Retrospective review of 42 patients with complete available data and a diagnosis of non-squamous cancer of the maxillary sinus treated with curative intent between 1994 and 1999 were performed. Information recorded included demography, clinical characteristics, histopathological findings, treatment methods, and outcome. Survival was also compared with that of squamous cancers of the maxillary sinus. RESULTS: The majority of patients presented with locally advanced disease (83%). Malignancies were 14 sarcomas, 8 adenoid cystic carcinoma, 8 mucoepidermoid carcinoma, 2 adenocarcinoma, and 10 miscellaneous tumors. Fifteen (35.7%) patients developed recurrent disease and six developed distant metastases. The most common site of recurrence was local (32.5%). The overall mean survival was 71.7 months and 5-year overall and disease-free survival was 51% and 48%, respectively. In contrast, the mean survival in the selected 62 patients with squamous cancers was 40 months and 5-year survival was 29% (P = 0.01). Tumor stage, histological, and treatment type was not associated with significant survival advantage. CONCLUSIONS: Patients with non-squamous cancers of the maxillary sinus present with locally advanced disease. Local tumor progression remains a significant pattern of failure; however, unlike squamous cancers they have a better prognosis.     

Comparison of liposomal cisplatin versus cisplatin in non-squamous cell non-small-cell lung cancer

Purpose  

Liposomal cisplatin was developed to reduce the systemic toxicity of cisplatin, particularly the nephrotoxicity, and it has been used in combination with other agents in pancreatic and head and neck cancers and non-small-cell lung cancer (NSCLC). Our objective was to compare the effectiveness of lipoplatin combined with paclitaxel versus cisplatin with paclitaxel in advanced non-squamous NSCLC.     

Efficacy of bevacizumab-containing chemotherapy for non-squamous non-small cell lung cancer with bone metastases

Purpose

Skeletal-related events (SREs) negatively affect the quality of life of patients with cancer. Vascular endothelial growth factor receptor (VEGFR)-targeted therapy is effective against bone metastasis in animal models, but the clinical efficacy of anti-VEGFR inhibitors against bone metastases remains unclear. Therefore, we aimed to investigate the efficacy of chemotherapy with bevacizumab, an anti-VEGF antibody, against bone metastases.

Methods

We retrospectively reviewed consecutive patients with non-squamous non-small cell lung cancer who received first-line platinum-based chemotherapy with zoledronic acid at Shizuoka Cancer Center between 2007 and 2011.

Results

Of 25 patients, 13 received bevacizumab-based chemotherapy (BEV group) and 12 received chemotherapy without bevacizumab (non-BEV group). The overall response (54 vs. 8 %, p = 0.01) and disease control (100 vs. 50 %, p = 0.01) rates were higher in the BEV group than in the non-BEV group. The bone-specific response (23 vs. 0 %, p = 0.038) and disease control (100 vs. 67 %, p = 0.01) rates were also higher in the BEV group. The median time to progression (TTP) for bone metastases was higher in the BEV group (13.7 vs. 4.3 months, p = 0.06), whereas that for overall disease was similar between the groups (5.7 vs. 2.6 months, p = 0.17). The proportions of patients with SREs were 23 and 50 % in the BEV and non-BEV groups, respectively (p = 0.16).

Conclusion

Bevacizumab might potentiate the antitumor activity of chemotherapy against systemic disease and bone metastases, prolonging bone-specific TTP and reducing the incidence of SRE.     

气管,主支气管原发性非鳞癌恶性肿瘤：附17例分析

Seventeen patients with primary non-squamous cell carcinoma in the trachea and main bronchus are reported. Tomography and bronchoscopy are of great help in the diagnosis of this disease. CT scan is useful to show the extent of the tumor and lymph node metastasis. The treatment should depend on the extent of the lesion, pathologic type and general condition of the patient. Surgery is the treatment of choice for the early stage lesion, while pre- or post-operative irradiation is given to patients with larger tumor. In patients with localized lesion but unsuitable for operation because of late stage or poor differentiation of the tumor, radical radiotherapy alone should be used. A total dose of 70-80 Gy/7-8 weeks is suggested.     

贝伐珠单抗联合化疗治疗非鳞状细胞非小细胞肺癌的疗效观察

目的：观察贝伐珠单抗联合化疗治疗非鳞状细胞非小细胞肺癌的疗效和安全性.方法：回顾性分析2010年7月-2011年12月解放军总医院经组织病理学证实的局部进展或复发转移的非鳞状细胞非小细胞肺癌患者接受贝伐珠单抗联合化疗方案治疗的临床资料.贝伐珠单抗7.5mg/kg,每3周1次,联合多西他赛、培美曲塞或吉西他滨±铂类化疗.化疗2周期后按实体肿瘤疗效评价标准（RECIST）评价疗效,按美国癌症研究所制定的常见毒性判定标准（NCI-CTC） 3.0版评价不良反应.结果：21例患者中无完全缓解病例,部分缓解4例,稳定13例,进展4例,客观缓解率19.0％（4/21）,疾病控制率81.0％（17/21）,中位无疾病进展时间为7.0月,中位生存时间为10.4月.与贝伐珠单抗相关的不良反应出血6例（28.6％）,高血压1例（4.8％）,主要为Ⅰ、Ⅱ度,Ⅲ、Ⅳ度少见.结论：贝伐珠单抗联合化疗治疗进展或复发的非鳞状细胞非小细胞肺癌疗效确切,耐受性好.     

局部晚期非鳞非小细胞肺癌同步放化疗两种方案比较研究

目的 比较两种方案治疗局部晚期非鳞非小细胞肺癌副反应及近期疗效。方法 回顾2009年3月—2013年1月42例局部晚期非鳞非小细胞肺癌患者,所有患者均接受同步放化疗,A组放疗同步培美曲塞+顺铂化疗,B组放疗同步多西他赛+顺铂化疗,比较A、B两组患者副反应及近期疗效。结果 A组28例患者,B组14例患者,两组副反应比较,血液毒性:白细胞减少、中性粒细胞减少、血色素降低、血小板减少无统计学差异(P＞0.05)。非血液毒性:放射性肺损伤发生率、咳嗽发生率B组明显高于A组,有统计学差异(P＜0.05)。而其他非血液毒性:肝功能损伤、肾功能损伤、发热、呼吸困难、放射性食管炎、乏力、体重下降、消化道反应、皮肤反应均无统计学差异(P＞0.05)。近期疗效:A、B两组有效率分别为75%及71.43%,无统计学差异(P＞0.05)。结论 放疗同步培美曲塞+顺铂化疗与同步多西他塞+顺铂化疗的两组疗效无显著差异,但培美曲塞在治疗局部晚期非鳞非小细胞肺癌副反应方面存在一定优势。     

The effect of chemotherapy with cisplatin and pemetrexed for choroidal metastasis of non-squamous cell carcinoma

Purpose

Choroidal metastasis from lung cancer is very rare in the clinical setting. Treatment for lung cancer with symptomatic choroidal metastasis remains uncertain because of the rarity of such cases.

Methods

We performed a retrospective study on symptomatic choroidal metastasis from lung cancer at the Kaohsiung Medical University Hospital from January 2010 to August 2011. In addition, we also performed literature review of all such patients (or of cancers with choroidal metastasis) treated with systemic chemotherapy.

Results

In our study, a total of 226 lung cancer patients were registered during the study period, and only four had choroidal metastasis (4/226, 1.77 %). Three were female (75 %) and one was male, with a mean age of 40.74 (range 26–60) years. Three patients had marked choroidal tumor regression after treatment with pemetrexed and cisplatin. In the literature reviews, there are only 12 patients (including our patients) received systemic chemotherapy alone instead of local therapy and eight (66.7 %) demonstrated choroidal tumor regression after treatment.

Conclusions

Symptomatic choroidal metastasis from lung cancer is extremely rare. Our findings indicate that systemic chemotherapy with pemetrexed and cisplatin may be a good option for such patients. Further large-scale studies for the treatment of such patients are warranted. However, currently, radiotherapy is still the gold standard for such patients.