替西罗莫司治疗转移性肾细胞癌初探

目的探讨替西罗莫司治疗转移性肾细胞癌的效果。方法 2008年6月4日至2008年12月18日共入组12例转移性肾细胞癌患者,接受替西罗莫司单药治疗,25mg,静脉滴注30～50分钟,每周1次,直至肿瘤进展或出现不可耐受的毒副作用。结果 12例患者中,按MSKCC评分中高危占75%(9/12),其中10例为多程治疗失败。最佳疗效:PR 2例(16.7%),另有6(50%)例患者出现不同程度的肿瘤缩小,PD 2例(16.7%)。临床受益率(CR+PR+SD≥24周)为41.7%(5/12)。中位PFS为8.4个月,中位OS 16.4个月。4例索拉非尼失败的患者的PFS分别为9个月、15个月、2.2个月和18.8个月。主要不良反应包括:皮疹、瘙痒、指甲改变、发热、口腔溃疡、高血糖、胆固醇和甘油三酯升高等。1例患者发生了V度间质性肺炎。结论替西罗莫司治疗转移性肾癌有效,对索拉非尼或舒尼替尼失败的患者的疗效值得进一步研究。代谢异常和间质性肺炎是需要重视的不良反应。

Temsirolimus for metastatic renal cell carcinoma:experience from a single center

Objective To evaluate the efficacy and safety profile of temsirolimus in Chinese renal cell carcinoma pa- tients. Methods From June 2008 to December 2008, 12 patients with renal cell carcinoma were enrolled and received temsirolimus 25 mg Ⅳ qw until disease appeared progression or intolerable side effects occurred. Results 9 （75 % ） out of the 12 patients were at intermediate or high risk according to the MSKCC criterion. 10 （83.3%） patients were heavily pretreated. The median treatment duration is 5.8 months. 2 （ 16. 7% ） patients achieved PR, 8 （61.5%） achieved SD as their best response. 6 （50%） additional patients had tumor shrinkage less than 30%. The clinical benefit rate （ CR ＋ PR＋SD≥24 weeks） was 41.7% （5/12）, with a median PFS of 8.4 months and median OS of 16.4 months for the whole cohort. 4 patients failed with previous sorafenib had PFS of 9, 15, 2. 2 and 18. 8 months respectively. The most common side effects included skin rash, itch, nail disorder, pyrexia, oral mucositis, hyperglycemia, and hypertriglyceri- demia. 1 patient developed grade V interstitial lung disease. 6 additional patients had radiographic lung abnormalities on their follow-up CT scan during treatment. Conclusion Temsirolimus is an active agent for metastatic renal cell carcino- ma. Metabolic abnormality and interstitial lung disease should be monitored carefully.