蘋果酸舒尼替尼二線治療胃腸間質(zhì)瘤的臨床觀察
發(fā)布時(shí)間：2018-08-06 09:17
【摘要】：背景胃腸道間質(zhì)瘤(Gastrointestinal Stromal Tumor,GIST)是目前臨床上最常見(jiàn)的間葉源性的腫瘤,占全部胃腸道腫瘤的1%~3%,而其中的原發(fā)部位以胃部最為常見(jiàn)(約為60%~70%),其次為小腸(大約為20%~30%),腸系膜、網(wǎng)膜及腹盆腔較為少見(jiàn)。據(jù)目前臨床資料統(tǒng)計(jì),每年我國(guó)的一百萬(wàn)人口中大約有10~20個(gè)新發(fā)的胃腸道間質(zhì)瘤的病例出現(xiàn)。手術(shù)切除是可切除胃腸道間質(zhì)瘤的標(biāo)準(zhǔn)治療方法,經(jīng)過(guò)手術(shù)切除后,約有40%~80%的GIST患者出現(xiàn)局部復(fù)發(fā)或遠(yuǎn)處的轉(zhuǎn)移,5年生存率只有45%,其中轉(zhuǎn)移型的患者1年生存率不到30%。靶向治療藥物格列衛(wèi)(甲磺酸伊馬替尼)對(duì)胃腸道間質(zhì)瘤具有良好的療效,但在治療過(guò)程中出現(xiàn)63%的耐藥率。蘋果酸舒尼替尼(索坦)是目前唯一被批準(zhǔn)作用于伊馬替尼耐藥的患者的二線藥物,但是國(guó)內(nèi)對(duì)此類的研究報(bào)道非常的少。目的探討格列衛(wèi)(甲磺酸伊馬替尼)臨床治療失敗后,二線靶向治療藥物索坦(蘋果酸舒尼替尼)臨床治療胃腸道間質(zhì)瘤的療效及安全性。方法回顧性分析,收集2010年1月至2016年5月在安徽醫(yī)科大學(xué)第一附屬醫(yī)院普外科收治的經(jīng)病理和免疫組化確診的GIST患者32例,所有的胃腸道間質(zhì)瘤患者均在格列衛(wèi)臨床治療失敗后,用二線靶向治療藥物舒尼替尼治療,以37.5mg/d的劑量,連續(xù)性給藥服用。觀察評(píng)估舒尼替尼的不良反應(yīng)及患者的生存時(shí)間。結(jié)果1、本組共32例患者,其中男性患者有22例,女性患者有10例,男性∶女性為2.2∶1,男性患者多見(jiàn),中位發(fā)病年齡為64歲,平均發(fā)病年齡為55.6歲,其中40~60歲的患者較多見(jiàn)。2、32例患者約在使用甲磺酸伊馬替尼12~24個(gè)月出現(xiàn)了病情的進(jìn)展,且在出現(xiàn)病情進(jìn)展后繼續(xù)服用甲磺酸伊馬替尼3~6個(gè)月后,病情進(jìn)展不能得到控制。3、32例患者在服用蘋果酸舒尼替尼后,部分患者的腫瘤病灶增長(zhǎng)停止或逐漸縮小,絕大部分患者的病情得到了控制或逐漸緩解。4、入組的32例患者在服用甲磺酸伊馬替尼后,出現(xiàn)的不良反應(yīng)為:水鈉潴留、皮膚色素減退、皮膚過(guò)敏、血液毒性、心血管毒性等;在服用蘋果酸舒尼替尼后,除了甲磺酸伊馬替尼常見(jiàn)的不良反應(yīng)外還有些特殊的不良反應(yīng),包括手足綜合征、甲狀腺功能減退、心臟毒性和高血壓等。5、32例胃腸道間質(zhì)瘤患者的1年和2年生存率分別為78%和46.9%;中位pfs為55周,中位os為96周;其中存活時(shí)間最長(zhǎng)的患者已存活5年以上。結(jié)論1胃腸道間質(zhì)瘤是一種較少見(jiàn)的胃腸道間葉源性腫瘤,其發(fā)病年齡在40~60歲之間居多,男性患者多于女性患者。2對(duì)于胃腸道間質(zhì)瘤患者,術(shù)后予以甲磺酸伊馬替尼靶向治療,可以明顯改善或延緩患者病情的進(jìn)展,但是隨著藥物的使用,患者逐漸出現(xiàn)了藥物的耐受性增強(qiáng),繼續(xù)服用甲磺酸伊馬替尼效果不佳。3對(duì)于對(duì)甲磺酸伊馬替尼耐藥的胃腸道間質(zhì)瘤患者,二線應(yīng)用蘋果酸舒尼替尼,能明顯控制病情的進(jìn)展,早期應(yīng)用對(duì)于胃腸道間質(zhì)瘤是有效的。4胃腸道間質(zhì)瘤患者,服用甲磺酸舒尼替尼會(huì)出現(xiàn)不同的不良反應(yīng),但是不良反應(yīng)尚能耐受。在予以蘋果酸舒尼替尼治療后不良反應(yīng)有:白細(xì)胞減少、肝功能損害、甲狀腺功能減退、血小板減少、手足綜合征、食欲減退、乏力、口腔黏膜炎和皮膚毒性等,不良反應(yīng)多為1~2級(jí),而3~4級(jí)較少,無(wú)因不良反應(yīng)出現(xiàn)停藥的患者,癥狀均可控制。5對(duì)甲磺酸伊馬替尼治療耐藥或治療失敗的胃腸道間質(zhì)瘤患者,予以蘋果酸舒尼替尼繼續(xù)治療,對(duì)于部分患者是可以使病情得到緩解的,甚至得到完全控制,故本研究對(duì)于一線靶向藥物治療失敗的應(yīng)用二線藥物治療胃腸道間質(zhì)瘤的治療有重要的參考價(jià)值。
[Abstract]:Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal tumor in the clinic, which accounts for the 1%~3% of all gastrointestinal tumors. The primary site is the most common (about 60%~70%) in the stomach, followed by the small intestine (about 20%~ 30%), mesentery, omentum and abdominal pelvic cavity are rare. According to the present clinical practice, the mesenteric, omentum and abdominal pelvic cavity are rare. Data statistics show that about one million of the one million people of our country have new cases of gastrointestinal stromal tumors each year. Surgical excision is a standard treatment for excision of gastrointestinal stromal tumors. After surgical excision, about 40%~80% of GIST patients have local recurrence or distant metastasis, and the 5 year survival rate is only 45%. The 1 year survival rate was less than the 30%. target therapy drug Greve (imatinib mesylate) had a good effect on gastrointestinal stromal tumors, but there was a 63% resistance rate during the treatment. Sulanitinib (Sultan) was the only second-line drug approved for imatinib resistance in patients, but the domestic study of this kind of drug Objective to investigate the efficacy and safety of the second line targeted drug Sultan (sulonate) in the clinical treatment of gastrointestinal stromal tumors after the failure of the clinical treatment of gleevin (imatinib mesylate). Methods a retrospective analysis was carried out in the Department of general surgery, the First Affiliated Hospital of Medical University Of Anhui, from January 2010 to May 2016. 32 patients with GIST were confirmed by pathology and immunohistochemistry. All the patients with gastrointestinal stromal tumors were treated with the second line target therapy, sulnitinib, with the dose of 37.5mg/d and continuous administration after the failure of gleguard's clinical treatment. The adverse reaction of sulninib and the patient's survival time were observed and evaluated. Results 1, 32 cases in this group. In the patients, there were 22 male patients, 10 female patients, male: 2.2: 1, male patients, the median age of 64 years and the average age of 55.6 years old, among which 40~60 years of age were seen in.2,32 patients about 12~24 months in the use of imatinib mesylate. After taking imatinib methanesulfonate for 3~6 months, the progression of the disease could not be controlled in.3,32 patients after taking suoninib malate, the tumor growth of some patients was stopped or gradually reduced, and the most of the patients were controlled or gradually relieved.4. The 32 patients in the group entered after taking imatinib mesylate. The adverse reactions are: water and sodium retention, skin pigmentation, skin allergy, hematological toxicity, cardiovascular toxicity, and some special adverse reactions, including hand foot syndrome, hypothyroidism, cardiac toxicity and hypertension, in addition to the common adverse reactions of imatinib methanesulfonate after taking sulonate malate, including hand foot syndrome, hypothyroidism, cardiac toxicity and hypertension. The 1 and 2 year survival rates of patients with stromal tumors were 78% and 46.9% respectively, median PFS was 55 weeks and median OS was 96 weeks; the longest surviving patients had survived for more than 5 years. Conclusion 1 gastrointestinal stromal tumors were a rare gastrointestinal lobar tumor with the majority of the age between 40~60 years, and the male patients were more than the female patients with.2. In patients with gastrointestinal stromal tumors, imatinib methanesulfonate targeted therapy after operation can significantly improve or delay the progression of the patient's condition, but with the use of the drug, the patient has gradually increased the tolerance of the drug, and the continued use of imatinib mesylate.3 for the imatinib mesylate resistant gastrointestinal stroma The tumor patients, the second line application of sulonnioil, can obviously control the progress of the disease. Early application of the gastrointestinal stromal tumor is an effective.4 gastrointestinal stromal tumor, taking suloninionate may have different adverse reactions, but the adverse reactions are still tolerable. Cytopenia, impairment of liver function, hypothyroidism, thrombocytopenia, hand foot syndrome, anorexia, asthenia, oral mucositis and skin toxicity and so on. Adverse reactions are mostly 1~2, and 3~4 is less, and there are no patients who have been stopped by adverse reactions, and the symptoms are controlled by.5 against imatinib in the treatment of drug resistance or the failure of the gastrointestinal tract. The patients with stromal tumors are treated with sugate malate, which can be relieved and even completely controlled for some patients. Therefore, this study is of important reference value for the treatment of gastrointestinal stromal tumors by the second line drugs for the failure of the first line targeting drug therapy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735
本文編號(hào)：2167263
[Abstract]:Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal tumor in the clinic, which accounts for the 1%~3% of all gastrointestinal tumors. The primary site is the most common (about 60%~70%) in the stomach, followed by the small intestine (about 20%~ 30%), mesentery, omentum and abdominal pelvic cavity are rare. According to the present clinical practice, the mesenteric, omentum and abdominal pelvic cavity are rare. Data statistics show that about one million of the one million people of our country have new cases of gastrointestinal stromal tumors each year. Surgical excision is a standard treatment for excision of gastrointestinal stromal tumors. After surgical excision, about 40%~80% of GIST patients have local recurrence or distant metastasis, and the 5 year survival rate is only 45%. The 1 year survival rate was less than the 30%. target therapy drug Greve (imatinib mesylate) had a good effect on gastrointestinal stromal tumors, but there was a 63% resistance rate during the treatment. Sulanitinib (Sultan) was the only second-line drug approved for imatinib resistance in patients, but the domestic study of this kind of drug Objective to investigate the efficacy and safety of the second line targeted drug Sultan (sulonate) in the clinical treatment of gastrointestinal stromal tumors after the failure of the clinical treatment of gleevin (imatinib mesylate). Methods a retrospective analysis was carried out in the Department of general surgery, the First Affiliated Hospital of Medical University Of Anhui, from January 2010 to May 2016. 32 patients with GIST were confirmed by pathology and immunohistochemistry. All the patients with gastrointestinal stromal tumors were treated with the second line target therapy, sulnitinib, with the dose of 37.5mg/d and continuous administration after the failure of gleguard's clinical treatment. The adverse reaction of sulninib and the patient's survival time were observed and evaluated. Results 1, 32 cases in this group. In the patients, there were 22 male patients, 10 female patients, male: 2.2: 1, male patients, the median age of 64 years and the average age of 55.6 years old, among which 40~60 years of age were seen in.2,32 patients about 12~24 months in the use of imatinib mesylate. After taking imatinib methanesulfonate for 3~6 months, the progression of the disease could not be controlled in.3,32 patients after taking suoninib malate, the tumor growth of some patients was stopped or gradually reduced, and the most of the patients were controlled or gradually relieved.4. The 32 patients in the group entered after taking imatinib mesylate. The adverse reactions are: water and sodium retention, skin pigmentation, skin allergy, hematological toxicity, cardiovascular toxicity, and some special adverse reactions, including hand foot syndrome, hypothyroidism, cardiac toxicity and hypertension, in addition to the common adverse reactions of imatinib methanesulfonate after taking sulonate malate, including hand foot syndrome, hypothyroidism, cardiac toxicity and hypertension. The 1 and 2 year survival rates of patients with stromal tumors were 78% and 46.9% respectively, median PFS was 55 weeks and median OS was 96 weeks; the longest surviving patients had survived for more than 5 years. Conclusion 1 gastrointestinal stromal tumors were a rare gastrointestinal lobar tumor with the majority of the age between 40~60 years, and the male patients were more than the female patients with.2. In patients with gastrointestinal stromal tumors, imatinib methanesulfonate targeted therapy after operation can significantly improve or delay the progression of the patient's condition, but with the use of the drug, the patient has gradually increased the tolerance of the drug, and the continued use of imatinib mesylate.3 for the imatinib mesylate resistant gastrointestinal stroma The tumor patients, the second line application of sulonnioil, can obviously control the progress of the disease. Early application of the gastrointestinal stromal tumor is an effective.4 gastrointestinal stromal tumor, taking suloninionate may have different adverse reactions, but the adverse reactions are still tolerable. Cytopenia, impairment of liver function, hypothyroidism, thrombocytopenia, hand foot syndrome, anorexia, asthenia, oral mucositis and skin toxicity and so on. Adverse reactions are mostly 1~2, and 3~4 is less, and there are no patients who have been stopped by adverse reactions, and the symptoms are controlled by.5 against imatinib in the treatment of drug resistance or the failure of the gastrointestinal tract. The patients with stromal tumors are treated with sugate malate, which can be relieved and even completely controlled for some patients. Therefore, this study is of important reference value for the treatment of gastrointestinal stromal tumors by the second line drugs for the failure of the first line targeting drug therapy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735
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