貝伐珠單抗在晚期非鱗非小細胞肺癌中的應(yīng)用觀察
發(fā)布時間：2019-03-30 09:12
【摘要】：肺癌的發(fā)病率逐年升高,特別是非小細胞肺癌,其中四分之三以上的患者在疾病確診時已處于晚期,目前單純化療的療效已到達瓶頸狀態(tài)。研究證實,血管內(nèi)皮生長因子是血管異常增生過程中各種影響因素的主要介質(zhì)。貝伐珠單抗作為抗血管生成藥物,能與人血管內(nèi)皮生長因子結(jié)合并阻斷其生物活性,從而抑制腫瘤新生血管的生成,進而切斷腫瘤營養(yǎng)供給,抑制腫瘤細胞增生與遷移。它是首個被美國食品藥品監(jiān)督管理局批準的用于晚期非小細胞肺癌的一線治療的抗血管生成藥物。許多研究已證實貝伐珠單抗聯(lián)合化療治療晚期非小細胞肺癌可以有效延長患者的生存期,對貝伐珠單抗在實際臨床中的應(yīng)用價值值得進一步驗證與分析。研究目的:本研究旨在觀察貝伐珠單抗聯(lián)合化療在治療晚期非鱗非小細胞肺癌的臨床應(yīng)用中的療效性與安全性。研究方法:回顧性地分析在2015年03月至2016年12月期間于青島大學(xué)附屬醫(yī)院腫瘤科治療的非小細胞肺癌患者48例,所有患者均經(jīng)病理學(xué)或細胞學(xué)診斷為腺癌,臨床分期為IV期,采用培美曲塞或吉西他濱或多西他賽或力撲素或長春瑞濱聯(lián)合貝伐珠單抗±鉑類(卡鉑或順鉑)方案治療,觀察患者的治療療效及治療過程中出現(xiàn)的不良反應(yīng)并進行隨訪。研究結(jié)果:所有患者完全緩解0例(0%),部分緩解10例(20.8%),穩(wěn)定30例(62.5%),進展8例(16.7%),客觀緩解率為20.8%,疾病控制率為83.3%�？傮w中位無進展生存期為6.4個月,中位總生存期為12.0個月。應(yīng)用培美曲塞方案治療的36名患者中,完全緩解0例(0%),部分緩解10例(27.8%),穩(wěn)定22例(61.1%),進展4例(11.1%),客觀緩解率27.8%,疾病控制率88.9%�？傮w中位無進展生存期7.3個月,中位總生存期13.1個月。亞組中一線治療患者的中位無進展生存期為8.8個月,中位總生存期為13.9個月,二線及以上治療患者的中位無進展生存期為4.3個月,中位生存期為10.3個月,兩者間有統(tǒng)計學(xué)差異(P0.05);應(yīng)用貝伐珠單抗4周期以上患者中位無進展生存期為9.2個月,中位總生存期為14.5個月,4周期及以下患者中位無進展生存期為4.4個月,中位總生存期為10.3個月,兩者間差異有統(tǒng)計學(xué)意義(P0.05)。最常見的不良反應(yīng)為化療相關(guān)的,主要有血象減少、惡心嘔吐、肝腎功異常,大部分為1-2級,給予對癥治療后好轉(zhuǎn)。貝伐珠單抗相關(guān)不良反應(yīng)有蛋白尿、出血、高血壓、血栓,1例患者因肺出血死亡,該患者既往有咯血史,大部分副反應(yīng)均經(jīng)治療后改善,嚴重不良反應(yīng)(3級及以上)少見。結(jié)論及意義:貝伐珠單抗聯(lián)合化療可有效改善晚期非鱗非小細胞肺癌患者的生存,貝伐珠單抗參與的維持治療可以明顯延長患者的總生存期,持續(xù)應(yīng)用貝伐珠單抗可改善患者生存,對貝伐珠單抗的臨床應(yīng)用有一定的指導(dǎo)意義。不良反應(yīng)多可耐受但要高度重視既往有咯血史的患者的應(yīng)用。
[Abstract]:The incidence of lung cancer is increasing year by year, especially non-small cell lung cancer (NSCLC). More than 3/4 of the patients are in advanced stage when the disease is diagnosed. At present, the curative effect of chemotherapy alone has reached the bottleneck state. It has been proved that vascular endothelial growth factor (VEGF) is one of the main mediators in the process of vascular dysplasia. Bevacizumab, as an anti-angiogenic drug, can bind to human vascular endothelial growth factor (VEGF) and block its biological activity, thus inhibit tumor angiogenesis, cut off tumor nutrition supply, and inhibit tumor cell proliferation and migration. It is the first anti-angiogenic drug approved by the Food and Drug Administration for first-line treatment for advanced non-small cell lung cancer. Many studies have proved that bevacizumab combined with chemotherapy can effectively prolong the survival time of patients with advanced non-small cell lung cancer, and the clinical value of beavazumab is worthy of further verification and analysis. Objective: to observe the efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced non-squamous non-small cell lung cancer (NSCLC). Methods: from March 2015 to December 2016, 48 patients with non-small cell lung cancer treated in the Department of Oncology, affiliated Hospital of Qingdao University were retrospectively analyzed. All patients were diagnosed as adenocarcinoma by pathology or cytology, and the clinical stage was IV stage. The patients were treated with pemetaxel or gemcitabine or docetaxel, or vinorelbine combined with bevacizumab 鹵platinum (carboplatin or cisplatin). The therapeutic efficacy and adverse reactions in the course of treatment were observed and followed up. Results: all patients had complete remission in 0 cases (0%), partial remission in 10 cases (20.8%), stabilization in 30 cases (62.5%), progression in 8 cases (16.7%), objective remission rate of 20.8% and disease control rate of 83.3%. The overall median progression-free survival was 6.4months and the median overall survival was 12.0 months. Of the 36 patients treated with Pemetrexil regimen, complete remission (0%), partial remission (10 cases, 27.8%), stability (22 cases, 61.1%), progress (4 cases, 11.1%) and objective remission rate (27.8%) were observed. The disease control rate was 88.9%. The overall median progression-free survival time was 7.3 months and the median overall survival time was 13.1 months. In the subgroup, the median progression-free survival time was 8.8months, the median total survival time was 13.9 months, the median progression-free survival time was 4.3months and the median survival time was 10.3 months in the first-line treatment group, and the median survival time was 13.9 months in the first-line treatment group and 10.3 months in the second-line treatment group. There was statistical difference between them (P0.05); The median progression-free survival time was 9.2months, the median total survival time was 14.5 months, and the median progression-free survival time was 4.4months in patients with 4 cycles and less than 4 cycles of bevaczumab, and the median progression-free survival time was 9.2months, the median survival time was 14.5 months. The median overall survival time was 10.3 months, the difference was statistically significant (P0.05). The most common adverse reactions were chemotherapy-related, mainly hemogram reduction, nausea and vomiting, abnormal liver and kidney function, most of which were grade 1 / 2 and improved after symptomatic treatment. The adverse reactions associated with beavazumab included proteinuria, hemorrhage, hypertension, thrombus, and one patient died of pulmonary hemorrhage. The patient had a history of hemoptysis in the past. Most of the side effects were improved after treatment, and severe adverse reactions (grade 3 or above) were rare. Conclusion: bevacizumab combined with chemotherapy can effectively improve the survival of patients with advanced non-squamous non-small cell lung cancer, and the total survival time of patients with advanced non-squamous non-small cell lung cancer can be significantly prolonged by taking part in the maintenance therapy of bevacizumab. Continuous use of bevacizumab can improve the survival of patients, and has some guiding significance for the clinical application of beavazumab. Adverse reactions are tolerable but should attach great importance to the use of patients with previous history of hemoptysis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
本文編號：2449994
[Abstract]:The incidence of lung cancer is increasing year by year, especially non-small cell lung cancer (NSCLC). More than 3/4 of the patients are in advanced stage when the disease is diagnosed. At present, the curative effect of chemotherapy alone has reached the bottleneck state. It has been proved that vascular endothelial growth factor (VEGF) is one of the main mediators in the process of vascular dysplasia. Bevacizumab, as an anti-angiogenic drug, can bind to human vascular endothelial growth factor (VEGF) and block its biological activity, thus inhibit tumor angiogenesis, cut off tumor nutrition supply, and inhibit tumor cell proliferation and migration. It is the first anti-angiogenic drug approved by the Food and Drug Administration for first-line treatment for advanced non-small cell lung cancer. Many studies have proved that bevacizumab combined with chemotherapy can effectively prolong the survival time of patients with advanced non-small cell lung cancer, and the clinical value of beavazumab is worthy of further verification and analysis. Objective: to observe the efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced non-squamous non-small cell lung cancer (NSCLC). Methods: from March 2015 to December 2016, 48 patients with non-small cell lung cancer treated in the Department of Oncology, affiliated Hospital of Qingdao University were retrospectively analyzed. All patients were diagnosed as adenocarcinoma by pathology or cytology, and the clinical stage was IV stage. The patients were treated with pemetaxel or gemcitabine or docetaxel, or vinorelbine combined with bevacizumab 鹵platinum (carboplatin or cisplatin). The therapeutic efficacy and adverse reactions in the course of treatment were observed and followed up. Results: all patients had complete remission in 0 cases (0%), partial remission in 10 cases (20.8%), stabilization in 30 cases (62.5%), progression in 8 cases (16.7%), objective remission rate of 20.8% and disease control rate of 83.3%. The overall median progression-free survival was 6.4months and the median overall survival was 12.0 months. Of the 36 patients treated with Pemetrexil regimen, complete remission (0%), partial remission (10 cases, 27.8%), stability (22 cases, 61.1%), progress (4 cases, 11.1%) and objective remission rate (27.8%) were observed. The disease control rate was 88.9%. The overall median progression-free survival time was 7.3 months and the median overall survival time was 13.1 months. In the subgroup, the median progression-free survival time was 8.8months, the median total survival time was 13.9 months, the median progression-free survival time was 4.3months and the median survival time was 10.3 months in the first-line treatment group, and the median survival time was 13.9 months in the first-line treatment group and 10.3 months in the second-line treatment group. There was statistical difference between them (P0.05); The median progression-free survival time was 9.2months, the median total survival time was 14.5 months, and the median progression-free survival time was 4.4months in patients with 4 cycles and less than 4 cycles of bevaczumab, and the median progression-free survival time was 9.2months, the median survival time was 14.5 months. The median overall survival time was 10.3 months, the difference was statistically significant (P0.05). The most common adverse reactions were chemotherapy-related, mainly hemogram reduction, nausea and vomiting, abnormal liver and kidney function, most of which were grade 1 / 2 and improved after symptomatic treatment. The adverse reactions associated with beavazumab included proteinuria, hemorrhage, hypertension, thrombus, and one patient died of pulmonary hemorrhage. The patient had a history of hemoptysis in the past. Most of the side effects were improved after treatment, and severe adverse reactions (grade 3 or above) were rare. Conclusion: bevacizumab combined with chemotherapy can effectively improve the survival of patients with advanced non-squamous non-small cell lung cancer, and the total survival time of patients with advanced non-squamous non-small cell lung cancer can be significantly prolonged by taking part in the maintenance therapy of bevacizumab. Continuous use of bevacizumab can improve the survival of patients, and has some guiding significance for the clinical application of beavazumab. Adverse reactions are tolerable but should attach great importance to the use of patients with previous history of hemoptysis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
【參考文獻】
相關(guān)期刊論文 前2條
1 陽秋香;張歡歡;袁太澤;梁穎;余錦秀;王文金;張秀萍;;貝伐單抗聯(lián)合放療對肺癌裸鼠移植瘤作用的研究[J];中國醫(yī)藥導(dǎo)報;2015年14期
2 趙靜;李航;張力;鐘巍;李龍蕓;文煜冰;王孟昭;;四例貝伐單抗所致腎損害臨床和病理特征分析[J];中國醫(yī)學(xué)科學(xué)院學(xué)報;2012年02期
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