吉西他滨联合替吉奥治疗铂类方案化疗失败晚期鼻咽癌患者临床观察
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摘要
目的晚期鼻咽癌的一线治疗是以含铂类为主的联合方案,对于铂类耐药后的患者目前尚无标准治疗方案。本研究评价吉西他滨联合替吉奥治疗铂类方案化疗失败后晚期鼻咽癌患者的疗效和安全性。方法回顾性分析2014-01-01-2017-06-30中南大学湘雅医学院附属海口医院收治的含铂类方案化疗失败后晚期鼻咽癌患者66例,根据治疗方法不同分为联合组(32例)和单药组(34例)。联合组:吉西他滨1 000mg/m2,持续静脉滴入30min,d1、d8;替吉奥80mg/(m2d),口服,分2次,d1～d14。单药组:吉西他滨1 000mg/m2,持续静脉滴入30min,d1、d8。两种治疗方案均21d为1个周期。分析两组患者的疗效和不良反应并进行随访。结果联合组与单药组的客观有效率分别为40.6%和17.6%,χ~2=3.898,P=0.048;疾病控制率分别为75.0%和67.6%,χ~2=0.435,P=0.510。中位无进展生存时间分别为6.0和5.0个月,χ~2=2.826,P=0.093;中位总生存时间分别为15.2和13.0个月,χ~2=1.131,P=0.288;1年生存率为分别64.8%和52.9%。两组最常见的不良反应为骨髓抑制及消化道反应,两组出现Ⅲ～Ⅳ级的骨髓抑制及消化道反应之间的差异无统计学意义,P>0.05。结论吉西他滨联合替吉奥治疗对铂类方案化疗失败后的晚期鼻咽癌的临床效果较好,较单药化疗组生存期延长,且患者耐受性较好,可以作为一种治疗选择。
OBJECTIVE Nasopharyngeal carcinoma(NPC)is prevalent in South China.Palliative chemotherapy has been used mostly with platinum-based regimens as a first line treatment.No standard salvage regimen has been used for patients with advanced nasopharyngeal carcinoma and disease progression after prior platinumbased chemotherapy.This study aimed to investigate the efficacy and safety of gemcitabine combined with tegafur in patients with advanced nasopharyngeal carcinoma previously treated with platinums.METHODS From January 1,2014 to June 30,2017,66 cases of advanced nasopharyngeal carcinoma of prior platinum based chemotherapy failure were retrospectively selected in Affiliated Haikou Hospital.The 66 patients were separated into 2 groups,32 patients received gemcitabine combined with tegafur chemotherapy regimen(combined group),gemcitabine 1 000 mg/m2 given intravenously over 30 minutes on days 1 and 8 with tegafur 80 mg/(m2·d)given orally twice a day from days 1 to 14 of a 21 days cycle.The other 34 patients received gemcitabine only 1 000 mg/m2 on days 1 and 8(single group)of a 21 days cycle.The adverse reactions and efficacy were evaluated aftert reatment.The patients were followed-up,and the survival was analyzed.RESULTS The objective response rates of combined group and single group were respectively 40.6%and 17.6%(χ~2=3.898,P=0.048).The disease control rate was 75.0%and 67.6%(χ~2=0.435,P=0.510).The median progression-free survival was 6.0 months and 5.0 months(χ~2=2.826,P=0.093),and the median overall survival was 15.2 months and 13.0 months(χ~2=1.131,P=0.288).The 1-year survival rate was 64.8%and 52.9%.The most frequent adverse reactions of the both groups was myelosuppression and gastrointestinal reactions,the gradeⅢ-Ⅳ myelosuppression and gastrointestinal reactions occurred in the two groups,but they had no statistical significance.CONCLUSIONS Compared with gemcitabine group,the survival period of gemcitabine combined with tegafur,gimeracil and oteracil porassium capsules group was longer and well tolerated in the treatment of advanced nasopharyngeal carcinoma after failure of platinum based chemotherapy.It can be used as a treatment option.
OBJECTIVE Nasopharyngeal carcinoma(NPC)is prevalent in South China.Palliative chemotherapy has been used mostly with platinum-based regimens as a first line treatment.No standard salvage regimen has been used for patients with advanced nasopharyngeal carcinoma and disease progression after prior platinumbased chemotherapy.This study aimed to investigate the efficacy and safety of gemcitabine combined with tegafur in patients with advanced nasopharyngeal carcinoma previously treated with platinums.METHODS From January 1,2014 to June 30,2017,66 cases of advanced nasopharyngeal carcinoma of prior platinum based chemotherapy failure were retrospectively selected in Affiliated Haikou Hospital.The 66 patients were separated into 2 groups,32 patients received gemcitabine combined with tegafur chemotherapy regimen(combined group),gemcitabine 1 000 mg/m2 given intravenously over 30 minutes on days 1 and 8 with tegafur 80 mg/(m2·d)given orally twice a day from days 1 to 14 of a 21 days cycle.The other 34 patients received gemcitabine only 1 000 mg/m2 on days 1 and 8(single group)of a 21 days cycle.The adverse reactions and efficacy were evaluated aftert reatment.The patients were followed-up,and the survival was analyzed.RESULTS The objective response rates of combined group and single group were respectively 40.6%and 17.6%(χ~2=3.898,P=0.048).The disease control rate was 75.0%and 67.6%(χ~2=0.435,P=0.510).The median progression-free survival was 6.0 months and 5.0 months(χ~2=2.826,P=0.093),and the median overall survival was 15.2 months and 13.0 months(χ~2=1.131,P=0.288).The 1-year survival rate was 64.8%and 52.9%.The most frequent adverse reactions of the both groups was myelosuppression and gastrointestinal reactions,the gradeⅢ-Ⅳ myelosuppression and gastrointestinal reactions occurred in the two groups,but they had no statistical significance.CONCLUSIONS Compared with gemcitabine group,the survival period of gemcitabine combined with tegafur,gimeracil and oteracil porassium capsules group was longer and well tolerated in the treatment of advanced nasopharyngeal carcinoma after failure of platinum based chemotherapy.It can be used as a treatment option.
引文
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[16]Peng PJ,Lv BJ,Wang ZH,et al.Multi-institutional prospective study of nedaplatin plus S-1chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-containing regimens[J].Ther Adv Med Oncol,2017,9(2):68-74.
[2]Qiu SF,Lu J,Zheng W,et al.Advantages of intensity modulated radiotherapy in recurrent T1-2nasopharyngeal carcinoma:a retrospective study[J].BMC Cancer,2014,14(1):797.
[3]满宪凤,范廷勇,邢军,等.鼻咽癌同步推量调强放疗与传统调强放疗的近远期疗效比较[J].中华肿瘤防治杂志,2016,23(4):244-247.
[4]徐洁,李祎萍,钱荣誉.调强放疗对中晚期鼻咽癌放射性脑损伤的相关影响[J].中华肿瘤防治杂志,2016,S2:65-68.
[5]Jin Y,Cai XY,Cai YC,et al.To build a prognostic score model containing indispensible tumor markers for metastatic nasopharyngeal carcinoma in an epidemic area[J].Eur J Cancer,2012,48(6):882-888.
[6]Sun Y,Li WF,Chen NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,ulticentre,randomised controlled trial[J].Lancet Oncol,2016,17(11):1509-1520.
[7]You R,Hua YJ,Liu YP,et al.Concurrent chemoradiotherapy with or without anti-EGFR-Targeted treatment for stageⅡ-Ⅳb nasopharyngeal carcinoma:Retrospective analysis with a large cohort and long follow-up[J].Theranostics,2017,7(8):2314-2324.
[8]Peng P,Qu X,Liao H,et al.PhaseⅡstudy of gemcitabine plus S-1chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-based chemotherapy[J].Ther Adv Med Oncol,2016,8(3):153-159.
[9]Lang J,Gao L,Guo Y,et al.Comprehensive treatment of squamous cell cancer of head and neck:Chinese expert consensus2013[J].Future Oncol,2014,10(9):1635-1648.
[10]胡少轩,何小慧,董梅,等.吉西他滨联合异环磷酰胺对铂类方案化疗失败的晚期鼻咽癌患者的疗效及安全性评价[J].中华肿瘤杂志,2015,37(8):632-636.
[11]Ma BB,Tannock IF,Pond GR,et al.Chemotherapy with gemcitabine-containing regimens for locally recurrent or metastatic nasopharyngeal carcinoma[J].Cancer,2002,95(12):2516-2523.
[12]Ngan RK,Yiu HH,Lau WH,et al.Combination gemcitabine and cisplatin chemotherapy for metasatic or recurrent nasopharyngeal carcinoma report of a phaseⅡstudy[J].Ann Oncol,2002,13(8):1252-1258.
[13]Zhang L,Huang Y,Hong S,et al.Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre,randomized,open-label,phase 3trial[J].Lancet,2016,388(10054):1883-1892.
[14]Sch9ffski P.The modulated oral fluoropyrimidine prodrug S-1,and its use in gastrointestinal cancer and other solid tumors[J].Anticancer Drugs,2004,15(2):85-106.
[15]Peng PJ,Chen H,Ou XQ,et al.Safety and efficacy of S-1chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-based chemotherapy:multi-institutional retrospective analysis[J].Drug Des Devel Ther,2014,8(1):1083-1087.
[16]Peng PJ,Lv BJ,Wang ZH,et al.Multi-institutional prospective study of nedaplatin plus S-1chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-containing regimens[J].Ther Adv Med Oncol,2017,9(2):68-74.
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