摘要
目的比较甲磺酸阿帕替尼与多西他赛用于三线及以上治疗晚期非小细胞肺癌(non-small-cell lung cancer,NSCLC)的临床疗效和安全性。方法回顾解放军总医院2016年3月-2017年6月收治的共128例三线及以上治疗使用阿帕替尼或多西他赛的晚期NSCLC患者的临床资料,观察组(n=60)接受口服阿帕替尼治疗,剂量为500 mg/d;对照组(n=68)使用多西他赛化疗,剂量为75 mg/m~2。两组均以21天为1个治疗周期,每2个周期复查评价两组患者的近期疗效及不良反应。结果 128例患者均可进行临床评价。阿帕替尼组中位无进展生存期(median progress-free survival,m PFS)显著长于多西他赛组(3.7个月vs 3.0个月,P=0.026),疾病控制率(disease control rate,DCR)显著高于多西他赛组(61.7%vs 8.6%,P=0.037);阿帕替尼组的客观缓解率(overall response rate,ORR)为20.0%(12/60),高于多西他赛组的19.1%(13/68),但差异无统计学意义(P>0.05)。阿帕替尼组生活质量明显优于多西他赛组(P<0.05)。阿帕替尼组Ⅲ~Ⅳ级不良反应发生率为18.3%(11/60),明显低于多西他赛的29.4%(20/68)(P<0.05)。两种药物不良反应多数为Ⅰ级或Ⅱ级,给予积极对症处理后患者大多可耐受。结论甲磺酸阿帕替尼可用于三线及以上治疗晚期NSCLC患者,其临床疗效优于多西他赛,且安全性较高,能够提高患者的生存时间和质量,可作为临床治疗的选择。
Objective To observe the clinical efficacy and adverse reactions of mesylate apatinib versus docetaxel for advanced non-small cell lung cancer after failure of second-line treatment. Methods Clinical data about 128 patients with advanced NSCLC admittted to our hospital from March 2016 to June 2017 were analyzed. The observation group(n=60) was treated with apatinib(500 mg/d) and the control group(n=68) was treated with docetaxel(75 mg/m~2). Treatment cycle of the two groups was 21 d. The clinical efficacy and adverse reaction of two groups were evaluated in every 2 cycles. Results The clinical evaluation was performed in 128 patients. The m PFS and DCR in apatinib were significantly greater than those in docetaxel group(3.7 months vs 3 months, 61.7% vs 48.6%, P <0.05, respectively). The ORR of docetaxel group was lower than that of apatinib group, but the difference was not statistically significant(20.0% vs 19.1%, P >0.05). As for improving the quality of life, apatinib was superior to docetaxel with significant difference(P <0.05). The incidence rate of serious adverse reactions of apatinib was 18.3%(11/60), which was significantly lower than 29.4%(20/68) in docetaxel group(P <0.05). Most of the adverse effects of these two drugs were gradeⅠorⅡ, which could be tolerated by most of the patients after symptomatic treatment. Conclusion The mesylate apatinib can be used for the advanced NSCLC treatment, and the clinical efficacy is superior to docetaxel with higher safety and longer survival time.
引文
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