贝伐单抗联合TC化疗方案对老年晚期NSCLC患者血清VEGF、bFGF水平及生存质量的影响
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摘要
目的:探讨贝伐单抗联合TC化疗方案在老年晚期非小细胞肺癌(NSCLC)中的应用效果。方法:选取2014年1月至2016年2月我院88例老年晚期NSCLC患者,随机数字表法分为观察组与对照组,每组44例。对照组采取单纯TC化疗方案,观察组在此基础上联合贝伐单抗治疗,两组均化疗3个周期。对比两组患者临床疗效、治疗前后血清相关因子[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)]水平、生存质量、化疗期间毒副反应及生存期。结果:观察组总有效率[63.64%(28/44)]与对照组[50.00%(22/44)]比较无显著差异(P>0.05),疾病控制率[88.64%(39/44)]高于对照组[70.45%(31/44)],差异有统计学意义(P<0.05);治疗前两组血清VEGF、bFGF水平比较无显著差异(P>0.05),治疗后观察组血清VEGF、bFGF水平低于对照组,差异有统计学意义(P<0.05);观察组生存质量改善率[50.00%(22/44)]高于对照组[27.27%(12/44)],差异有统计学意义(P<0.05);两组化疗期间白细胞下降、恶心/呕吐、脱发等毒副反应发生率及分级情况比较无显著差异(P>0.05);观察组中位生存期为19个月,对照组中位生存期为14个月;观察组6个月生存率[97.73%(43/44)]与对照组[93.18%(41/44)]比较无显著差异(P>0.05),12个月生存率[84.09%(37/44)]、24个月生存率[34.09%(15/44)]高于对照组[65.91%(29/44)、15.91%(7/44)],差异有统计学意义(P<0.05)。结论:贝伐单抗联合TC化疗方案治疗老年晚期NSCLC,有利于进一步提高疾病控制率,改善患者生存质量,延长生存期,可能与联合方案可下调血清VEGF、bFGF表达,并对肿瘤新生血管生成产生抑制作用有关,且具有一定安全性。
Objective:To explore the application effect of bevacizumab combined with TC chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer(NSCLC).Methods:88 elderly patients with advanced NSCLC in our hospital from January 2014 to February 2016 were selected and divided into the observation group and the control group according to the random number table method,with 44 cases in each group.The control group received TC chemotherapy alone,and the observation group was treated with bevacizumab on the basis of the control group.The two groups were treated for 3 cycles of chemotherapy.The clinical efficacy,levels of serum related factors[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)] before and after treatment,the quality of life,side effects and life cycle during chemotherapy were compared between two groups.Results:The total effective rate of the observation group was 63.64%(28/44),which was not significantly different from that of the control group 50.00%(22/44)(P>0.05).The disease control rate in the observation group was 88.64%(39/44), higher than that in the control group 70.45%(31/44),and the difference was statistically significant(P<0.05).There was insignificant difference in serum levels of VEGF and b FGF between the two groups before treatment( P> 0. 05). After treatment,the serum levels of VEGF and b FGF in the observation group were lower than those in the control group,and the difference was statistically significant( P < 0. 05). The improvement rate of quality of life in the observation group was 50. 00%( 22/44),higher than that in the control group 27. 27%( 12/44),and the difference was statistically significant( P < 0. 05). There was insignificant difference between the two groups in the incidence of leukocyte decline,nausea/vomiting and alopecia during chemotherapy( P > 0. 05). The median survival time of the observation group was 19 months,and the median survival time of the control group was 14 months. The 6 months survival rate of the observation group was 97. 73%( 43/44) and that of the control group was 93. 18%( 41/44),but there was insignificant difference( P > 0. 05). The 12 months survival rate was 84. 09%( 37/44),and the 24 months survival rate was 34. 09%( 15/44),higher than the control group 65. 91%( 29/44) and 15. 91%( 7/44),and the difference was statistically significant( P < 0. 05). Conclusion: The combination of bevacizumab and TC chemotherapy in the treatment of advanced NSCLC in the elderly is beneficial to further improve the rate of disease control,improve the quality of life and prolong life period. It may be related to the reduction of serum VEGF and b FGF,and the inhibition effect on neovascularization of tumor,and it has certain safety.
Objective:To explore the application effect of bevacizumab combined with TC chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer(NSCLC).Methods:88 elderly patients with advanced NSCLC in our hospital from January 2014 to February 2016 were selected and divided into the observation group and the control group according to the random number table method,with 44 cases in each group.The control group received TC chemotherapy alone,and the observation group was treated with bevacizumab on the basis of the control group.The two groups were treated for 3 cycles of chemotherapy.The clinical efficacy,levels of serum related factors[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)] before and after treatment,the quality of life,side effects and life cycle during chemotherapy were compared between two groups.Results:The total effective rate of the observation group was 63.64%(28/44),which was not significantly different from that of the control group 50.00%(22/44)(P>0.05).The disease control rate in the observation group was 88.64%(39/44), higher than that in the control group 70.45%(31/44),and the difference was statistically significant(P<0.05).There was insignificant difference in serum levels of VEGF and b FGF between the two groups before treatment( P> 0. 05). After treatment,the serum levels of VEGF and b FGF in the observation group were lower than those in the control group,and the difference was statistically significant( P < 0. 05). The improvement rate of quality of life in the observation group was 50. 00%( 22/44),higher than that in the control group 27. 27%( 12/44),and the difference was statistically significant( P < 0. 05). There was insignificant difference between the two groups in the incidence of leukocyte decline,nausea/vomiting and alopecia during chemotherapy( P > 0. 05). The median survival time of the observation group was 19 months,and the median survival time of the control group was 14 months. The 6 months survival rate of the observation group was 97. 73%( 43/44) and that of the control group was 93. 18%( 41/44),but there was insignificant difference( P > 0. 05). The 12 months survival rate was 84. 09%( 37/44),and the 24 months survival rate was 34. 09%( 15/44),higher than the control group 65. 91%( 29/44) and 15. 91%( 7/44),and the difference was statistically significant( P < 0. 05). Conclusion: The combination of bevacizumab and TC chemotherapy in the treatment of advanced NSCLC in the elderly is beneficial to further improve the rate of disease control,improve the quality of life and prolong life period. It may be related to the reduction of serum VEGF and b FGF,and the inhibition effect on neovascularization of tumor,and it has certain safety.
引文
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[10] Shimizu T,Saijo N.Common toxicity criteria:Version 2.0,an improved reference for grading the adverse reaction of cancer treatment[J].Nihon Rinsho,2003,61(6):937-942.
[11] Wald O,Shapira OM,Izhar U.CXCR4/CXCL12 axis in non small cell lung cancer(NSCLC) pathologic roles and therapeutic potential[J].Theranostics,2013,3(1):26-33.
[12] Morosibilot D,Smit E,De JCC,et al.Non-small cell lung cancer patients with brain metastases treated with first-line platinum-doublet chemotherapy:Analysis from the European FRAME study[J].Lung Cancer,2015,90(3):427-432.
[13] Carretero R,Sektioglu IM,Garbi N,et al.Eosinophils orchestrate cancer rejection by normalizing tumor vessels and enhancing infiltration of CD8(+) T cells[J].Nat Immunol,2015,16(6):609-617.
[14] Michishita M,Uto T,Nakazawa R,et al.Antitumor effect of bevacizumab in a xenograft model of canine hemangiopericytoma[J].J Pharmacol Sci,2013,121(4):339-342.
[15] Costanzo DFD,Mazzoni F,Mela MM,et al.Bevacizumab in non-small cell lung cancer[J].Drugs,2008,68(6):737-746.
[2] Chang WJ,Sun JM,Lee JY,et al.A retrospective comparison of adjuvant chemotherapeutic regimens for non-small cell lung cancer(NSCLC):Paclitaxel plus carboplatin versus vinorelbine plus cisplatin[J].Lung Cancer,2014,84(1):51-55.
[3] Pircher A,Wasle IK,Mian M,et al.Docetaxel in the treatment of non-small cell lung cancer(NSCLC)-an observational study focusing on symptom improvement[J].Anticancer Res,2013,33(9):3831-3836.
[4] Zhao YY,Xue C,Jiang W,et al.Predictive value of intratumoral microvascular density in patients with advanced non-small cell lung cancer receiving chemotherapy plus bevacizumab[J].J Thorac Oncol,2012,7(1):71-75.
[5] Tamiya M,Tamiya A,Nakao K,et al.Efficacy of carboplatin and paclitaxel with bevacizumab as salvage chemotherapy for non-small cell lung cancer after failure of platinum-doublet chemotherapy[J].Anticancer Res,2012,32(8):3553-3557.
[6] Uzuka T,Aoki H,Natsumeda M,et al.Effectiveness of maximal safe resection for glioblastoma including elderly and low Karnofsky performance status patients:Retrospective review at a single institute[J].Neurol Med Chir(Tokyo),2012,52(8):570-576.
[7] Chen XP,Wang JP.Surgery[M].Eighth Edition.Beijing:People's Health Publishing House,2013:282-288.[陈孝平,汪建平.外科学[M].第8版.北京:人民卫生出版社,2013:282-288.]
[8] Yang XN,Wu YL.Evaluation criteria for therapeutic efficacy of solid tumors RECIST[J].Evidence-Based Medicine,2004,4(2):85-90.[杨学宁,吴一龙.实体瘤治疗疗效评价标准-RECIST[J].循证医学,2004,4(2):85-90.]
[9] Wang ZH,Wu XL,Liu H.Preliminary observation on the effect of syndrome differentiation and treatment of traditional Chinese medicine in combination with chemotherapy of lung cancer[C].Tenth National Academic Conference on Chinese and Western Medicine Combined with Blood Stasis and Blood Circulation and Blood Stasis Research,2013.[王兆会,伍小丽,刘鸿.中医辨证施治配合肺癌化疗减毒增敏作用的初步观察[C].第十次全国中西医结合血瘀证及活血化瘀研究学术大会,2013.]
[10] Shimizu T,Saijo N.Common toxicity criteria:Version 2.0,an improved reference for grading the adverse reaction of cancer treatment[J].Nihon Rinsho,2003,61(6):937-942.
[11] Wald O,Shapira OM,Izhar U.CXCR4/CXCL12 axis in non small cell lung cancer(NSCLC) pathologic roles and therapeutic potential[J].Theranostics,2013,3(1):26-33.
[12] Morosibilot D,Smit E,De JCC,et al.Non-small cell lung cancer patients with brain metastases treated with first-line platinum-doublet chemotherapy:Analysis from the European FRAME study[J].Lung Cancer,2015,90(3):427-432.
[13] Carretero R,Sektioglu IM,Garbi N,et al.Eosinophils orchestrate cancer rejection by normalizing tumor vessels and enhancing infiltration of CD8(+) T cells[J].Nat Immunol,2015,16(6):609-617.
[14] Michishita M,Uto T,Nakazawa R,et al.Antitumor effect of bevacizumab in a xenograft model of canine hemangiopericytoma[J].J Pharmacol Sci,2013,121(4):339-342.
[15] Costanzo DFD,Mazzoni F,Mela MM,et al.Bevacizumab in non-small cell lung cancer[J].Drugs,2008,68(6):737-746.