雷替曲塞经TACE治疗原发性肝癌的临床疗效分析
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摘要
目的探究单药雷替曲塞经TACE治疗原发性肝癌的疗效及安全性方法选取2013年1月—2015年12月收治的原发性肝癌患者59例,分为雷替曲塞组(A组,n=24),表柔比星组(B组,n=35)。A组行单药雷替曲塞(3 mg/m~2)TACE治疗,B组行单药表柔比星(40 mg/m~2)TACE治疗。1个月为1个疗程,术后分别根据改良的实体瘤疗效评价标准(mRECIST)和美国国立癌症研究院常见不良反应术语评定标准(NCI-CTCAE)V4.0分别进行疗效评价和不良反应评估,并且比较两组中位无进展生存期(mPFS)。结果两组都无完全缓解(CR)病例,其中A组治疗有效率(RR)37.5%,疾病控制率(DCR)87.5%;B组分别为25.7%,80.5%,两组比较差异无统计学意义(P>0.05)。两组不良反应主要有白细胞减少、红细胞减少、血小板下降、呕心呕吐、发热、肝区疼痛、转氨酶升高等,差异均无统计学意义(P>0.05)。A、B两组mPFS分别为181 d、71 d,差异有统计学意义(P=0.042)。结论雷替曲塞单药方案经TACE治疗原发性肝癌的疗效和不良反应与表柔比星相当,但能显著延长患者mPFS。
Objective To investigate the clinical efficacy and safety of transcatheteer arterial chemoembolization(TACE) with single drug of raltitrexed in treating primary hepatocellular carcinoma(HCC). Methods A total of 59 HCC patients, who were admitted to authors' hospital during the period from January 2013 to December 2015, were divided into raltitrexed group(group A, n=24) and epirubicin group(group B, n=35). TACE with single drug of raltitrexed(3 mg/m~2) was adopted for the patients of group A,while TACE with single drug of epirubicin(40 mg/m~2) was employed for the patients of group B. Every therapeutic course lasted for one month. After the treatment, modified Response Evaluation Criteria in Solid Tumors(mRECIST) and the National Cancer Institute Common Adverse Reaction Terminology Assessment Standard(NCI-CTCAE) V4.0 were separately used to evaluate the curative efficacy and adverse reactions. The median progression free survivals(mPFSs) of the two groups were compared. Results No complete remission was achieved in all patients of both groups. In group A, the effective rate was 37.5% and the disease control rate was 87.5%, which in group B were 25.7% and 80.5% respectively; the differences between the two groups were not statistically significant(P >0.05). The main adverse reactions included leukopenia,erythrocytopenia, thrombocytopenia, nausea and vomiting, fever, pain at liver region, elevated level of transaminase, etc., but no statistically significant differences in the above indexes existed between the two groups(P>0.05). The mPFSs in group A and group B were 181 days and 71 days respectively, the difference between the two groups was statistically significant(P =0.042). Conclusion In treating primary HCC, the curative effect and adverse reactions of TACE with single drug of raltitrexed are roughly the same as those of TACE with single drug of epirubicin, but TACE with single drug of raltitrexed can significantly prolong patient's mPFS.
Objective To investigate the clinical efficacy and safety of transcatheteer arterial chemoembolization(TACE) with single drug of raltitrexed in treating primary hepatocellular carcinoma(HCC). Methods A total of 59 HCC patients, who were admitted to authors' hospital during the period from January 2013 to December 2015, were divided into raltitrexed group(group A, n=24) and epirubicin group(group B, n=35). TACE with single drug of raltitrexed(3 mg/m~2) was adopted for the patients of group A,while TACE with single drug of epirubicin(40 mg/m~2) was employed for the patients of group B. Every therapeutic course lasted for one month. After the treatment, modified Response Evaluation Criteria in Solid Tumors(mRECIST) and the National Cancer Institute Common Adverse Reaction Terminology Assessment Standard(NCI-CTCAE) V4.0 were separately used to evaluate the curative efficacy and adverse reactions. The median progression free survivals(mPFSs) of the two groups were compared. Results No complete remission was achieved in all patients of both groups. In group A, the effective rate was 37.5% and the disease control rate was 87.5%, which in group B were 25.7% and 80.5% respectively; the differences between the two groups were not statistically significant(P >0.05). The main adverse reactions included leukopenia,erythrocytopenia, thrombocytopenia, nausea and vomiting, fever, pain at liver region, elevated level of transaminase, etc., but no statistically significant differences in the above indexes existed between the two groups(P>0.05). The mPFSs in group A and group B were 181 days and 71 days respectively, the difference between the two groups was statistically significant(P =0.042). Conclusion In treating primary HCC, the curative effect and adverse reactions of TACE with single drug of raltitrexed are roughly the same as those of TACE with single drug of epirubicin, but TACE with single drug of raltitrexed can significantly prolong patient's mPFS.
引文
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[9]Horikawa M,Miyayama S,Irie T,et al.Development of conventional transarterial chemoembolization for hepatocellular carcinomas in Japan:historical,strategic,and technical review[J].AJR Am J Roentgenol,2015,205:764-773.
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[11]李爱军,马森林,吴孟超.分子靶向药物在肝癌治疗中的作用[J].肝胆胰外科杂志,2015,27:255-258.
[12]吕桂帅,陈磊,王红阳.我国肝癌研究的现状与前景[J].生命科学,2015,27:237-248.
[13]Rougier P,Ducreux M,Kerr D,et al.A phaseⅡstudy of raltitrexed‘Tomudex’in patients with hepatocellular carcinoma[J].Ann Oncol,1997,8:500-502.
[14]Zhao C,Fan L,Qi F,et al.Raltitrexed plus oxaliplatin-based transarterial chemoembolization in patients with unresectable hepatocellular carcinoma[J].Anticancer Drugs,2016,27:689-694.
[15]许飞,李忱瑞,孙伟,等.原发性肝癌TACE术中雷替曲塞的临床应用[J].介入放射学杂志,2017,26:418-421.
[16]贺红杰,宋磊,赵丹懿,等.雷替曲塞联合奥沙利铂经TACE治疗不可切除肝癌患者的疗效评价[J].介入放射学杂志,2016,25:40-43.
[2]Zhao H,Zhang Y,Sun J,et al.Raltitrexed inhibits HepG2 cell proliferation via G0/G1 cell cycle arrest[J].Oncol Res,2016,23:237-248.
[3]Barni S,Ghidini A,Coinu A,et al.A systematic review of raltitrexed-based first-line chemotherapy in advanced colorectal cancer[J].Anticancer Drugs,2014,25:1122-1128.
[4]曹云娣,严文跃,刘宝瑞,等.雷替曲塞的研究进展及临床应用[J].临床医学研究与实践,2016,1:178-180.
[5]吴婷婷,陈丁丁,智俊娜,等.雷替曲塞的临床应用[J].中国现代应用药学,2014,31:643-646.
[6]中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肝胆病杂志,2011,27:1141-1159.
[7]Lencioni R,Llovet JM.Modified RECIST(mRECIST)assessment for hepatocellular carcinoma[J].Semin Liver Dis,2010,30:52-60.
[8]皋文君,刘砚燕,袁长蓉.国际肿瘤化疗药物不良反应评价系统---通用不良反应术语标准4.0版[J].肿瘤,2012,32:142-144.
[9]Horikawa M,Miyayama S,Irie T,et al.Development of conventional transarterial chemoembolization for hepatocellular carcinomas in Japan:historical,strategic,and technical review[J].AJR Am J Roentgenol,2015,205:764-773.
[10]Meza-Junco J,Montano-Loza AJ,Liu DM,et al.Locoregional radiological treatment for hepatocellular carcinoma:which,when and how?[J].Cancer Treat Rev,2012,38:54-62.
[11]李爱军,马森林,吴孟超.分子靶向药物在肝癌治疗中的作用[J].肝胆胰外科杂志,2015,27:255-258.
[12]吕桂帅,陈磊,王红阳.我国肝癌研究的现状与前景[J].生命科学,2015,27:237-248.
[13]Rougier P,Ducreux M,Kerr D,et al.A phaseⅡstudy of raltitrexed‘Tomudex’in patients with hepatocellular carcinoma[J].Ann Oncol,1997,8:500-502.
[14]Zhao C,Fan L,Qi F,et al.Raltitrexed plus oxaliplatin-based transarterial chemoembolization in patients with unresectable hepatocellular carcinoma[J].Anticancer Drugs,2016,27:689-694.
[15]许飞,李忱瑞,孙伟,等.原发性肝癌TACE术中雷替曲塞的临床应用[J].介入放射学杂志,2017,26:418-421.
[16]贺红杰,宋磊,赵丹懿,等.雷替曲塞联合奥沙利铂经TACE治疗不可切除肝癌患者的疗效评价[J].介入放射学杂志,2016,25:40-43.