阿帕替尼治疗晚期恶性肿瘤骨转移患者疗效及安全性评价
摘要
目的评价阿帕替尼单药治疗晚期恶性肿瘤骨转移患者的疼痛缓解情况、疗效和安全性。方法选取2016年1月至2017年2月来本科治疗的晚期恶性肿瘤骨转移患者56例,根据随机数字表法分为观察组、对照组,每组28例,其中对照组采用帕米膦酸二钠治疗,而观察组采用阿帕替尼单药治疗,评价阿帕替尼单药治疗晚期恶性肿瘤骨转移患者的疼痛缓解情况及其有效性和安全性。结果⑴观察组28例首次疗效评价,2例患者达到部分缓解,14例患者疾病稳定,6例患者疾病进展,6例患者不可评价,ORR=9. 09%,DCR=72. 73%。对照组28例首次疗效评价,1例患者达到部分缓解,12例患者疾病稳定,7例患者疾病进展,8例患者不可评价,ORR=5. 00%,DCR=65. 00%,总有效率与观察组比较差异无统计学意义(P=0. 098)。⑵观察组中22例可评价患者NRS评分明显高于对照组20例可评价患者,差异有统计学意义(t=3. 954,P <0. 01)。⑶治疗后观察组患者的KPS评分、SAS评分改善情况明显优于对照组(t=7. 985,9. 091,P <0. 05)。⑷两组发生的主要不良反应为高血压、手足皮肤反应、蛋白尿等,且观察组腹泻发生率明显低于对照组(P <0. 05)。⑸观察组治疗后12个月内的存活率为78. 57%,对照组为71. 42%。结论与帕米膦酸二钠相比,阿帕替尼可显著改善晚期恶性肿瘤骨转移患者疼痛情况、生存质量和焦虑,且不良反应多为轻中度,可控可耐受。
引文
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[2]马宁强,邓智平,苏海川,等.人钙调神经磷酸酶AαRNAi慢病毒载体的构建与鉴定[J].现代肿瘤医学,2012,20(3):433-437. DOI:10. 3969/j. issn. 1672-4992. 2012. 03. 01.
[3]马瑞,曲秀娟,刘云鹏,等.恶性肿瘤骨转移疼痛患者治疗及预后的临床分析[J].中国医科大学学报,2015,44(5):443-447. DOI:10. 3969/j. issn. 0258-4646. 2015. 05. 013.
[4]李洪涛,孙元珏,沈赞.骨转移癌分子靶向治疗进展[J].癌症进展,2015,13(1):10-13. DOI:10. 11877/j. issn. 1672-1535. 2015. 13. 01. 02.
[5] Bachelier R,Confavreux CB,Peyruchaud O,et al. Combination of anti-angiogenic therapies reduces osteolysis and tumor burden in experimental breast cancer bone metastasis[J]. Int J Cancer,2014,135(6):1319-1329. DOI:10. 1002/ijc. 28787.
[6] Kaya M,Wada T,Nagoya S,et al. Prevention of postoperative progression of pulmonary metastases in osteosarcoma by antiangiogenic therapy using endostatin[J]. J Orthop Sci,2007,12(6):562-567. DOI:10. 1007/s00776-007-1179-1.
[7] Wang D,Zhong ZY,Li MX,et al. Vector-based Ape1 small interfering RNA enhances the sensitivity of human osteosarcoma cells to endostatin in vivo[J]. Cancer Sci,2007,98(12):1993-2001.DOI:10. 1111/j. 1349-7006. 2007. 00616. x.
[8] Zwolak P,Dudek AZ,Bodempudi VD,et al. Local irradiation in combination with bevacizumab enhances radiation control of bone destruction and cancer-induced pain in a model of bone metastases[J]. Int J Cancer,2008,122(3):681-688. DOI:10. 1002/ijc. 23157.
[9]安丽,陈石.唑来膦酸联合厄罗替尼治疗非小细胞肺癌骨转移临床疗效观察[J].海南医学,2011,22(5):10-13. DOI:10.3969/j. issn. 1003-6350. 2011. 05. 004.
[10]仲召阳,王东,卿毅,等.贝伐珠单抗抑制骨肉瘤血管生成及与放疗的协同作用研究[J].解放军医学杂志,2009,34(6):733-736. DOI:10. 3321/j. issn:0577-7402. 2009. 06. 024.
[11] Tokito T,Shukuya T,Akamatsu H,et al. Efficacy of bevacizumab-containing chemotherapy for non-squamous non-small cell lung cancer with bone metastases[J]. Cancer Chemother Pharmacol,2013,71(6):1493-1498. DOI:10. 1007/s00280-013-2148-3.
[12] Beuselinck B,Wolter P,Karadimou A,et al. Concomitant oral tyrosine kinase inhibitors and bisphosphonates in advanced renal cell carcinoma with bone metastases[J]. Br J Cancer,2012,107(10):1665-1671. DOI:10. 1038/bjc. 2012. 385.
[13] Keizman D,Ish-Shalom M,Pili R,et al. Bisphosphonates combined with sunitinib may improve the response rate,progression free survival and overall survival of patients with bone metastases from renal cell carcinoma[J]. Eur J Cancer,2012,48(7):1031-1037. DOI:10. 1016/j. ejca. 2012. 02. 050.
[14]李峰,安琪,韩超,等.唑来膦酸联合盐酸埃克替尼治疗肺癌骨转移的疗效分析[J].中国医院药学杂志,2014,34(13):1096-1099. DOI:10. 13286/j. cnki. chinhosppharmacyj. 2014. 13. 14.
[15] de Bono JS,Logothetis CJ,Molina A,et al. Abiraterone and increased survival in metastatic prostate cancer[J]. N Engl J Med,2011,364(21):1995-2005. DOI:10. 1056/NEJMoa1014618.
[16] Scher HI,Fizazi K,Saad F,et al. Increased survival with enzalutamide in prostate cancer after chemotherapy[J]. N Engl J Med,2012,367(13):1187-1197. DOI:10. 1056/NEJMoa1207506.
[17] Nilsson S,Heinrich D,O'Sullivan JM,et al. Updated analysis of the phase III,double-blind,randomized,multinational study of radium-223 chloride in castration-resistant prostate cancer(CRPC)patients with bone metastases[J]. J Clin Oncol,2012,30(18):4512. DOI:10. 1200/jco. 2012. 30. 18_suppl. lba4512.
[18] Benedict SH,Yenice KM,Followill D,et al. Stereotactic body radiation therapy:the report of AAPM Task Group 101[J]. Med Phys,2010,37(8):4078-4101. DOI:10. 1118/1. 3438081.
[19]赵凤,田伟,曾铭,等.阿帕替尼联合立体定向放射治疗用于前列腺癌骨转移治疗的研究[J].实用医院临床杂志,2017,14(4):15-18. DOI:10. 3969/j. issn. 1672-6170. 2017. 04. 004.
[20]高万露,汪小海.患者疼痛评分法的术前选择及术后疼痛评估的效果分析[J].实用医学杂志,2013,29(23):3892-3894.DOI:10. 3969/j. issn. 1006-5725. 2013. 23. 038.
[21]李学,李园,贾立群.唑来膦酸注射液治疗恶性肿瘤骨转移疼痛的临床观察[J].现代肿瘤医学,2010,18(6):1194-1196.DOI:10. 3969/j. issn. 1672-4992. 2010. 06. 60.