VM-26和DDP联合化疗治疗恶性胶质瘤:20例分析

Teniposide and Cisplatin Regimen for Malignant Glioma:Analysis of 20 Cases

背景与目的:化疗是胶质瘤重要的辅助治疗方法,然而,疗效肯定的化疗方案不多。我们前期对恶性胶质瘤体外化疗药物敏感性试验研究表明,替尼泊甙(teniposide,VM-26)和顺铂(cisplatin,DDP)是对胶质瘤敏感性相对较高的药物。所以,我们采用VM-26+DDP联合化疗方案治疗恶性胶质瘤患者,探讨其疗效和不良反应。方法:总结分析中山大学肿瘤防治中心神经肿瘤科收治的经手术后病理确诊的恶性胶质瘤患者20例, 所有病例均接受了手术后的辅助放射治疗。VM-26 300 mg/m2,分3-5天静滴;DDP 80 mg/m2,分3-5天静滴;每周期3-4周,对接受大于或等于2周期化疗者按WHO疗效评价标准进行疗效评价。不良反应评价按美国国立癌症研究所(National Cancer Institute,NCI)评价标准。结果:15例患者进入疗效评价和生存分析。1例 (7%)完全缓解(complete response,CR),2例(13%)部分缓解(partial response,PR),9例(60%)稳定(stable disease,SD),3例(20%)进展(progressive disease,PD)。客观有效率(CR+PR)为20%,有效加稳定率(CR+PR+ SD)为80%。全组1年生存率为58%。VM-26+DDP联合化疗的主要不良反应为骨髓抑制,Ⅲ、Ⅳ度粒细胞减少 4例,占20%(4/20),但可在一周内自行恢复或经短期(3-5天)G-CSF对症处理后恢复正常。无因粒细胞减少延迟治疗及减小剂量病例。结论:VM-26+DDP联合化疗治疗恶性胶质瘤,有与其它常用化疗方案相似的客观有效率,和更高的疾病稳定率,不良反应耐受性好,值得进一步扩大病例深入研究。

BACKGROUND & OBJECTIVE:Chemotherapy is an important adjuvant treatment for malignant glioma. Unfortunately, confirmed chemolherapy regimens with satisfactory efficacy for glioma were few. Our previous investigation of in vitro cytotoxicity assay with primary glioma indicated that teniposide (VM-26) and cis- platin(DDP) were comparative sensitive, and thus we have applied this regimen (VM-26 + DDP) to treat malignant glioma and evaluated the efficacy as well as side-effect. METHODS : Twenty patients with histologically confirmed malignant gliomas were enrolled in this study, and all patients received radiotherapy following surgery. The chemotherapeutic regi- men consisted of VM-26 300mg/m2 and DDP 80mg/m2, which were divided for 3-5 days intravenous administration with every 3-4 weeks a cycle. The patients who received more than one cycle were evaluated. The clinical efficacy were evaluated according to WHO standard, and side-effect were assessed according to NCI (National Cancer Institute) standard. RESULTS: Fifteen patients were included for evaluation: complete response(CR)was achieved in only 1 case (7%) and 2 cases (13%) were partial response (PR), while stable disease (SD) were found in 9 patients (60%), and progressive disease(PD) were in 3 cases(20%). Objective response rate (CR + PR) was 20%, and response plus stable (CR+PR+SD) was 80%. One year overall survival was 58%. The major toxicity of this regimen was myelotoxicity. Four patients (20%) developed grade III or IV leukopenia, which were recovered in 1 week following G-GSF treatment. There was no treatment discontinuation or dose reduction caused by toxicity. CONCLUSION : Our primary experience with 20 glioma patients indicates that VM-26 + DDP regimen had similar objective response rate and better disease stabilization as compared with conventional chemotherapeutic regimen, with acceptable side-effect, and thus worth for further investigation.