生物化疗、化疗或生物疗法用于治疗恶性黑色素瘤的回顾性分析

Retrospective analysis of biochemotherapy versus chemotherapy or biotherapy for metastatic melanoma

背景与目的:近年来恶性黑色素瘤发病率有明显上升趋势,恶性黑色素瘤对单纯放、化疗不甚敏感,然而,它是一种免疫原性较高的肿瘤,联合免疫治疗可以提高疗效,因此,恶性黑色素瘤治疗的合理性在于它的综合治疗。本研究回顾性分析观察Ⅲ、Ⅳ期恶性黑色素瘤患者应用生物化学、生物或化学治疗的近期和远期疗效。方法:分析102例Ⅲ、Ⅳ期恶性黑色素瘤患者化学治疗(达卡巴嗪、顺铂、福莫司汀)、生物治疗(白细胞介素-2、干扰素α-2b、树突状细胞)或生物化疗(上述两者联合续贯)的临床疗效。中位随访时间2年(1至4年)。结果:近期疗效:生物化疗组36例,有效率(RR)为69.44%,与生物治疗组(34例,RR29.41%)和化学治疗组(32例,RR46.89%)相比,差异有显著性(P<0.05)。远期疗效生物化疗组的中位生存时间(MST)为2年9个月,与生物治疗组(MST为2年2个月)和化学治疗组(MST为1年2个月)相比,差异有显著性(P<0.05)。然而,毒副作用在生物化疗明显高于其他两组,但经一般处理,患者均可耐受。结论:恶性黑色素瘤患者经生物化学治疗可明显提高有效率并延长生存时间。

Background and purpose： In recent years the incidence of malignant melanoma has a clear upward trend. Malignant melanoma is less sensitive to radiotherapy or chemotherapy alone. However, malignant melanoma is a tumor with higher immunogenicity, the biotherapy combined with chemotherapy can improve the efficacy. This study analysed retrospectively the efficacy of either chemotherapy with biotherapy or sequential biochemotherapy consisting of same chemotherapy plus biotherapy for advanced melanoma （Ⅲ and Ⅳ stage）. Methods： 102 patients with malignant melanoma received either chemotherapy （dacarbazine, cisplatin and foremustine） alone, biotherapy （interleukin-2,interferon alfa-2 and dendritic cell vaccine） alone or biochemotherapy （chemotherapy plus biotherapy）. Response was assessed every 6 cycles. The median time of follow up was 4 years. Results： Among 102 patients enrolled, 36 were assessable for biochemotherapy, 34 for biotherapy and 32 for chemotherapy. Response rates were 69.44% for biochemotherapy, 29.41% for biotherapy and 46.89% for chemotherapy. The median survival time （MST） for biochemotherapy was 2 years and 9 months with a 2-year survival rate of 47.22%, biotherapy was 2 years and 2 months with a 2-year survival rate of 41.17%, chemotherapy was 1 years and 2 months with a 2-year survival rate of 15.62%. Biochemotherapy produced substantially more constitutional, hemodynamic, and myelosuppressive toxic effects. Conclusion： Cytokines plus dendritic cell vaccine substantially augment the antitumor activity of chemotherapy at the expense of considerable toxicity in patients with metastatic melanoma.