VIP方案治疗小细胞肺癌的初步研究

Preliminary study of small cell lung cancer treated with VIP regimen

目的：探索高剂量强度的化疗方案ＶＩＰ（ＶＰ１６，ＩＦＯ，ＰＤＤ）能否提高小细胞肺癌的疗效，以及在小剂量ＧＣＳＦ支持下能否保证其剂量强度。方法：１９例小细胞肺癌患者，接受高剂量强度的ＶＩＰ方案化疗：ＶＰ１６１００ｍｇ／ｍ２ｉｖｄ１～５，ＩＦＯ１．５ｇ／ｍ２ｉｖｄ１～５，Ｍｅｓｎａ０．４ｇｉｖ，于ＩＦＯ注射后０、４、８ｈ各一次；ＤＤＰ２０ｍｇ／ｍ２ｉｖｄ１～５；于ｄ７开始应用ＧＣＳＦ２～３μｇ／ｋｇ·ｄ，皮下注射直至血白细胞＞５×１０９／Ｌ时停药。每３周重复，共４～６疗程，局限期病人进行辅助胸部放疗。结果：初治的１６例中，ＣＲ７例（４４８％）、ＰＲ９例（５６２％），ＣＲ＋ＰＲ为１００％。４例ＰＲ的局限期病例中，通过放射治疗又有２例获得ＣＲ，３例复治病例亦有２例ＰＲ。相对剂量强度为９２８％。初治的病例，中位生存期１１个月，范围为５～３６个月，２例ＣＲ的病例获得了２年无病生存。主要的不良反应为骨髓抑制及恶心、呕吐。结论：高剂量强度的ＶＩＰ方案化疗能获得较高的有效率及完全缓解率，毒性能耐受。

Purpose:To explore the effect of intensive VIP regimen in the treatment of small cell lung cancer,and to evaluate the possibility of intensive chemotherapy supported with low dose G CSF. Method:Nineteen patients with small cell lung cancer (SCLC) received 4 6 cycles of VIP chemotherapy:Vp 16 100mg/m2 iv d 1～5,IFO 1.5g/m2 iv d1～5. Mesna 0.4 iv following IFO 0、4、8 h, d 1～5, DDP 20 mg/ iv d 1～5. G CSF 2 3 μg/kg·d was administered daily,started from d7 followed chemotherapy till WBC>5.0×109/L.In the limited stage patients,adjuvant chest irradiation was given following 4 cycles of chemotherapy.Result:In the 16 previous untreated patients,the complete response rate and the partial response rate was 44.8%(7/16) and 52.8%(9/16) respectively.The overall response rate was 100%.The median survival was 11 months(range 5 36 months).Two patients got 2 year disease free survival.In the 3 previous treated cases,2 patients was PR.The relative dose intensity was 92.8%.The main side effects were myelosuppression,nausea and vomting.Conclusion:The intensive VIP regimen can improve the efficacy of SCLC,and the toxicity was moderate.Low dose G CSF can increase the dose intensity of chemotherapy.