贝伐单抗联合化疗治疗晚期转移性恶性肿瘤的临床效果观察

Observation study of clinical efficacy of Bevacizumab combined with Chemotherapy for advanced and metastatic Cancer

目的观察贝伐单抗联合化疗治疗晚期转移性恶性肿瘤的近期效果和不良反应。方法59例晚期转移性恶性肿瘤（结直肠癌42例，肺腺癌17例）患者给予贝伐单抗联合化疗。结直肠癌患者一线化疗27例，即贝伐单抗联合奥沙利铂，二线化疗15例，即贝伐单抗联合伊立替康方案；肺腺癌患者应用多西紫杉醇与顺铂联合贝伐单抗化疗。化疗应用4～6个周期，贝伐单抗应用至病情进展。治疗过程中根据美国国立癌症研究所制定的通用毒性评分标准（3．0版本）评价不良反应级别。结果42例结直肠癌患者中，一线治疗27例，完全缓解（CR）1例，部分缓解（PR）13例，稳定（SD）4例，进展（PD）9例，有效率51．9％（14／27），疾病控制率66．7％（18／27）；二线治疗15例，PR5例，SD4例，PD6例，有效率33．3％（5／15），疾病控制率60．0％（9／15）；结直肠癌患者一线治疗的有效率有高于二线治疗的趋势，但差异无统计学意义（x2=1．335，P=0．248）。17例肺腺癌患者CR1例，PR7例，SD5例，PD4例，有效率47．1％（8／17），疾病控制率76．5％（13／17）。可能与贝伐单抗相关的主要不良反应：59例患者发生3级咯血1例、3级血栓栓塞1例，较常见不良反应为1或2级的鼻出血、咯血、高血压、蛋白尿等，程度均较轻患者可以耐受。结论贝伐单抗联合化疗治疗晚期转移性恶性肿瘤患者近期效果好；其不良反应患者可耐受，其远期疗效有待进一步研究。

Objective To study the therapeutic efficacy and toxicity of Bevacizumab combined with Chemotherapy in patients with advanced and metastatic cancer. Methods Fifty-nine patients of advanced metastatic cancer （ Forty-two patients of refractory metastatic colorectal cancer and 17 advanced adenocarcinoma） were treated with normalized chemotherapy combined with Bevacizumab. Patients with refractory metastatic colorectal cancer were treated with Bevacizumab combined with FOLFIRI or FOLFOX4, and patients with advanced adenocarcinoma of NSCLC were treated with Bevacizumab in combination with docetaxel and cisplatin for 4 -6 cycles, Bevacizumab was used until progressive disease （PD）. During treatment, adverse effect were assessed with Common Toxicity Criteria V3.0 developed by National Cancer Institute. Results Among the 42 patients of metastatic colorectal cancer,27 were treated with First-line 1 with complete remission （ CR）, 13 partial response（PR） ,4 stable disease（SD） and 9 PD,the effective rate （ER） was 51.9% （5/15）, disease control rate（DCR） was 66. 7% （ 18/27 ） ; Fifteen patients were treated with second-line PR, of which 5 PRD,d SD,6 PD. ER was 33.3% （5/15） ,and DCR was 60. 0% （9/15）. The effective rate were slightly higher in the First-line treatment group than that in the second-line treatment group, however, the difference was not statistically significant （ X2 = 1. 335, P = 0. 248 ）. Among the 17 patients of NSCLC, of which 1 CR,7 PR,5 SD,4 PD. RR was 47. 1% （8/17） ,and DCR was 76. 5% （ 13/17 ）. The major toxicities were one grade 3 hemoptysis observed in one patient, grade 3 thrombosis was observed in one patient. Other common adverse effects, were epistaxis, hemoptysis, hypertension and proteinuria, which were not severe and could be well tolerated. Conclusion Bevacizumab Combined with Chemotherapy was effective in short term for the patients with advanced and metastatic cancerMost patients could tolerate the side effects. Further studies should be done to prove the long-term effects.