改良INP方案对晚期非小细胞肺癌患者的疗效分析

Efficacy of chemotherapy of modified INP regimen for advanced non-small cell lung cancer

目的观察改良INP方案对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者及脑转移癌患者的临床效果及不良反应,同时探讨Ⅲ型β微管蛋白(β-tubulin-Ⅲ)在晚期NSCLC中的表达情况,及其与异环磷酰胺/诺维本/铂类化疗疗效的关系。方法回顾性分析广州医学院第一附属医院收治的29例晚期非小细胞肺癌患者的临床资料。所有患者采用改良INP方案[异环磷酰胺(IFO)3 000 mg/m2,第1天,同时使用尿路保护剂美司钠+诺维本(NVB)25 mg/m2,第1天+顺铂(DDP)60 mg/m2,分3天静脉滴注],每3周1疗程。结果 29例晚期非小细胞肺癌患者经改良INP方案治疗,初治患者PR 2例(2/9),SD 6例(6/9),PD 1例(1/9),客观缓解率(ORR)22.2%,疾病控制率(DCR)88.9%;复治患者PR 2例(2/20),SD 14例(14/20),PD 4例(4/20),ORR 10.0%,DCR达80.0%,总的ORR为13.8%,总DCR达82.8%。脑转移患者12例,除2例不可评估外,其余10例患者PR 3例(3/10),SD 4例(4/10),PD 3例(3/10),脑转移灶的ORR为30.0%,DCR达70.0%,不良反应大多轻度且可控。同时β-tubulin-Ⅲ低表达者对该方案的反应优于高表达者。结论晚期非小细胞肺癌患者采用改良INP方案进行化疗,临床疾病控制率较高,耐受性良好,对脑转移患者亦有较好疗效,肿瘤组织β-tubulin-Ⅲ表达水平可能与该方案的疗效相关。

Objective To investigate the efficacy and toxicity of chemotherapy of modified INP regimen in treatment of advanced non-samll cell lung cancer and brain metastases. At the same time,to explore the relationship between the expression of β-tubulin-Ⅲ in NSCLC biopsies and sensitivity to this modified INP regimen. Methods The clinical data of 29 patients with advanced non-samll cell lung cancer admitted to The First Affiliated Hospital, Guangzhou Medical College were retrospectively analyzed. All the patients reeeived modified INP regimen [ ifosfamide （ 3 000 mg/㎡） , iv, dl ＋ vinorelbine （ 25 mg/㎡ ）, iv, dl ＋ cisplatin （ 60 mg/㎡ ）, iv, divide into three days ] every three weeks. The efficacy and toxicity of the modified INP were evaluated and all the data were analyzed via 2 independent sample tests. Results In initial treatment of patients,partial response （PR） was observed in 2 cases, stable disease （SD） in 6 cases and progression disease（PD） in 1 case, with an overall response rate（ORR） of 22.2 % and disease control rate （DCR） of 88.9% ;in the retreatment of patients,PR was observed in 2 cases, SD in 14 cases, and PD in 4 cases, with an ORR of 10.0% and DCR of 80. 0%. The total ORR and DCR were 13.8% and 82.8%. In brain metastases patients,PR was observed in 3 cases, SD in 4 cases, and PD in 3 cases,with an ORR of 30.0% and DCR of 70.0%. The toxicity was mild. Further, NSCLC patients with low β-tubulin-Ⅲ expression had better ORR than those with high expression. Conclusions The modified INP regimen is effective and well-tolerable for patients with advanc, ed NSCLC,especially for brain metastases patients. The β-tubulin-Ⅲ expression is associated with the efficacy of this regimen probably.