依托泊苷、伊立替康分别联合顺铂方案不同序贯顺序治疗广泛期小细胞肺癌的回顾性分析

Comparative study of different sequential orders of EP and IP in the treatment of extensive-stage small-cell lung cancer

目的:回顾性比较依托泊苷联合顺铂(EP)与伊立替康联合顺铂(IP)不同序贯顺序治疗广泛期小细胞肺癌(E-SCLC)的优劣性。方法:共90例E-SCLC初治患者。A组一线接受EP方案(依托泊苷:100 mg·m-2,静滴,d1～d3,顺铂:75 mg·m-2,静滴,d1,每3周重复),直到疾病进展,换用IP方案(伊立替康:60 mg·m-2,静滴,d1,d8,d15,顺铂:75 mg·m-2,静滴,d1,每3周重复)序贯治疗;B组序贯顺序与A组相反;统计并比较两组疗效及毒副反应。结果:A组59人,B组31人。两组的总生存时间为12.0月及13.6月,二次进展时间为6.6月及8.4月,一线无疾病生存时间(PFS)为5.1月及6.1月,二线PFS为2.9月及3.2月,均无统计学差异。EP与IP方案的一、二线治疗总反应率(一线:76.27%∶80.65%;二线27.25%∶36.84%)及肿瘤控制率(一线:89.83%∶93.55%;二线85.71%∶73.68%)均无统计学差异。一线治疗中EP方案3/4级中性粒细胞减少(66%∶35%,P=0.003)的发生率高于IP方案,3/4级腹泻(24%∶32%,P=0.012)及呕吐反应(10%∶19%,P=0.005)的发生率低于IP方案。二线治疗时IP方案3/4级中性粒细胞减少发生率增加(58%∶33%,P=0.034)。IP方案作为一线治疗的3/4级中性粒细胞减少(29%∶58%,P=0.017)发生率明显低于作为二线治疗的发生率。结论:有超过60%的患者能接受二线治疗。两种序贯方式近、远期疗效相当。IP作为一线治疗的序贯治疗方案毒副作用更小。IP序贯EP方案是更值得推荐的序贯方案。

OBJECTIVE To compare different sequential orders of EP and IP in the treatment of extensive stage small cell lung cancer. METHODS 90previously untreated patients were included. Arm A accepted EP as first-line therapy （etoposide： 100 mg.m 2, ivdrip, dl-3, cisplatin： 75 mg.m 2,ivdrip,dl, every 3 weeks） to progression followed by IP （irinotecan： 60 mg · m 2 ,ivdrip,dl, 8,15, cisplatin： 75 mg.m-2 ,ivdrip,dl, every 3 weeks） ,while the two regimens were in the reverse order in arm 13. The efficacy and toxicity were compared. RESULTS Overall survival （OS） was 12. 0 months in 59 patients allocated to EP then IP versus 13. 6 months in 31 patients allocated to IP then EP. Time to second progression （TTsP） was 6. 6 months in arm A versus 8.4 months in arm B. In first-line therapy, median progression free survival （PFS） was 5.1 versus 6.1 months, while the second-line PFS was 2.9 versus 3.2 months. They were all of no statistical differences. The response rate （RR） （first- line; 76. 27 vs 80. 65% ; second-line 27. 25% vs 36. 84%） and tumor control rate （TCR） （first-line： 89.83% vs 93.55%; sec- ond line 85.71 % vs 73.68%） of EP and IP were all of no statistical differences. In first line treatment ,there were higher rate of grade 3/4 neutropenia（66% vs 35% ,P = 0. 003）, and lower rate of diarrhea（24% vs 32G, P = 0. 012） and vomiting（ 10% vs 19% ,P= 0. 005）in EP compared with IP. Graded/4 neutropenia was increased when IP was administered as the second line compared with EP（58% vs 33G, P = 0. 034）. Less grade 3/4 neutropenia（29% vs 58 %, P = 0. 017）was observed when IP was administered as the first line. CONCLUSION More than 60 percent patients took 2 lines treatments. There were no statistical differences between the two sequences in efficacy in the treatment of E-SCLC. There were less htoxicities when IP was adminis- trated as first line. IP followed by EP appears to be the preferable sequence in terms of toleranco