吉西他滨联合洛铂治疗紫杉类耐药晚期肺鳞癌临床观察

Efficacy of domestic gemcitabine combined with Lobaplatine in salvage treatment of taxanes-refractory ad- vanced lung squamous carcinoma

目的观察吉西他滨联合洛铂治疗对含紫杉类联合化疗一线方案失败的晚期肺鳞癌近期疗效和主要毒副反应。方法共入组经含紫杉类联合化疗一线方案治疗失败的晚期肺鳞癌患者71例，患者均要求接受不少于2个周期的二线化疗，给予吉西他滨1000mg／m^2（第1、8天）静脉滴注；洛铂30mg／m^2（第2天）静脉滴注；3～4周为1个周期，治疗中密切观察化疗相关毒副反应；根据实体瘤RECIST1．0实体瘤近期疗效标准进行疗效评价和生存时间的随访。结果71例患者共完成175．0个周期化疗，人均2．6个周期；其中最少完成1个周期，最多4个周期化疗终止治疗；未完成2个周期患者共3例，未作疗效分析，仅对毒性反应进行评价。共有68例患者参与疗效评价与分析，其中完全缓解（CR）0例；部分缓解（PR）15例，占22．O％（15／68）；稳定（SD）18例，占26．4％（18／68）；临床获益（DCR）33例，占48．5％（33／68）；中位生存时间（mOS）至疾病进展时间（TTP）13．6周，mOS为7．9个月，1年生存率42．6％（29／68）。主要毒性反应为白细胞、血小板减少为主的骨髓抑制，约38．3％（67／175）。结论吉西他滨联合洛铂对曾经含紫杉类方案一线化疗失败的晚期肺鳞癌患者的挽救治疗具有较好疗效，安全性较好，可用于晚期肺鳞癌一线方案耐药后继续化疗。

Objective To evaluate the effiacy and adverse reactions of domestic gemcitabine combined with lobaplatine in salvage treatment of taxanes-refractory advanced lung squamous canceroma. Methods 71 patients with squamous carcinoma of lung, all had been failer to combined chemotherapy with taxanes treatment before, received the treatment with domestic gemcitabine （ 1 000mg/m^2,dl, 8 ） combined with lobaplatine （ 30mg/m^2, d2 ） , 21-28 days as a cycle , at least 2 cycles should been recieved. The therapeutic efficacy was evaluated after 2 cycles of chemotherapy ,according to RECIST1.0 standard. Results All of 175 cycles had been observed. In terms of the treatment efficacy, 68 patients could be evaluated objectively of 71 cases patients, partial response （PR） was 15 cases （22.0%）, stable disease （SD） was 18 cases （ 26.4% ）, with an overall response rate （RR） was 22.0% （ 15/68 ）, disease control rate （DCR） was 48.5 % （33/68）. The median time to progression （TTP） was 13.6 weeks, the median survival time （OS） was 7.9 months. One year survival rate was 42.6% （29/68）. On 71 cases for a total of 175 cycles of chemotherapy, the major toxic reaction was hematological toxicities ,including myelosuppression about 38.3% （67/175） for grade Ⅲ and Ⅳ. Conclusion The combination treatment of domestic gemcitabine plus lobaplatin is a feasible and active scheme in salvage treatment of taxanes-refractory advanced quamous carcinoma of lung.