持续静脉输注去甲长春花碱加顺铂治疗晚期恶性肿瘤的临床研究

Continuous infusion of navelbine with cisplatin for management of advanced or metastatic non small cell lung cancer and breast cancer

目的 :临床研究去甲长春花碱 (诺维本 ,Navelbine,NVB)持续静脉输注是否可以提高疗效并减轻毒副反应。方法 :转移或复发的晚期乳腺癌以及不能手术的Ⅲ—Ⅳ期非小细胞肺癌的病人。其中去甲长春花碱的给药方式采用注射泵通过锁骨下深静脉置管进行 2 4小时持续给药。治疗方案 :NVB 10mg静脉一次推注第 1天 ,NVB10mg静脉持续滴注 2 4小时 ,第 1— 5天 ,DDP 40mg静脉滴注 2小时第 1— 3天 ,盐酸格拉司琼 3mg静脉推注第 1,3,5天。 2 1天为 1周期 ,2周期后评价疗效。结果 :47例病人中非小细胞肺癌 35例 ,乳腺癌 12例。平均年龄为 5 8.9岁。非小细胞肺癌中鳞癌病人 12例 ,腺癌病人 2 3例 ;Ⅱ期 2例 ,Ⅲ期 19例 ,Ⅳ期 14例 ;乳腺癌病人均为浸润型导管癌 ,其中Ⅲ期为 3例 ,Ⅳ期为 9例。可评价疗效病人 44例。非小细胞肺癌病人 19例达PR ,总有效率为 5 7%。乳腺癌病人 1例达CR ,6例达PR ,总有效率为 6 3%。可评价毒性反应病人 47例。主要毒性反应为白细胞下降及轻度的消化道反应。其中白细胞Ⅲ—Ⅳ度毒性达 5 1% ,粒细胞下降Ⅲ—Ⅳ度毒性达 40 %。消化道反应较为轻微 ,Ⅲ—Ⅳ度呕吐只占 6 .4%。神经毒性相当轻微 ,只有 6 .4%的病人有Ⅰ度的感觉神经损伤 ,没有病人出现如肠麻庳的严重神经毒性。结论

Purpose:Clinical research has been done to show whether continuous infusion of navelbine can increase curative effect and decrease toxicity.Methods:Patients studied were non operable NSCLC and recurrent or metastatic breast cancer. Navelbine is given through a catheter in the venae subclavia by continuous infusion for 24 hours. Regimen:NVB 10 mg/iv/day 1+NVB 10 mg/iv continuous infusion 24 h/day 1—5+DDP 40 mg/iv 2h/day 1—3+Gransetron 3 mg/iv day1,3,5 given every 21 days. Results:Among 47 patients 35 patients were NSCLC and 12 patients were breast cancer. Average age was 58.9 years. Of the NSCLC patients, 12 were squamous cell carcinoma and 23 patients were adenocarcinoma; two patients were stage Ⅱ and 19 patients stage Ⅲ, 19 patients stage Ⅳ. All of the breast cancer cases were infiltrative duct carcinoma. Three patients were stage Ⅱ and nine patients were stage Ⅳ. Of the 47 patients, 44 patients were evaluable for response and 47 patients for toxicity. Response rate of NSCLC was 57%(19 pr) and breast cancer 63% (1 cr, 6 pr). Main toxicity was granulocytopenia and vomiting. WHO Ⅲ—Ⅳ grade granulocytopenia was 40% and vomiting 6.4%. Peripheral nerves toxicity was mild and only 6.4% patients had WHO I grade peripheral sensory nerve damage. No patients had severe nerve toxicity such as enteroplegia.Conclusions:Comparison of continuous infusion Navelbine and Cisplatin with classic usage of navelbine for management of NSCLC and breast cancer showed increased response rate and decreased toxicity. Administration through catheter venae subclavia can avoid chemo phlebitis. [