替莫唑胺联合伊立替康治疗复发性非小细胞肺癌脑转移的疗效和毒副作用分析

Efficacy and Safety of Temozolomide in Combination with Irinotecan in Non-Small Cell Lung Cancer Patients with Relapsed/refractory Brain Metastasis

目的:评价替莫唑胺联合伊立替康治疗复发性非小细胞肺癌(NSCLC)脑转移的疗效及毒副反应。方法:对20例既往至少经一线化疗方案治疗和(或)全脑放射治疗后未达缓解或缓解后复发的患者给予替莫唑胺每天150~200mg·m-2,第1天~第5天,伊立替康60 mg?m-2,iv,第1、8天,21d为1周期,最多化疗6周期。结果:20例患者中,男性12例(60.0%),女性8例(40.0%),中位年龄为54岁,ECOG评分≤1分,治疗周期数1~6周期,中位治疗3周期。其中2例部分缓解,近期有效率10%,4例稳定(20.0%),14例进展(70.0%)。毒副反应可耐受,最常见的不良反应是骨髓抑制和胃肠道反应。骨髓抑制主要表现为:白细胞(WBC)或中性粒细胞(NEUT)下降20例(100%),其中I^II度14例(70.0%),III度5例(25.0%),IV度1例(5.0%);胃肠道反应较轻微,主要为I^II度15例(75.0%)。其余较常见的毒副反应还包括腹泻5例(25.0%),其中I度4例(20.0%),II度1例(5.0%),肝功能损害3例,均为I度(15.0%)。结论:替莫唑胺联合伊立替康治疗复发性NSCLC脑转移的化疗疗效良好,毒副反应轻微。

Objective：To evaluate the efficacy and safety of temozolomide in combination with irinotecan in non-small cell lung cancer patients with relapsed/refractory brain metastasis.Methods：Twenty NSCLC patients with brain metastasis refractory to or relapsed after first line chemotherapy and/ or whole brain radiation were treated with temozolomide 150～200mg/m2/d on day 1～5 and irinotecan 60 mg/m2 on day 1 and day 8 administered every 3 weeks,with a maximum of 6 cycles of chemotherapy.Results：Twelve male （60.0％） and 8 female （40.0％） ECOG ≤ 1 patients were enrolled,with median age of 54.Median duration of chemotherapy was 3 cycles,with a range of 1～6 cycles.Overall response rate was 10.0％ （2 partial response）,and 4 had stable disease （20.0％）.Adverse effects were generally tolerable with the most common side effects affecting hematological and GI systems.Hematological toxicities：leucopenialneutropenia in 20 pts,including Grade 1～2 in 14 （70％）,Grade 3 in 5（25.0％）,and Grade 4 in 1（5.0％）.Nausea/vomitting were generally slight with Grade 1～2 in 15 pts （75.0％）.Other AE included diarrhea in 5 pts （25.0％,4 Grade 1 and 1 Grade 2）,and abnormal liver function in 3 pts （15％,Grade 1）.Conclusion：Combination chemotherapy with temozo Iomide and irinotecan was effective in NSCLC patients with relapsed/refractory brain metastasis,and showed tolerable and manageable toxicities.