拓扑替康治疗晚期复发妇科恶性肿瘤的临床观察

Effect of topotecan in advanced recurrent gynecologic cancer

目的 评价拓扑替康在晚期复发妇科恶性肿瘤治疗中的近期疗效及血液学毒性.方法 选择中国医学科学院肿瘤医院妇瘤科2011年11月至2014年2月收治的20例晚期妇科恶性肿瘤患者,完全随机分配11例应用拓扑替康周疗方案：3.5 mg/（m2·d）,第1、8、15天,每28天重复.另外9例为拓扑替康月疗方案（单药或联合）：1.25 mg/（m2·d）,第1～5天,每21天重复.中位疗程数为3个.从给药方式、复发类型、无铂间期、既往化疗方案数的不同观察拓扑替康用于晚期复发妇科恶性肿瘤的近期疗效和血液学毒性.结果 20例患者中,0例完全缓解,2例部分缓解,10例疾病稳定,8例疾病进展.拓扑替康周疗临床有效5例;月疗临床有效7例,其中联合治疗临床有效3例.铂敏感型复发5例,临床有效4例,铂耐药型复发15例,临床有效8例.3例月疗（3/9）和1例周疗（1/11）患者在疗程中或治疗后出现3或4级骨髓抑制,周疗方案的血液学毒性低于月疗方案.结论 拓扑替康用于铂敏感型或铂耐药型晚期妇科恶性肿瘤复发后的二线治疗效果较满意,周疗方案血液学毒性较低,耐受性较好.

Objective To evaluate the short-term effect of topotecan （Hycamtin） in the treatment of advanced recurrent gynecologic cancer and its hematological toxicity.Methods Twenty patients with advanced recurrent gynecologic cancer from November 2011 to February 2014 were recruited and randomly divided into weekly therapy group （11 cases） receiving topotecan every week [3.5 mg/（m2 · d） at the 1st,8th and 15th,repeated every 28 days] and monthly therapy group （9 cases） receiving topotecan （single or combined use） every month [1.25 mg/（m2 · d）,from the 1st-5th,repeated every 21 days].The median course of treatment was three.The administration method,recurrence type,clinical response,course number and extent of myelosuppression were observed.Results No complete response was recorded among the 20 patients,there were 2 of partial response,10 of stable disease and 8 of disease progression.Five patients in weekly therapy group and 7 in monthly therapy group （including 3 of drug combination） had clinical improvement.There were 5 patients of platinum-sensitive,among them 4 cases had improvement,there were 15 cases with platinum-resistant,among them 8 cases had improvement.Grades 3 or 4 myelosuppression occurred in 4 patients including 3 of monthly therapy group and 1 of weekly therapy group,suggesting less hematological toxicity of monthly therapy project.Conclusions Topotecan shows good effect in the treatment of advanced recurrence gynecologic cancer patients with platinum-sensitive or not type and weekly administration can be well tolerated with less hematological toxicity.