白蛋白结合型紫杉醇治疗老年晚期非小细胞肺癌的临床评估

Retrospective analysis of albumin-bound paclitaxel in the treatment of elderly patients with advanced non-small cell lung cancer

目的 分析单药白蛋白结合型紫杉醇治疗老年晚期非小细胞肺癌（NSCLC）的疗效及安全性。方法 回顾性分析2011年10月至2014年3月间采用白蛋白结合型紫杉醇单药、周疗方法治疗的23例老年晚期NSCLC患者的近期疗效、不良反应和生存时间。结果 23例NSCLC患者中，部分缓解6例，稳定10例，进展7例，客观有效率为26.1%，疾病控制率为69.6%。中位无进展生存时间为5.33个月（95% CI为2.95-7.70个月），中位生存时间为40.33个月（95% CI为29.82-50.83个月）。主要不良反应表现为白细胞减少（82.6%）、中性粒细胞减少（78.3%）、恶心或呕吐（56.5%）、乏力（52.2%）、周围神经毒性（26.1%）、肌肉关节酸痛（30.4%）、血小板减少（13.0%）和心律失常（4.3%）。合并慢性疾病组患者的周围神经毒性和肌肉关节酸痛发生率分别为50.0%和66.7%，明显高于未合并慢性疾病组（9.1%和9.1%），差异有统计学意义（均P〈0.05）。结论 单药白蛋白结合型紫杉醇治疗老年晚期NSCLC可取得较好的客观疗效，且患者耐受性良好。

Objective To observe the safety and short-term efficacy of sigle drug albumin-bound paclitaxel （ABP） in the treament of elderly patients with advanced non-small cell lung cancer （NSCLC）. Methods A total of 23 elderly patients with advanced NSCLC who received weekly ABP regimen （ 130 mg/m^2/week） in our hospital from October 2011 to March 2014 were retrospectively evaluated. The short-term efficacy, progression-free survival （PFS）, and overall survival （OS） were analyzed. Results The median treatment period was 4 cycles （2-10 cycles）. Partial response, stable disease, progressive disease, overall response rate, and disease control rate were 26.1%, 43.5%, 30.4%, 26.1% and 69.6%, respectively. The median PFS was 5.33 months （95% CI：2.95-7.70 months）, while the median OS was 40.33 months （95% CI： 29.82-50.83 months）. Major adverse events included leucopenia （82.6%）, neutropenia （78.3%）, nausea or vomiting （ 56.5% ）, fatigue （ 52.2% ）, peripheral neuropathy （ 26.1% ）, myalgia/arthralgia （ 30.4% ）, thrombocytopenia （13.0%） and arrhythmia （4.3%）. The patients accompanied with chronic diseases had significantly higher incidence rate of peripheral neuropathy and myalgia/arthralgia eompared with the patients without accompanied chronic diseases （ 50. 0% vs. 9.1% and 66.7% vs. 9.1%, P 〈 0.05 for both）. Conclusion The weekly single drug ABP regimen is effective and well-tolerated in elderly patients with advanced NSCLC.