重组改构人肿瘤坏死因子姑息治疗晚期肿瘤伴随恶性胸腔积液的临床观察

Application of recombinant mutated human tumor necrosis factor as palliative treatment for advanced cancer and malignant pleural effusion

目的回顾性分析重组改构人肿瘤坏死因子(rmhTNF)在晚期肿瘤伴恶性胸腔积液患者姑息治疗中的效果。方法将25例晚期肿瘤伴发恶性胸腔积液的患者最大限度地引流胸腔积液,然后给予rmhTNF 300万IU,每3天一次,连续4次,观察疗效和不良反应。结果治疗后4例患者由于已经进入肿瘤终末期,于4周内死亡。在治疗4周内有76.2%(16/21)的患者未复发;对于曾经使用其他方法治疗过的15例患者,有73.3%(11/15)未复发。25例患者共给药83次,其中发热发生率10.8%(9/83),流感样症状发生率1.2%(1/83),总发生率为12.0%(10/83)。所有的不良反应是完全可逆的,对症治疗即可消失。结论胸腔内灌注rmhTNF治疗恶性胸腔积液是一种不良反应相对较少,疗效确切的方法,在其他方法失败的情况下也有效,适用于身体状况较差进行姑息治疗的患者。

Objective To evaluate the efficacy of recombinant mutated human tumor necrosis factor （rmhTNF） as pal-liative care for patients with advanced cancer and malignant pleural effusion. Method 25 cases of advanced cancer pa-tients with malignant pleural effusion were administered with intensive management of pleural drain, and then were given thoracic perfusion of rmhTNF 3,000,000 IU, once every 3 days for 4 times in a row, the curative effect and adverse reac-tions were observed afterwards. Result After treatment, 4 patients died in 4 weeks due to their end-stage diseases;While during the same period, 76.2%（16/21） of patients had no recurrence;For 15 patients who had other prior therapy, 73.3%（11/15） had no relapse;25 patients had a total of 83 administrations, in which 10.8%（9/83） had fever, 1.2%（1/83） devel-oped flu-like symptoms, so the overall incidence of adverse reactions was 12.0%（10/83）, which were reversible and man-ageable. Conclusion Intrathoracic perfusion of rmhTNF is an effective yet safe therapy in the treatment of malignant pleural effusion, with relatively less adverse reactions, and is an alternative palliative option for patients with poor condi-tions when other therapies fail.