雷替曲塞为基础化疗方案治疗晚期原发性肝癌的临床观察

Clinical Observation of Raltitrexed-based Regimen for Advanced Primary Liver Carcinoma

目的回顾性分析雷替曲赛为基础化疗方案治疗晚期原发性肝癌的疗效及安全性。方法 31例原发性肝癌患者,均接受以雷替曲塞为基础方案化疗,其中二线治疗14例,三线及以上治疗17例,方案包括雷替曲塞联合伊立替康(TOMIRI)、雷替曲塞联合奥沙利铂(TOMOX)、雷替曲塞联合吉西他滨(TOMGEM)、雷替曲塞单药(RTX)。按照RECIST1.1版标准评价客观疗效,按照NCICTC 4.0版标准评价不良反应。结果 31例患者完成1周期以上的化疗,均可评价疗效,其中无完全和部分缓解患者,13例患者稳定(SD),18例患者进展(PD),有效率(RR)为0%,疾病控制率(DCR)为41.9%,中位TTP(m TTP)为63天,中位OS(m OS)为189天。常见的不良反应为骨髓抑制及消化道反应,多为Ⅰ~Ⅱ级,患者均可耐受。结论雷替曲塞为基础化疗方案对标准治疗失败的晚期原发性肝癌仍有一定的疾病控制率,且安全性良好,值得进一步深入研究。

Objective To evaluate clinical efficacy and adverse events of raltitrexed-based regimens for advanced primary liver carcinoma patients. Methods A total of 31 advanced primary liver carcinoma patients were treated with raltitrexed-based regimens, 14 patients were the second-line treatment, 10 patients were the third-line treatment and 7 patients were the fourth-line treatment. The chemotherapy regimens were irinotecan（CPT-11）, oxaliplatin（AXO）, gemcitabine（GEM） combined with raltitrexed respectively and single raltitrexed. The efficacy of all patients were evaluated according to Response Evaluation Criteria in Solid Tumors 1.1（RECIST 1.1）. The adverse events were evaluated by Common Terminology Criteria for Adverse Events Version 4.0（NCN-CTC 4.0）. Results Thirty-one patients could be evaluated. No one achieved complete response（CR） or partial response（PR）, 13 patients achieved stable disease（SD） and 18 patients achieved progressive disease（PD）. The effective rate（CR＋PR） was 0%. The disease control rate（CR＋PR＋SD） was 41.9%. The median time to progression（m TTP） and median overall survival（m OS） were 63 and 189 days, respectively. The main adverse events were myelosuppression and gastrointestinal reactions. These adverse events wereⅠ~Ⅱdegree and well-tolerated. Conclusion Raltitrexed-based regimens for advanced primary liver carcinoma are effective and well-tolerable. It may lengthen the overall survival and is worthy of further study.