口服长春瑞滨节拍化疗治疗晚期多线治疗失败的非小细胞肺癌的临床观察

Efficacy and Toxicity of Metronomic Oral Vinorelbinen in Advanced Non-small Cell Lung Cancer after Failure to Multiple-lines Treatments

背景与目的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受新的多线治疗有助于延长患者的总生存时间。节拍化疗通过多种机制控制肿瘤生长,而且副作用更小。口服长春瑞滨是进行节拍化疗的合适药物。因此,我们对口服长春瑞滨节拍化疗治疗晚期多线治疗失败的NSCLC的疗效及不良反应进行了分析。方法收集2016年3月-2017年1月北京和睦家医院及首都医科大学宣武医院收治的26例接受口服长春瑞滨节拍化疗的晚期多线治疗失败的NSCLC的临床资料,并进行回顾性分析。结果中位随访时间为4(2-12)个月。患者的中位治疗周期数为2(1-8)个,无患者达到完全缓解,2例(8%)患者达部分缓解,11例(42%)达疾病稳定,13例(50%)为疾病进展。患者的有效率为8%,疾病控制率为50%。中位疾病无进展时间(progression-free survival,PFS)为2.0个月。对影响PFS的各因素进行单因素分析中,体能状态(performance status,PS)评分为1分的患者优于2分患者(P=0.012)。PFS与性别、年龄、吸烟状态和病理类型均无关。治疗的耐受性好,严重毒性反应非常少见。没有出现IV级或不可耐受的毒性反应。没有患者因不良反应(adverse events,AEs)出现死亡或因治疗AEs而需要住院治疗。结论口服长春瑞滨节拍化疗可作为治疗晚期NSCLC,尤其是PS评分差的患者的有效药物,安全性高,患者的耐受性好。

Background and objective The development of new treatments beyond first-line in metastatic non-small cell lung cancer（NSCLC） contributed to the increase in overall survival. Metronomic chemotherapy involves several mechanisms of anti-tumor with less toxicity. Oral vinorelbine has paved the way for innovative treatment strategies through metronomic regimens. Therefore, this study assessed the efficacy and safety of metronomic oral vinorelbinen in advanced NSCLC after failure to multiple-lines treatments. Methods Our retrospective study enrolled 26 patients who received metronomic oral vinorelbinen. Survival factors were evaluated by univariate regression analysis. Results The median follow-up time was 4 months（range 2-12）. The median number of treatment cycles was 2（range 1-8）. No patient achieved complete remission, 2 cases（8%） partial remission, 11 cases（42%） stable disease, 13 cases（50%） progression disease. Overall response rate was 8% and disease control rate was 50%. The median progression-free survival（PFS） was 2 months. In univariate analysis, patients with performance status（PS）=1 had a statistically significantly longer PFS than patients with PS=2. Gender, age, smoking status and histology were not prognostic factors according to PFS. Treatment was well tolerated with rare serious toxicity. No grade 4 adverse events（AEs） or occurrences of intolerable toxicity were observed. There was no treatment-related death and none of the study patients required hospitalization for treatment-related adverse events. Conclusion Metronomic oral vinorelbinen is effective in advanced NSCLC after the failure of multiple lines treatments with an acceptable AE profile, especially in patients with high PS.