甲磺酸阿帕替尼联合腹腔灌注顺铂治疗合并腹腔积液的老年晚期卵巢癌的临床疗效

Clinical Efficacy of Apatinib Combined with Intraperitoneal Injection of Cisplatin in Treatment of Elderly Advanced Ovarian Cancer Patients with Malignant Ascites

目的探讨甲磺酸阿帕替尼联合腹腔灌注顺铂用于二线及以上治疗失败的合并腹腔积液的老年晚期卵巢癌的临床疗效和安全性。方法回顾性分析2016年4月-2017年4月在我院接受过二线及二线以上治疗失败的16例合并腹腔积液的老年晚期卵巢癌患者,均经病理诊断明确,给予腹腔注射顺铂注射液(40 mg,1周1次,共4次),同时联合阿帕替尼500mg/天口服,直到患者病情进展或对药物产生的副作用无法耐受。观察药物的临床疗效和不良反应发生情况,应用KaplanMeier法进行生存分析。结果 16例卵巢癌患者的腹水控制有效率达100%,肿瘤治疗有效率(RR)和疾病控制率(DCR)分别为18.8%以及56.2%;治疗前后血清肿瘤标志物(CEA、CA125、HE4)水平比较,差异具有统计学意义;中位无进展生存期(PFS)以及中位生存期(OS)分别为5.8个月和7.0个月;患者药物耐受性较好,常见不良反应为Ⅰ-Ⅲ级高血压、骨髓抑制、手足综合征和蛋白尿。结论阿帕替尼联合腹腔灌注顺铂对于二线及以上治疗失败的合并腹腔积液的老年晚期卵巢癌有较好的效果,不良反应可控,患者生活质量得到明显改善,具有临床应用的价值。

Objective To evaluate the efficacy and safety of apatinib combined with intraperitoneal injection of cisplatin in treatment of elderly advanced ovarian cancer patients with malignant ascites after failure of second-line or beyond treatment. Methods The data of 16 elderly patients who were pathologically confirmed with advanced ovarian cancer and with malignant ascites but failed from second-line or beyond treatment were retrospectively analyzed. All the patients were given intraperitoneal injection of cisplatin(40 mg, once a week, 4 times per case) and oral administration of apatinib(500 mg·d-1) until disease progression or intolerable toxicity. The clinical effects and adverse reactions were observed and recorded. The overall survival was analyzed with Kaplan-Meier. Results The response rate(RR) of malignant ascites was 100%. The RR and disease control rate(DCR) was 18.8% and 56.2% respectively. Compared with before treatment, the results of tumor markers CEA, CA125 and HE4 after treatment had statistically significant changes(P<0.05). The median progression free survival(PFS) and median overall survival(OS) were 5.8 months and 7.0 months respectively. Apatinib treatment was well tolerated, without severe toxicities. The common adverse events included grade Ⅰ-Ⅲ hypertension, myelosuppression, hand-foot syndrome and proteinuria.Conclusion Administration of apatinib combined with intraperitoneal injection of cisplatin is still beneficial to elderly advanced ovarian cancer patients with malignant ascites after failure of second-line or beyond treatment. The adverse reactions are tolerable, and the quality of life is improved, so it deserves further clinical application.