阿帕替尼联合伊立替康二线治疗小细胞肺癌的临床疗效

Clinical Analysis of Apatinib Combined with Irinotecan in the Second Line Treatment of Small Cell Lung Cancer

目的探讨阿帕替尼(Apatinib)联合伊立替康(Irinotecan)二线治疗小细胞肺癌(SCLC)的临床疗效。方法回顾性分析昆明医科大学第二附属医院2012年8月至2018年12月间42例小细胞肺癌患者临床资料,均病理证实为小细胞肺癌,一线均使用EP(依托泊苷+顺铂)方案6疗程,病情进展判定为一线治疗失败。二线治疗分为对照组(拓扑替康)20例:口服拓扑替康1.4mg/m^2d1~5,3周一疗程;实验组(阿帕替尼+伊立替康)22例:口服阿帕替尼500~625mg/d直至病情进展或无法耐受,伊立替康150~180mg/m^2ivgttd1,3周一疗程。比较2组临床疗效、T细胞亚群水平、肿瘤标记物变化及不良反应情况。结果对照组和实验组2组6个月客观有效率(ORR)分别为40.0%和72.7%,6个月疾病控制率(DCR)分别为15.0%和45.5%,2组无疾病进展生存期(PFS)分别为(9.2±3.1)个月和(12.6±6.8)个月,总生存时间(OS)分别为(6.2±5.1)个月和(10.2±6.9)个月;2组ORR、DCR、PFS、OS比较有统计学差异(P<0.05);实验组高血压、出血、口腔黏膜炎、腹泻和胆碱能综合症发生率明显高于对照组,有统计学差异(P<0.05),其它副反应差异不大。结论阿帕替尼联合伊立替康在二线治疗小细胞肺癌中的临床疗效显著,值得临床推广应用。

Objective To retrospectively analyze the clinical efficacy of Apatinib combined with Irinotecan in the second line treatment of Small Cell Lung Cancer (SCLC).Methods 42 patients with Small Cell Lung Cancer (SCLC) from August 2012 to December 2018 were retrospectively analyzed.All of them were pathologically confirmed as small cell lung cancer.All patients were treated with EP (etoposide+cisplatin) regimen for 6 courses.The progression of the disease was determined to be a failure of first-line treatment.Second line therapy was divided into control group (topotecan) 20 cases: oral topotecan 1.4 mg/m^2 d1~5,3 weeks one course;22 patients in the experimental group (Apatinib+Iritecan) were treated with Apatinib 500~625 mg/d until the disease progressed or could not be tolerated.The course of treatment was Iritecan 150~180 mg/m^2 ivgtt d1,3 weeks one course.The clinical efficacy,T cell subsets,tumor markers and adverse reactions were compared between the two groups.Results The objective effective rate (ORR) of 6 months was 40.0% and 72.7% in the control group and the experimental group.The disease control rate(PFS)of the two groups was(9.2 ±3.1)months and(12.6 ±6.8)months respectively.The total survival time(OS)of the two groups was(6.2±5.1)months and(10.2±6.9) months,respectively,with significant difference in ORR,DCR,PFS,OS between the two groups (P < 0.05).The incidence of hypertension,bleeding,oral mucositis,diarrhea and Cholinergic syndrome in the experimental group was significantly higher than that in the control group (P < 0.05).Conclusion Apatinib combined with Irinotecan is effective in the second line treatment of the Small Cell Lung Cancer (SCLC),and it is worthy of popularizing.