鼻咽癌联合化疗的疗效及ADPRT抑制剂烟酰胺对化疗增效作用的初步观察

CHEMOTHERAPY OF NASOPHARYNGEAL CARCINONA-A PRELIMINARY REVALUATION OF TREATMENT RESPONSE AND POSSIBLE POTENTIATION EFFECT OF ADPRT INHIBITOR NICOTINAMIDE

动物实验已证明腺苷二磷酸核糖转移酶(ADPRT) 抑制剂烟酰胺(NA)对DDP、BLM等药物有选择性增效作用。本文采用DDP、5—Fu和BLM(PFB)或Carboplatin、5—Fu和BLM(CFB)治疗鼻咽癌(NPC)94例,并用前瞻性随机对照研究方法,首次对NA的化疗增效作用进行临床观察。结果试验组及对照组的缓解率和毒性反应均无统计学差异(P>0.05),未能证实NA的选择性增效作用。但临床试验所用NA剂量较动物实验治疗剂量明显为低,且病例较少,故仍值得作进一步临床研究。PFB治疗初治NPC30例,缓解率90％(27/30),放疗后局部复发和远处转移35例,缓解率51.43％(18/35);CFB治疗初治NPC22例,缓解率68.18(15/22)。PFB和CFB两组的缓解率和毒性反应发生率均无统计学差异(P>0.05),但CFB组的毒性反应恢复较快,提示Carboplatin对NPC的疗效与DDP相似而毒性反应较易恢复。PFB和CFB对NPC均有良好的近期疗效,且毒性较小,值得推广。

The selective enhancement of the antitumour activity of DDP and BLM by Nicotinamide(NA), an inhibitor of adenosine-ribose transferase (ADPRT), has been confirmed in animal experiments. In this study, 94 patients with nasopharyngeal carcinoma (NPC) were randomly divided into two groups, group A, 53 patients, was treated with PFB (DDP, 5-Fu and BLM) /CFB ( Carboplatin, 5-Fu and BLM) plus NA (200mg /m2 × 7d) while group B, 41 patients, received PFB/CFB alone without NA. The results of this study showed that no statistical difference was found in response rate and the rate of side effects between the two groups (P>0.05). .Although this pilot clinical study does not ratify selective enhancing effect of NA on the antitumour activity of DDP and BLM, it warrants further study in a larger series of patients, and using higher dose of NA. In this study, PFB achieved a response rate of 90% , while CFB achieved a response rate of 60.2% in prev busty untreated NPC patients, with no statistical difference. (P>0.05) The iicidence rate of toxicity was also similar, but the GI toxicijty of CFB were recovered more quickly. This indicates that carboplatin, compared with DDP, has comparable chemotherapeutic activity against NPC with less persistant toxicity. Both PFB and CFB regimens were well tolerated in this study with acceptable toxicity.