阿帕替尼联合替莫唑胺剂量密度方案治疗术后放化疗后复发恶性脑胶质瘤的近期疗效观察

Short-term efficacy of apatinib combined with dose-dense temozolomide in treatment of recurrent malignant glioma after postoperative chemoradiotherapy

目的比较阿帕替尼联合替莫唑胺(Temozolomide,TMZ)不同给药方案或/和伊立替康(Irinotecan,CPT-11)化疗方案治疗术后放化疗后复发恶性脑胶质瘤的近期疗效及不良反应。方法选取郑州大学第一附属医院放疗科2018年1月至2019年1月收治的术后放化疗后复发恶性脑胶质瘤患者38例,根据治疗方式不同分为A、B、C三组,其中A组为阿帕替尼联合TMZ剂量密度方案共12例;B组为阿帕替尼联合TMZ标准5天给药方案共14例;C组为阿帕替尼联合CPT-11和TMZ标准5天给药方案方案共12例。28天为1周期,4周期后评估对比各组总有效率(ORR)、疾病控制率(DCR)、6个月无进展生存期率(6m-PFS)及不良反应。结果A、B两组相比A组ORR值及DCR值明显高于B组,差异有统计学意义(P<0.05);B、C组及A、C组之间相比,差异均无统计学意义(P>0.05)。A组6个月PFS率高于B组,差异有统计学意义(P<0.05),B、C组及A、C组之间相比差异无统计学意义(P>0.05)。C组骨髓抑制、消化道反应明显高于A、B两组,差异有统计学意义(P<0.05),三组患者高血压、蛋白尿、手足综合征等不良反应相比差异无统计学意义(P>0.05)。结论阿帕替尼联合TMZ剂量密度方案治疗复发恶性脑胶质瘤安全有效,具有临床应用价值。

Objective to compare the short-term efficacy and adverse reactions of apatinib combined with Temozolomide(TMZ)or/and Irinotecan(cpt-11)chemotherapy for recurrent malignant glioma after postoperative chemoradiotherapy.Methods 38 patients with recurrent malignant glioma after postoperative radiotherapy and chemotherapy admitted to the radiotherapy department of the first affiliated hospital of zhengzhou university from January 2018 to January 2019 were selected.They were divided into three groups according to different treatment methods:A,B and C.The group A included 12 patients received the regimen of apatinib combined with dose-dense TMZ.Group B included 14 patients in the regimen of apatinib combined with standard 5-day TMZ standard.Group C included 12 patients in the regimen of apatinib combined with cpt-11 and standard 5-day TMZ.After 4 cycles,the total effective rate(0 RR),disease control rate(DCR),progression-free survival rate(6 m-PFS)and adverse reactions were evaluated and compared in each group.Results The ORR and DCR values of group A and group B were significantly higher than those of group B,with statistically significant differences(P<0.05).There was no statistically significant difference between groups B and C,as well as between groups A and C(P>0.05).The 6-month PFS rate of group A was higher than that of group B,and the difference was statistically significant(P<0.05).The difference between group B,C and group A and C was not statistically significant(P>0.05).Myelosuppression and gastrointestinal reactions in group C were significantly higher than those in group A and group B,with statistically significant differences(P<0.05),and no statistically significant differences in adverse reactions such as hypertension,proteinuria and hand-foot syndrome among the three groups(P>0.05).Conclusion Apatinib combined with dose-dense TMZ is safe and effective in the treatment of recurrent malignant glioma.