阿帕替尼联合替莫唑胺密集方案治疗复发恶性胶质瘤

Apatinib combined dose-dense temozolomide in the treatment of recurrent malignant glioma

目的观察阿帕替尼或阿帕替尼联合替莫唑胺密集方案治疗复发恶性胶质瘤的临床效果。方法选取郑州大学第一附属医院45例病理确诊的复发恶性胶质瘤患者进行随机分组化疗,其中替莫唑胺密集方案15例,单纯应用阿帕替尼15例,阿帕替尼联合替莫唑胺密集方案15例,比较3组患者治疗2周后MMSE、KPS评分的改善情况及1个月后肿瘤减小和瘤周水肿范围缩小程度,观察持续治疗20个月患者生存情况和无进展生存疗期情况,评估3组患者的治疗效果。结果单纯阿帕替尼和联合治疗组2周后MMSE、KPS评分的改善情况均明显优于单纯替莫唑胺治疗组(均P<0.05),且1个月后的肿瘤和瘤周水肿缩小程度亦明显优于单纯替莫唑胺治疗组(均P<0.05)。3组患者1个月内的临床缓解率替莫唑胺组为13.3%,阿帕替尼组为40%,联合治疗为53.4%;持续治疗观察20个月,无进展生存期分别为替莫唑胺组(5.27±3.79)月、阿帕替尼组(9.07±4.04)月、联合治疗组(11.87±4.78)月,后2组明显长于单纯替莫唑胺组(均P<0.05);联合治疗组的总生存期较单纯替莫唑胺组有所延长(P<0.05)。结论阿帕替尼治疗或阿帕替尼联合替莫唑胺密集方案,可以在短期内明显改善患者症状,减轻肿瘤周围水肿,并可以延长患者无进展生存期,与单纯替莫唑胺方案相比,甚至可以延长总生存期,使复发恶性胶质瘤患者获益。

Objective To investigate the clinical effect of apatinib and apatinib combined dose-dense temozolomide in therapy of recurrent malignant glioma.Methods 45 recurrent malignant glioma patients were randomly assigned to 3 different treatment groups.15 cases accepted dose-dense temozolomide treatment,15 cases accepted apatinib therapy and 15 cases accepted apatinib combined dose-dense temozolomide treatment.The change of clinical scores of MMSE and KPS after two weeks,the variation of tumor sizes and edema scale around the neoplasm according the magnetic resonance image(MRI)one month later,the overall survival(OS)and the progression free survival(PFS)after 20 months of normal treatment,and respective clinical efficacy of each group were evaluated and compared.Results The improvement of MMSE and KPS scores in apatinib treatment group and combined treatment group after two weeks were more appatent than that in temozolomide solely treat group(P<0.05);One month later,the decrease of tumor sizes and edema scale around tumor in apatinib treat group and combined treat group were more apparent than that in temozolomide solely treat group(P<0.05),and the objective response rate in apatinib treat group(40%)and combined treat group(53.4%)were better than that in temozolomide solely treat group(13.3%)(P<0.05);After 20 months of treatment,the PFS of combined treatment group was prolonged obviously(P<0.05);Combined treatment also prolonged overall survival apparently(P<0.05).Conclusion Fecurrent malignant glioma patients could benefit from the apatinib treatment or apatinib combined dose-dense temozolomide treatment,and apatinib maybe a promising choice for the treatment of recurrent malignant glioma.