阿帕替尼与依托泊苷治疗复发难治小细胞肺癌的效果比较

Effect comparison of Apatinib and Etoposide in the treatment of relapsed and refractory small cell lung cancer

目的比较阿帕替尼与依托泊苷治疗复发难治小细胞肺癌(SCLC)的临床效果。方法选取2016年1月~2018年1月九江市第一人民医院收治肿瘤科的98例复发难治SCLC患者作为研究对象,采用计算机将其随机分为阿帕替尼组(52例)与依托泊苷组(46例)。阿帕替尼组患者口服阿帕替尼500 mg/d,依托泊苷组患者口服依托泊苷胶囊175 mg/d,共10 d,每21天为1个疗程。按照RECISIT 1.1标准评价疗效,包括客观缓解率(ORR)及疾病控制率(DCR);检测血清神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(ProGRP)水平变化;对患者进行随访,计算中位无进展生存期及中位总生存期;对治疗期间的不良反应发生情况进行评价。结果阿帕替尼组患者的ORR、DCR均高于依托泊苷组,差异有统计学意义(P<0.05)。治疗前,两组患者的NSE、ProGRP水平比较,差异无统计学意义(P>0.05);两组患者治疗后的NSE、ProGRP水平均低于治疗前,且阿帕替尼组低于依托泊苷组,差异有统计学意义(P<0.05)。阿帕替尼组患者的中位总生存期、中位无进展生存期(5.2、4.2个月)长于依托泊苷组(3.9、3.0个月),差异有统计学意义(P<0.05)。阿帕替尼组患者的乏力、骨髓抑制、胃肠道反应、肝肾功能损害及心脏毒性发生率均低于依托泊苷组,高血压、蛋白尿发生率均高于依托泊苷组,差异有统计学意义(P<0.05);两组患者的手足综合征发生率比较,差异无统计学意义(P>0.05)。结论阿帕替尼治疗复发难治SCLC的效果优于依托泊苷,可作为复发难治SCLC靶向治疗的新选择。

Objective To compare the clinical effect of Apatinib and Etoposide in the treatment of relapsed and refractory small cell lung cancer(SCLC).Methods Ninety-eight patients with relapsed and refractory SCLC addmited to the Department of Oncology in Jiujiang No.1 People′s Hospital from January 2016 to January 2018 were selected as research objects and randomly divided into Apatinib group(52 cases)and Etoposide group(46 cases)by computer.Patients in the Apatinib group received Apatinib 500 mg/d orally,and patients in the Etoposide group received Etoposide Capsules 175 mg/d orally for 10 days,with a course of treatment every 21 days.According to RECISIT 1.1 standard,the efficacy was evaluated,including objective response rate(ORR)and disease control rate(DCR).Serum levels of neuron-specific enolase(NSE)and gastrin-releasing peptide precursor(ProGRP)were detected.The patients were followed up to calculate median progression-free survival and median overall survival.The occurrence of adverse reactions during treatment was assessed.Results The ORR and DCR of the Apatinib group were higher than those of the Etoposide group,and the differences were statistically significant(P<0.05).Before treatment,there were no statistically significant differences in the levels of NSE and ProGRP between the two groups(P>0.05).The NSE and ProGRP levels of the two groups after treatment were lower than those before treatment,and those in the Apatinib group were lower than those in the Etoposide group,the differences were statistically significant(P<0.05).The median overall survival and median progression-free survival(5.2,4.2 months)of patients in the Apatinib group were longer than those in the Etoposide group(3.9,3.0 months),and the differences were statistically significant(P<0.05).The incidences rates of fatigue,bone marrow suppression,gastrointestinal reactions,liver and kidney damage,and cardiotoxicity in the Apatinib group were lower than those in the Etoposide group,and the incidence rates of hypertension and proteinuria were high er than those in the Etoposide group,with statistical significances(P<0.05).There was no statistically significant difference in the incidence of hand-foot syndrome between the two groups(P>0.05).Conclusion Apatinib is more effective in the treatment of relapsed and refractory SCLC,and can be used as a new choice for targeted therapy for relapsed and refractory SCLC.