伊立替康二线治疗难治性复发小细胞肺癌的疗效分析

Analysis of the Efficacy of Irinotecan in the Second-line Treatment of Refractory and Relapsed Small Cell Lung Cancer

背景与目的肺癌死亡率在恶性肿瘤中高居首位,小细胞肺癌(small cell lung cancer,SCLC)是肺癌恶性程度最高的一种,其倍增时间短,患者在治疗过程中易发生迅速耐药,且复发后病情迅速恶化。目前除拓扑替康外,缺乏有效的二线单药化疗方案。本研究旨在探究伊立替康(irinotecan,CPT-11)二线单药治疗难治性复发SCLC的疗效及安全性。方法收集吉林国文医院肿瘤内科2012年4月-2020年3月确诊的一线治疗后6个月内复发的经单药CPT-11二线化疗的SCLC患者107例,末次随访至2020年11月。记录患者的无进展生存时间(progression free survival,PFS)和总生存时间(overall survival,OS),观察单药CPT-11化疗效果以及不良反应发生情况。结果患者的中位PFS为3.8(3.4-4.4)个月,中位OS为8.1(6.5-10.9)个月,客观缓解率(objective response rate,ORR)为16.82%(18/107),DCR为55.14%(59/107),3级-4级不良反应发生率较低,其中中性粒细胞减少为13.08%,迟发性腹泻为7.48%,恶心呕吐为17.76%,肝功能受损为6.54%。影响单药CPT-11二线化疗患者PFS的因素有性别(P=0.001)、NSE(P=0.029)以及积液状态(P=0.040),影响OS的因素仅为NSE水平(P=0.033)。结论针对于难治性复发的SCLC患者,CPT-11单药二线化疗方案有一定疗效,耐受较好,值得推广应用。

Background and objective Among malignant tumors,lung cancer has the highest mortality rate.Small cell lung cancer(SCLC)is a kind of malignant lung cancer.Its doubling time is very fast.Patients are prone to drug resistance during treatment,and their condition often deteriorates rapidly after recurrence.Except for topotecan,there is a lack of effective second-line single-agent chemotherapy.This study aims to analysis the efficacy and safety of irinotecan(CPT-11)in the second-line treatment of refractory and relapsed SCLC.Methods A total of 107 SCLC patients were collected from the Department of Oncology,Jilin Guowen Hospital,who were diagnosed from April 2012 to March 2020,relapsed within 6 months after first-line treatment,and received second-line chemotherapy with single-agent CPT-11.Follow-up until November 2020,calculate the patient’s progression free survival(PFS)and overall survival(OS),and summarize the effects and adverse reactions of CPT-11 chemotherapy.Results The patient’s median PFS was 3.8(3.4-4.4)months,median OS was 8.1(6.5-10.9)months,objective response rate(ORR)was 16.82%(18/107),and DCR was 55.14%(59/107).The incidence of grade 3-4 adverse reactions in patients was relatively low.Among them,neutropenia was 13.08%,delayed diarrhea was 7.48%,nausea and vomiting was 17.76%,and liver function impairment was 6.54%.The influencing factors of PFS in single-agent CPT-11 second-line chemotherapy were gender(P=0.001),NSE(P=0.029),and effusion(P=0.040).While the influencing factors of OS were NSE level only(P=0.033).Conclusion For patients with refractory relapsed SCLC,CPT-11 single-agent second-line chemotherapy has a certain effect,is well tolerated,and is worthy of promotion.