贝伐珠单抗或重组人血管内皮抑制素联合顺铂胸腔灌注治疗肺腺癌恶性胸腔积液患者的临床研究

Intrathoracic injection of bevacizumab combined or recombinant human endostatin combined with cisplatin in treatment of malignant pleural effusion of lung adenocarcinoma: A clinical study

目的比较贝伐珠单抗或重组人血管内皮抑制素联合顺铂胸腔灌注治疗肺腺癌恶性胸腔积液患者的临床疗效及药物不良反应发生情况.方法回顾性分析我院肺腺癌恶性胸腔积液患者123例,其中贝伐珠单抗联合顺铂组(贝伐组)63例,治疗方案为贝伐珠单抗100 mg+顺铂40 mg胸腔灌注,d1、d4、d7;重组人血管内皮抑制素联合顺铂60例,治疗方案为重组人血管内皮抑制素45 mg+顺铂40 mg胸腔灌注,d1、d4、d7;均为3周一个疗程.2个疗程结束后比较2组方案治疗恶性胸腔积液的客观缓解率和药物不良反应发生情况;比较治疗前后血清及胸腔积液中癌胚抗原(CEA)、糖类抗原125(CA125)变化水平及卡氏功能评分(KPS)变化.结果贝伐组客观缓解率高于重组人血管内皮抑制素组(90.48%vs.76.67%,P<0.05).与治疗前相比,治疗后2组患者血清及胸腔积液中CEA、CA125均明显降低,贝伐组血清及胸腔积液中CA125分别为(112.35±21.88)和(231.46±56.63)μmol·L^(-1),降低更为明显(P<0.05),2组血清、胸腔积液中CEA降低差异无统计学意义.与治疗前相比,治疗后2组患者KPS评分明显升高,差异有统计学意义(P<0.05).治疗过程中药物不良反应主要为骨髓抑制、高血压、乏力、消化道反应等,贝伐组的高血压反应率高于重组人血管内皮抑制素组(39.68%vs.20.00%,P<0.05),其他药物不良反应发生率差异无统计学意义(P>0.05).结论贝伐珠单抗联合顺铂胸腔灌注治疗肺腺癌恶性胸腔积液优于重组人血管内皮抑制素联合顺铂,可作为治疗恶性胸腔积液的首选推荐方案.

Objective To compare the clinical efficacy and adverse drug reactions of bevacizumab or recombinant human endostatin combined with cisplatin pleural perfusion in the treatment of patients with malignant pleural effusion of lung adenocarcinoma.Methods Retrospective analysis of 123 patients with malignant pleural effusion of lung adenocarcinoma, 63 cases in Bevac group, the research plan was bevacizumab 100 mg plus cisplatin 40 mg with thoracic perfusion, d1, d4, d7;60 cases in recombinant human endostatin, the plan was recombinant human endostatin 45 mg plus cisplatin 40 mg with thoracic perfusion, d1, d4, d7;both course of treatment was three weeks. After 2 courses,the objective remission rate and the occurrence of adverse drug reactions of the two groups of treatments for malignant pleural effusion were compared;the changes of carcinoembryonic antigen (CEA),carbohydrate antigen (CA125),Karnofsky (KPS) were compared. Results The objective remission rate in Bevac group was higher than that in recombinant human endostatin group (90.48% vs. 76.67%,P<0.05). After treatment,CEA and CA125 in serum and pleural effusion of the two groups were significantly decreased. CA125 in serum and pleural effusion of Bevac group were (112.35±21.88) and (231.46±56.63) μmol·L^(-1),decreased more obviously than recombinant human endostatin group (P<0.05). There was no significant difference in the reduction of CEA in serum and pleural effusion between the two groups. After treatment,the KPS score of patients in two groups increased significantly before treatment (P<0.05). During treatment, the adverse drug reactions were mainly bone marrow suppression,hypertension,fatigue,gastrointestinal reactions,etc. The incidence of hypertension in Bevac group was higher than that in recombinant human endostatin group (39.68% vs. 20. 00%,P<0.05). Other adverse drug reactions were similar in the two groups (P>0.05). Conclusion Bevacizumab combined with cisplatin pleural perfusion is better than recombinant human endostatin combined with cisplatin in the treatment of malignant pleural effusion of lung adenocarcinoma,which can be used as the first-choice recommendation treatment for malignant pleural effusion.