安罗替尼+诱导化疗联合同步放化疗治疗晚期鼻咽癌的近期疗效观察

Short-term efficacy of anlotinib plus induction chemotherapy combined with concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma

目的观察局部晚期鼻咽癌(LA-NPC)患者在标准治疗——诱导化疗联合同步放化疗中,加入安罗替尼治疗的效果及可耐受性。方法选取2021年1至9月浙江省肿瘤医院收治的新确诊LA-NPC患者为34例研究对象。患者均接受诱导化疗[多西他赛(75 mg/m2,静脉滴注,d1)、顺铂(75 mg/m2,静脉滴注,d1)和安罗替尼(12 mg,口服,1次/d,d1~14)],每3周为1个周期,治疗3个周期。放化疗为顺铂(100 mg/m2,静脉滴注,d1)和安罗替尼(12 mg,口服,1次/d,d1~14)2个周期,同时进行调强放疗(肿瘤靶区>66 Gy)。在诱导化疗结束2周和同步放化疗结束4周后,评价肿瘤近期疗效和不良反应发生情况。结果34例患者按计划完成诱导化疗联合同步放化疗治疗,23例(67.6%)按计划完成5个周期安罗替尼治疗。诱导化疗后2周鼻咽部肿瘤和阳性淋巴结完全缓解率达29.4%和58.8%;治疗结束后4周客观缓解率达97.1%。治疗期间未发生5级不良反应,诱导化疗及同步放化疗期间分别发生12例(35.3%)和14例(41.2%)3~4级不良反应,其中常见的为口腔黏膜炎、白细胞减少和中性粒细胞降低。结论LA-NPC患者采用安罗替尼+诱导化疗联合同步放化疗治疗可以获得较好的肿瘤反应率,特别是在诱导化疗治疗后肿瘤完全缓解率较高,并且不良反应可以耐受。

Objective To evaluate the efficacy and safety of anlotinib plus induction chemotherapy combined with concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma(LA-NPC).Methods Patients with newly diagnosed LA-NPC(stageⅢ-Ⅳ-A)treated in Zhejiang Cancer Hospital from January to September 2021 were screened and treated with induction chemotherapy(docetaxel:75 mg/m2,IV drop infusion,d1;cisplatin:75 mg/m2,IV drop infusion,d1 and anlotinib:12 mg,orally,q.d,d1-14)for 3 cycles(3-weeks as a cycle).Chemoradiotherapy was given(cisplatin:100 mg/m2,IV drop infusion,d1 and anlotinib:12 mg,orally,q.d,d1-14)for two cycles,along with intensitymodulated radiotherapy(gross tumor volume>66 Gy).Two weeks after the end of induction chemotherapy and 4 weeks after concurrent chemoradiotherapy,the efficacy was evaluated according to RECIST 1.1 criteria,and the occurrence of acute toxicity was evaluated with NCI CTCAE 3.0 criteria.Results Thirty four patients completed induction chemotherapy combined with concurrent chemoradiotherapy as planned,and 23 patients(67.6%)completed 5 cycles of anlotinib as scheduled.The complete response(CR)rate of nasopharyngeal tumor and positive lymph nodes was 29.4%and 58.8%2 weeks after induction chemotherapy.The objective response rate(ORR)at 4 weeks after the treatment was 97.1%.No grade 5 adverse reactions occurred during the treatment,grade 3-4 adverse reactions occurred in 12(35.3%)and 14(41.2%)cases during induction chemotherapy and concurrent chemoradiotherapy,respectively,and oral mucositis,leukopenia,and neutropenia were common adverse reactions.Conclusion Patients with LA-NPC can achieve an excellent response rate with anlotinib plus induction chemotherapy combined with concurrent chemoradiotherapy,especially the great CR rate after the induction chemotherapy,meanwhile the adverse reactions are tolerable.