曲拉西利联合拓扑替康二线治疗广泛期小细胞肺癌1例及文献分析

Trilaciclib combined with topotecan as second⁃line treatment for extensivestage small⁃cell lung cancer:a case report and literature review

小细胞肺癌(SCLC)恶性程度高、预后差,约2/3的患者在确诊时已发生远处转移,疾病进展迅速,复发率高。目前,以拓扑替康为主的化疗方案仍然是SCLC二线治疗的标准方案,但疾病缓解时间短,受益于其疗效的患者不足1/4。骨髓抑制(CIM)是肿瘤化疗中最常见的毒副反应,严重的骨髓抑制会降低化疗的剂量强度和抗肿瘤疗效。曲拉西利是一种短效、可逆的细胞周期蛋白依赖性激酶(CDK)4/6抑制剂,2022年7月已获批用于SCLC化疗所致骨髓抑制的预防治疗。已有研究表明,曲拉西利具有较好的骨髓保护作用,其抗肿瘤作用仍需进一步探讨。本文报道1例伴有多发转移的晚期SCLC患者采用“曲拉西利联合拓扑替康二线治疗方案”获得超过1年无进展生存时间的病例。

Small cell lung cancer(SCLC)is characterized by a high degree of malignancy,with poor prognosis and high⁃growth fraction.About two⁃thirds of patients have developed distant metastasis at the time of diagnosis with rapid disease progression and high recurrence rates.Currently,topotecan⁃based chemotherapy remains the standard second⁃line treatment of SCLC with unfavorable disease remission,and less than one⁃fourth of patients have benefited from its efficacy.Chemotherapy⁃induced myelosuppression(CIM)is the most common toxicity in cancer chemotherapy,and severe CIM will reduce the dose intensity and anti⁃tumor efficacy of chemotherapy.Trilaciclib is a short⁃acting intravenous cyclin⁃dependent kinase 4/6(CDK4/6)inhibitor administered prior to chemotherapy to preserve hematopoietic stem and progenitor cells and immune system function during chemotherapy,which has been approved by NMPA for prevention of CIM in SCLC in July 2022.Previous results showed that trilaciclib yielded favorable bone marrow protection during chemotherapy,but its anti⁃tumor effects in second⁃line treatment of SCLC have not been determined.This paper reports a case of a patient with advanced small⁃cell lung cancer with multiple metastases who obtained progression⁃free survival time of more than 1 year using trilaciclib combined with topotecan as second⁃line treatment.