贝伐单抗或血管内皮抑制素联合化疗治疗局部晚期EGFR野生型非小细胞肺癌的近期疗效及毒副反应

Short-term efficacy and side effects of bevacizumab or rh-endostatin combined with chemotherapy in treatment of locally advanced EGFR wild-type non-small cell lung cancer

目的:探讨贝伐单抗联合DP方案或血管内皮抑制素联合DP方案治疗局部晚期基因野生型非小细胞肺癌(NSCLC的近期疗效及毒副反应。方法:选取广东医科大学附属暨中山医院暨中山市陈星海医院呼吸内科2014年1月至2017年1月收治的72例局部晚期基因野生型NSCLC患者,按照随机数字法分为贝伐单抗组(34例)与血管内皮抑制素组(38例),前者接受贝伐单抗联合多西他赛和顺铂治疗,后者接受血管内皮抑制素联合多西他赛和顺铂治疗。按照RECISIT 1.1标准评价两组患者治疗前后病灶大小变化,检测血清VEGF、CEA、细胞角蛋白21-1片段(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)水平变化,评价治疗期间的毒副反应。结果:治疗后,贝伐单抗组患者CR、PR、SD、PD、DCR、ORR分别为2例、12例、15例、5例、41.18%、85.29%,血管内皮抑制素组患者CR、PR、SD、PD、DCR、ORR分别为2例、16例、14例、6例、47.37%、84.21%,血管内皮抑制素组患者DCR显著高于贝伐单抗组(P<0.05);血管内皮抑制素组患者治疗后血清VEGF、CEA下降趋势较贝伐单抗组明显(均P<0.05)。血管内皮抑制素组患者胃肠反应、皮肤反应、心脏毒性发生率高于贝伐单抗组患者,贝伐单抗组患者出血发生率高于血管内皮抑制素组患者(P<0.05)。结论:在局部晚期基因野生型NSCLC患者中,血管内皮抑制素联合DP方案疗效优于贝伐单抗联合DP方案,可根据患者不同特点选择相应的治疗方案,尽量减轻治疗期间的毒性反应,规避临床风险。

Objective:To investigate the short-term efficacy and toxicity of bevacizumab combined with DP or rh-endostatin(recombinant human vascular endostatin injection)combined with DP in locally advanced EGFR wild-type non-small cell lung cancer(NSCLC).Methods:Seventy-two patients with treatment of locally advanced EGFR wild-type NSCLC admitted to the Department of Respiratory Medicine of Zhongshan Hospital Affiliated to Guangdong Medical University from January 2014 to January 2017 were divided into bevacizumab group(34 cases)and rh-endostatin group(38 cases)according to the random number method.The former group was treated with bevacizumab combined with docetaxel and cisplatin,while the latter was treated with rh-endostatin combined with docetaxel and cisplatin.According to RECISIT 1.1 standard,the changes of lesion size before and after treatment in two groups were evaluated.Serum levels of vascular endothelial growth factor(VEGF),carcinoembryonic antigen(CEA),cytokeratin 21-1 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCC)were measured.The adverse reactions during treatment were also evaluated.Results:In bevacizumab group,patients with CR,PR,SD,PD,DCR and ORR were 2 cases,12 cases,15 cases,5 cases,41.18%and 85.29%,respectively.In rh-endostatin group,patients with CR,PR,SD,PD,DCR,ORR were 2 cases,16 cases,14 cases,6 cases,47.37%and 84.21%,respectively.The DCR in rh-endostatin group was significantly higher than that in bevacizumab group(P<0.05).The serum levels of VEGF and CEA in rh-endostatin group decreased more obvious than those in bevacizumab group(all P<0.05).The incidence of gastrointestinal reaction,skin reaction and cardiac toxicity in rh-endostatin group was higher than that in bevacizumab group,while the incidence of bleeding in bevacizumab group was higher than that in rh-endostatin group(all P<0.05).Conclusion:In patients with locally advanced EGFR wild-type NSCLC,rh-endostatin combined with DP regimen is better than bevacizumab combined with DP regimen.In clinical practice,corresponding treatment regimen can be selected according to different characteristics of patients,so as to minimize the toxic reaction during treatment and avoid clinical risk.