122例老年脑胶质瘤患者抗血管生成药物治疗中颅内出血及缺血性卒中发生的临床调查研究

目的探讨老年脑胶质瘤患者抗血管生成治疗中颅内出血及缺血性卒中的发生情况。方法按照随机数字表法将纳入的122例老年脑胶质瘤患者随机分为观察组与对照组,各61例,对照组患者给予替莫唑胺治疗,观察组在对照组的基础上联合贝伐珠单抗治疗,两组疗程均为12周。比较两组患者的近期疗效、生存质量改善情况、治疗前后血清血管内皮生长因子(VEGF)和表皮生长因子(EGF)水平变化以及颅脑出血和缺血性卒中的发生情况。结果观察组总有效率(78.69%)显著高于对照组(63.93%)(P<0.05)。观察组生存质量提高率(70.49%)显著高于对照组(52.46%)(P<0.05)。两组患者治疗后血清VEGF、EGF水平均较治疗前明显降低(P<0.05);观察组治疗后血清VEGF、EGF水平均显著低于对照组(P<0.05)。观察组颅内出血和缺血性卒中的发生率(6.56%、4.92%)均高于对照组(1.64%、0.00%),但差异无统计学意义(P>0.05)。观察组患者总生存期(OS)和无进展生存期(PFS)均明显长于对照组(P<0.05)。结论抗血管生成药物贝伐珠单抗治疗老年脑胶质瘤患者的近期疗效良好,可提高患者生存质量,降低血清VEGF、EGF水平,但其颅脑出血和缺血性卒中的发生率较高。

血清VEGF、CEA检测作为NSCLC抗血管生成药物疗效评估标志物的价值研究

目的探讨血清血管内皮生长因子(VEGF)、癌胚抗原(CEA)水平作为非小细胞肺癌(NSCLC)患者化疗联合抗血管生成药物治疗疗效评估标志物的价值。方法选取100例NSCLC患者分别采用化疗(n=50)、化疗联合抗血管生成药物治疗(n=50),化学发光方法检测两组患者治疗前后血清VEGF及CEA的水平,比较患者近期疗效与血清VEGF、CEA水平之间的关系。结果化疗联合抗血管生成药物治疗相较化疗组治疗效果更优,其客观缓解率更高(36%vs.18%)。接受化疗联合抗血管生成药物治疗有效患者治疗后血清VEGF水平比治疗前血清VEGF水平显著降低,差异有统计学意义(99.15 pg/mL vs.207.9 ng/mL,P<0.001),而无效患者治疗前后血清VEGF水平没有明显变化(121.3 pg/mL vs.111.9 pg/mL,P=0.731)。治疗2周期后,化疗联合抗血管生成药物治疗有效患者VEGF水平相较治疗前下降40%以上(41%±25%),而CEA仅下降26%(26%±32%)。另外,化疗联合抗血管生成药物治疗有效的患者治疗前VEGF水平较治疗无效组更高,特别是采用贝伐单抗/安罗替尼治疗的患者。结论血清VEGF、CEA水平对非小细胞肺癌患者化疗联合抗血管生成药物的疗效评估具有良好的指导和预测意义。

Arterial-phase contrast-enhanced ultrasonography for evaluating anti-angiogenesis treatment: A pilot study

AIM:To verify whether arterial-phase contrast-enhanced ultrasonography(CEUS) of tumor parenchymal tissue is useful for evaluation of anti-angiogenesis agents.METHODS:Rabbits with liver tumor were subjected to CEUS,and images of the nodular maximal diameter in vascular phase were recorded.Image analysis was performed to plot the time intensity curve(TIC) at the tumor parenchyma,which set the diameter of the region of interest of intensity measurement.The TIC was calculated to obtain the time to peak intensity(TPI) and the magnitude of PI.Rabbits were randomly assigned to a treatment group with sorafenib and a control group.Two weeks later,the same ultrasound examination was repeated followed by pathological testing to assess the effect of sorafenib on the liver tumor.RESULTS:In four rabbits in the treatment group,the rate of change of tumor size was decreased comparedwith that of the control(the rate 2.3 vs 7.9,P = 0.02).The TPI of the treatment group elongated significantly(the rate 3.1 vs 1.1,P = 0.07 for SonoVue,2.0 vs 0.88,P = 0.09 for Sonazoid).The magnitude of PI showed no significant changes.In pathological examination,capillary diameters in the treatment group were significantly smaller than those in the control group(26.4 vs 42.8 μm,P = 0.013).CONCLUSION:Analysis of the TIC in the arterial phase of tumor tissue could evaluate the efficacy of antiangiogenesis drug treatment in liver tumor.

Antiangiogenic agents combined with chemotherapy in non-small cell lung cancer

As a targeted therapy, antiangiogenic treatment has been increasingly studied for advanced non-small cell lung cancer(NSCLC) and has proven effective for the treatment of advanced NSCLC. Bevacizumab, a monoclonal antibody targeting angiogenesis, is the only antiangiogenic agent approved for use in combination with first-line chemotherapy for non-squamous NSCLC. Small-molecule inhibitors targeting the tyrosine kinase receptor have also shown promise when combined with standard chemotherapeutic agents in patients with advanced NSCLC. However, unlike bevacizumab, not all other antiangiogenic agents show significant benefits when combined with chemotherapy. As for the failures of most other combinations, the combination schedule may be an important reason that has so far been overlooked in clinical trials. This article reviews the combination of angiogenic agents with chemotherapy in the treatment of NSCLC.

精准医疗背景下化疗在ⅢB/Ⅳ期非小细胞肺癌治疗中的作用

肺癌中非小细胞肺癌(NSCLC)占80%~85%,近十年NSCLC的治疗获得了长足发展,迎来个体化精准治疗的新时代。在这样的背景下,化疗仍是ⅢB/Ⅳ期NSCLC病患治疗的基石,对于驱动基因阴性的患者,以含铂的双化疗方案为主。对于驱动基因阳性的患者,化疗联合靶向药物可提高其疗效,且可以在出现靶向耐药后联合使用,改善患者的生存期。化疗药物同时联合免疫检查点抑制剂治疗可给患者带来生存获益。在ⅢB/Ⅳ期NSCLC患者的治疗中,化疗仍有不可撼动的作用。