培美曲塞治疗晚期非小细胞肺癌近期疗效分析

Objective:The aim of our study was to observe the efficacy and toxicity of 50 cases of advanced non-small cell lung cancer (NSCLC) patients treated by pemetrexed.Methods:Fifty patients,including 29 females and 21 males,with a median age 62 years (35–82 years),13 of whom were treated with pemetrexed only and the left 37 cases were treated with pemetrexed combined with platinum in the Department of Oncology,Renmin Hospital of Wuhan University from June 2006 to March 2009.Single agent regimen:patients received pemetrexed 500 mg/m2 on day 1 with every 21 days.Combination regimen:patients received pemetrexed 500 mg/m2 on day 1 and carboplatin 300 mg/m2 on day 1 or cisplatin 35 mg/m2 on day 1 to day 3 or nedaplatin 80 mg/m2 on day 1 by intravenous infusion with 21 days as one cycle.RECIST 1.0 standard was used to evaluate the clinical efficiency,and the WHO toxicity standard was used to evaluate toxic reaction,and the QOL was used to evaluate the quality of life.Results:All patients were given 162 cycles (at least 2 cycles,at most 6 cycles) and the response rate of all the patients were evaluated.There were 2 complete remission (CR),7 partial remission (PR),22 stable disease (SD) and 19 progressive disease (PD) in the group,the overall response rate was (RR) was 18.0% and disease control rate (DCR) 62.0%.The quality of life improvement rate reaches 58.0%.The major toxic reaction included neutropenia,thrombocytopenia,hypemia,nausea,and vomiting.Most of the severity of these effects was grade I–II and well tolerated.Conclusion:Chemotherapy with pemetrexed or pemetrexed combined with platinum in the treatment of advanced non-small cell lung cancer is effective,safe and well-tolerable,which can improve quality of life of the patient.     

吉非替尼治疗晚期非小细胞肺癌不良反应的护理

目的 探讨晚期非小细胞肺癌患者应用吉非替尼治疗的疗效及不良反应.方法 选择30例晚期非小细胞肺癌患者,应用吉非替尼治疗90d后对其疗效及不良反应进行观察.结果 本组发生皮疹10例(33.33%),腹泻9例(30%),胃肠道反应5例(16.67%),肝功能异常4例(13.33%),间质性肺炎2例(6.67%).用药期间加强皮肤、口腔、胃肠道护理,密切监测生命体征、肝功能、呼吸功能,可提高疗效.结论 晚期非小细胞肺癌患者应用吉非替尼治疗出现不良反应时,及时进行护理干预和对症处理至关重要,有助于保证用药安全、提高治疗依从性和患者舒适度,能有效地提高患者的生存质量.     

吉西他滨联合顺铂治疗局部晚期非小细胞肺癌疗效观察

目的:探讨吉西他滨联合顺铂治疗局部晚期非小细胞肺癌(NSCLC)的方法和临床疗效.方法:将2006年6月至2010年6月我院收治的60例NSCLC的患者随机分为观察组40例和对照组20例,观察组采用吉西他滨联合顺铂治疗,对照组采用长春地辛、异环磷酰胺、顺铂方案化疗,比较两组患者的临床疗效及不良反应.结果:观察组的近期总有效率为82.5%(33/40)显著高于对照组的近期总有效率45.0%(9/20),P<0.05.观察组与对照组的不良反应物显著性差异,P>0.05.结论:吉西他滨联合顺铂治疗NSCLC有较好的近期疗效,不良反应可耐受,有利于改善患者的生存质量.     

晚期非小细胞肺癌化学治疗毒副反应的观察及护理

目的 探讨采用NP与GP方案治疗晚期非小细胞肺癌(NSCLC),患者化疗期间常见的毒副反应及护理对策.方法将78例经细胞学或病理学确诊的晚期NSCLC患者随机分为2组,其中40例使用NP方案(NP组),38例使用GP方案(GP组).观察化疗中出现的毒副反应并采取相应的护理措施,比较2组患者的毒副反应发生情况.结果 2组临床疗效相当,化疗期间出现的毒副反应均主要为骨髓抑制、胃肠道反应和发热;GP方案对患者的骨髓抑制较NP方案明显(P<0.05),而2组在其他毒副反应的发生率比较差异无统计学意义(P>0.05).结论 NP方案与GP方案均是治疗晚期NSCLC的较好方案,通过有效的护理干预,可减轻药物毒性反应引起的损害,使化疗如期进行.     

立体适形放疗与常规放疗对老年非小细胞肺癌的疗效比较

比较立体适形放疗与常规放疗对老年非小细胞肺癌的疗效,结果表明:立体适形放疗的治疗效果更有优势。     

多西他赛联合顺铂治疗晚期非小细胞肺癌36例临床观察

近年来肺癌在世界上发病率和死亡率迅速上升，每年新发病例接近120万。而肺癌中非小细胞肺癌（non—small cell lung cancer，NSCLC）约占80％，未经治疗的转移性非小细胞肺癌患者中位生存期仅4个月。以铂类为主的联合用药方案仍是目前国际公认的晚期非小细胞肺癌的标准方案。     

针对表皮生长因子受体的非小细胞肺癌靶向治疗

靶向治疗是特异性针对肿瘤发生、发展环节的新的一种药物治疗方法,近年来针对表皮生长因子受体的靶向治疗取得了长足的进展,为肺癌患者尤其是非小细胞肺癌患者的治疗带来了曙光.本文就表皮生长因子受体靶向治疗的作用机制及临床疗效、毒副作用做一综述.     

多西他赛与吉西他滨分别顺泊治疗晚期非小细胞肺癌的临床研究

Objective: The aim of this study was to evaluate the clinical efficacy and side effects of docetaxel/cisplatin regiment and gemcitabine/cisplatin regiment in the patients with advanced non-small-cell lung cancer (NSCLC). Methods: Seventy six patients with advanced NSCLC who were chemotherapy-naive were enrolled in two groups. In docetaxel group (DP group) the patients received docetaxel 75 mg/m2 and cisplatin 60 mg/m2 on day 1. In gemcitabine group (GP group) the patients received gemcitabine 1000 mg/m2 on day 1 and day 8. The dosage of cisplatin was the same as DP group. The two regiments were administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Results: The overall response rates were 43.5% in DP group and 45.9% in GP group. The response rate was significantly different between the initial treated group and retreated group in both two groups (53.8% vs 23.0% in DP group and 56% vs 25% in GP group, P < 0.05, respectively). The main side effects were bone marrow suppression and thrombocytopenia. Conclusion: Docetaxel/cisplatin regiment and gemcitabine/cisplatin regiment for the patients with advanced NSCLC were efficient and well-tolerated chemotherapeutic approachs with low toxicity levels. The efficacy and major toxicity in two groups were similar.     

吉西他滨联合卡铂作为诱导方案治疗老年不可手术的非小细胞肺癌

Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine (GEM) and carboplatin (CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable non-small cell lung cancer (NSCLC). Methods: Seventy-eight cases of elderly patients have been cytologically and pathologically confirmed with locally advanced unresectable NSCLC, the age of the patients ranged from 65 to 75 years. The patients were treated with the combined regimen of gemcitabine and cisplatin. GEM 1000 mg/m2 intravenously injected by drip on the 1st, 8th day and the dosage of CBP was AUC 4 that was used on the 1st day, 21 days apart to each cycle, most patients received 2 cycles. Treatment response was evaluated according to the criteria of RECIST (Response Evaluation Criteria in Solid Tumor), the side effect of the regimen was judged based on WHO criteria. Results: Seventy-eight patients were evaluated and received a total of 156 cycles chemotherapy. There were no complete regression that could be observed, but 32 cases had partial regression (PR), 37 cases with no change (NC) and 9 cases with progression disease (PD). The overall response rate was 41.0%. The main side effects were hematological toxicity. Conclusion: The GC regimen could be used as induction treatment for elderly patients with locally advanced unresectable NSCLC, and the regimen could be well tolerated and is safe in terms of side effects.     

Smac在非小细胞肺癌表达的临床意义

Objective:The aim of our study was to investigate the clinical significance of Smac (second mitochondria-derived activator of caspase) expression on non-small cell lung cancer (NSCLC). Methods:The expression of Smac was evaluated on RNA and protein level in tumor tissues. The expression of Smac mRNA was examined by RT-PCR in 59 samples of tumor tissues and matched normal lung tissues. The expression of Smac protein was examined by IHC in 213 cancer tissues. Results:The positive rate of Smac mRNA was found in 59.3% of cancer tissues, but only in 30.5% of matched normal tissues (P < 0.05). The positive rate of Smac protein was 76.5%. The expression of Smac in stage II disease was significantly higher than that in stage I disease (P = 0.001). The survival of patients with Smac overexpression was significantly shorter than those who were negative. Conclusion:Smac might be involved in the progression of NSCLC, the biologic significance of Smac in primary lung cancer needs further study.     

非含铂双药和非含铂单药治疗老年和/或PS差的非小细胞肺癌病人疗效:荟萃分析

Objective:The aim of the study was to compare the efficacies and toxicities of non-platinum doublets (doublets group) with a non-platinum single agent (single-agent group) in previously untreated advanced non-small cell lung cancer (NSCLC) patients with elderly age and/or poor performance status (PS).Methods:The PubMed database was screened.Subsequently,the hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS),relative risks (RRs) for overall response rate (ORR) and one-year survival,and odds ratios (ORs) for the different types of toxicities were pooled using the Review Manager 5.0 package.Results:This study comprised of 1427 patients enrolled in four randomized controlled trials.The pooled HR showed that the doublet group could increase ORR (P = 0.002) with no heterogeneity (P = 0.64),and might improve OS (P = 0.01 / P = 0.06) with heterogeneity (P < 0.001).There was no significant difference in PFS (P = 0.16) and one-year survival (P = 0.25) between two treatment groups.The doublet group led to more grade 3/4 neutropenia and thrombocytopenia than the single-agent group (P = 0.02 and P = 0.000,respectively).The incidences of grade 3/4 anemia,vomiting,mucositis,constipation,diarrhea,neurotoxicity,allergy,and fatigue between the two treatment groups were insignificant.Conclusion:Except for neutropenia and thrombocytopenia,the non-platinum doublets could increase ORR,and might improve OS for NSCLC patients with elderly age and/or poor PS without addition of more side effects;however,the doublets showed an increased rate of neutropenia and thrombocytopenia.The addition of doublets may not improve PFS and one-year survival.     

Cyclin B1和survivin在非小细胞肺癌中的表达和意义

Objective: We studied the expression of cyclin B1 and survivin in human non-small cell lung cancer (NSCLC), and the relationship between such expression and clinicopathological features of NSCLC. Methods: One hundred cases of tissue specimen including NSCLC, neighboring noncancerous tissue and normal lung tissue were collected at random. These specimens were detected by immunohistochemical methods. Results: The expression of cyclin B1 and survivin showed significant difference (P < 0.01) between NSCLC tissues, proliferating epithelial cells of bronchioles and small bronchi in neighboring noncancerous tissues, and normal lung tissues. Compared with normal lung tissues, there was an overexpression of cyclin B1 and survivin in NSCLC and an enhancing expression of cyclin B1 and survivin in proliferating epithelial cells of bronchioles and small bronchi in neighboring noncancerous tissues. Significantly positive correlation was found between the overexpression of cyclin B1 and that of survivin in 100 NSCLC cases (P < 0.01). The significantly positive correlation was also found between the enhancing expression of cyclin B1 and that of survivin in proliferating epithelial cells of bronchioles and small bronchi in neighboring noncancerous tissues (P < 0.01). No statistical significance was found between the different histological types, the differentiated degree, lymphatic metastasis and the expression of cyclin B1 and survivin (P > 0.05) in NSCLC. Statistical significance was marked between different clinical stages of NSCLC and the expression of cyclin B1 and survivin (P < 0.05). Conclusion: The overexpression of cyclin B1 and survivin was found in NSCLC. The expression of cyclin B1 and survivin might be up-regulated during an early step of tumorigenesis and during the development of NSCLC. The progression of cell cycle could be efficiently connected with the control of apoptosis by the interrelations between the overexpression of cyclin B1 and that of survivin in NSCLC during the G2/M phase. The overexpression of cyclin B1 and survivin might be used as marker in showing the dividing and proliferating ability, and the inhibiting apoptosis ability (lengthening cell lifespan) of NSCLC. Moreover, the overexpression of cyclin B1 and survivin was associated with the clinic stages of NSCLC.     

Effect of clarithromycin treatment of natural killer cell activity in patients with advanced non-small cell lung cancer]

The treatment of a 14-membered ring macrolide, clarithromycin (CAM), prolongs the survival time of patients with unresectable nonsmall cell lung cancer, and improves the host factor. As we previously reported, one of the underlying mechanisms is that the treatment of CAM increases the bioactivity of interleukin-12 (IL-12). In the present study, we administered CAM to murine lung cancer treatment models with Lewis lung carcinoma and to 18 patients with unresectable non-small lung cancer whose anticancer treatment had been terminated. The timing of CAM administration was examined and the time course of NK activity was measured. In the murine lung cancer treatment models, administration of CAM 7 days after anticancer chemotherapy more strongly inhibited the tumor growth and more rapidly and significantly increased NK activity, compared to the concomitant use of CAM with an anticancer chemotherapy. In humans, the NK activity which had decreased after anticancer treatment, tended to be increased after one month of treatment with CAM (p = 0.06). One month of treatment with CAM significantly increased the NK activity (p < 0.05) of the following subjects: patients with stage III in the clinical stages, patients with squamous cell carcinoma, patients who had received radiotherapy alone as pretreatment therapy, and patients whose pretreatment therapy effect was partial response (PR). We conjectured that increasing NK activity was one of the underlying mechanisms of the macrobiotic effect of CAM. CAM was especially effective for patients in the early clinical stages and patients who responded well to pretreatment therapy. Murine lung cancer models showed that non-concomitant use of CAM with anticancer chemotherapy was more effective.     

One-hour paclitaxel plus carboplatin in the treatment of advanced non-small cell lung cancer: results of a multicentre, phase II trial

The aim of this phase II study was to determine the activity and toxicity of paclitaxel (administered by 1-h infusion) and carboplatin in advanced non-small cell lung cancer when used in a multicentre, community-based treatment setting. 100 chemotherapy-naive patients with stage IIIB or IV non-small cell lung cancer were treated between March 1995 and February 1996. All patients had Karnofsky performance status 70-100, measurable disease and adequate bone marrow, kidney and liver function. All patients received intravenous (i.v.) paclitaxel 225 mg/m2 by 1-h infusion followed immediately by carboplatin at a targeted area under the concentration time curve (AUC) of 6.0 using the Calvert formula. Courses were repeated every 21 days. Colony stimulating factors were not used routinely. 38 of 94 evaluable patients (40%) had objective responses to treatment (3 complete responses, 35 partial responses). An additional 32 patients had stable disease at initial re-evaluation. Weight gain during treatment was experienced by 47% of patients with objective response or stable disease. The median survival in this group of 100 patients was 8 months, with an actuarial 1-year survival of 42%. Leucopenia was common, but hospitalisation for treatment of neutropenia and fever occurred in only 3% of courses. Cumulative peripheral neuropathy was common, but usually appeared after the third or fourth course and was severe (grade 3) in only 15% of patients. Other grade 3 and 4 toxicity was uncommon. There was one treatment-related death due to sepsis. This large multicentre community-based phase II trial demonstrated the efficacy of paclitaxel and carboplatin combination chemotherapy in advanced non-small cell lung cancer. When paclitaxel is given by 1-h infusion, this regimen is easily administered in the outpatient setting.