恩度联合化疗一线治疗老年晚期肺鳞癌的临床研究

[摘要] 目的 观察抗肿瘤新药重组人血管内皮抑素注射液（恩度）联合吉西他滨、顺铂一线治疗老年晚期肺鳞癌的疗效，探讨其对血管内皮生长因子（VEGF）的影响和心脏毒性的耐受。化疗前和化疗后第3周及第6周采用ELISA法测定血清VEGF的水平。 方法 45例老年晚期肺鳞癌患者接受恩度联合吉西他滨和顺铂方案治疗，每3周为1个周期。用药1周期后评价毒性，2周期后评价疗效。 结果 总共完成的治疗周期数为156个，平均3.44个周期，完全缓解为8.89%（4/45），部分缓解为40.00%（18/45），总有效率为48.89%，疾病控制率为82.2%（37/45）。化疗后3周，血清VEGF水平明显下降，较化疗前比较差异有统计学意义（P ＜ 0.05）；化疗后6周血清VEGF水平显著下降，与化疗后3周比较差异有统计学意义（P ＜ 0.05）。G3/4级的毒性主要是血液学毒性。有3例患者出现严重频发房性早搏和相关症状，肌钙蛋白升高，LEVF降低。9例在治疗后出现了心电图变化，表现ST-T段改变和Ⅰ度房室传导阻滞以及窦性心动过速，行心脏彩超及心肌酶谱、肌钙蛋白等检查均无异常。6例出现了轻至中度血压升高。化疗后患者生活质量QOL评分高于治疗前（P ＜ 0.05）。 结论 恩度联合吉西他滨和顺铂方案一线治疗老年晚期肺鳞癌疗效可靠，可以抑制肿瘤的生长和转移，抑制血管内皮生长因子的表达。心血管的毒性可以耐受，该方案毒性低、安全性好。

[关键词] 恩度；吉西他滨；顺铂；老年；晚期；肺鳞癌；抗肿瘤血管生成；血管内皮生长因子

[中图分类号] R734.2 [文献标识码] C [文章编号] 1674-4721（2012）07（a）-0011-03

Clinical study of Endostar plus chemotherapy as first-line treatment of geratic patients with advanced squamous cell carcinoma of the lung

WANG Zhidong TIAN Xiaocai LIU Zhengsheng HAN Youjian LIANG Fengling

Internal Medicine-oncology, Hunan Province Geriatric Hospital, Changsha 410016, China

[Abstract] Objective To observe therapeutic effect and cardiovascular adverse reaction of rh-endostat in injection (YH-16, Endostar) combined with Gemcitabine and cisplatin as first-line treatment of the geratic with advanced squamous cell carcinoma of the lung. Meanwhile, to approach its affection to VEGF (vascular endothelial growth factor) and cardiac tolerance to the adverse reaction. Used ELISA to test VEGF′s concentration in blood of the patients before chemotherapy and during the course in the third and the sixth week. Methods Forty-five geratic patients with advanced Squamous cell carcinoma of the lung, stage Ⅲ-Ⅳ were the administered Endostar combined with Gemcitabine and cisplatin. Every course lasted 3 weeks. Each patient was evaluated cardiovascular adverse reaction after one course and therapeuticed effect after two courses. Results The total therapeutic courses completed were 156, the average course was 3.44. Complete remission rate(CRR) was 8.89% (4/45)，partial remission rate(PRR) was 40.00% (18/45), total effective rate (TER) was 48.89% (22/45), disease control rate (DCR) was 82.2% (37/45). VEGF′s concentration in blood decreased markedly after 3 week′s chemotherapy with significant statistical difference compared with before chemotherapy (P < 0.05); VEGF′s concentration in blood decreased markedly after 6 week′s chemotherapy compared with 3 week′s chemotherapy (P < 0.05). The suffered toxicity of grade 3/4 was mainly hematology toxicity, and 3 cases emerged severe frequent atrial premature beats and correlated symptoms, higher troponin, lower LEVF. 9 cases had changes in electrocardiogram, such as T wave and ST-T segment changes, Ⅰ degrees atrioventricular block and sinus tachycardia. They None abnormal could be found in cardiac colour doppler ultrasound or cardiac zymogram, troponin. 6 cases suffered mild or moderate increasing blood pressure. The score of QOL (quality of life) was higher compared with before chemotherapy (P < 0.05). Conclusion The therapeutic effect of endostar combined Gemcitabine and cisplatin as the first-line on geratic patients with advanced squamous cell carcinoma of the lung is reliable and it can inhibit tumor growth and metastasis as well as the expression of VEGF. Cadiovascular adverse reaction can be tolerant. It is with low toxicity and safe.