摘要
目的分析甲磺酸阿帕替尼在晚期结直肠癌标准二线治疗失败后三线治疗的疗效、安全性及可能影响疗效预测的因素。方法收集2015年10月至2018年7月于我院晚期结直肠癌标准二线治疗失败或不可耐受患者,接受甲磺酸阿帕替尼三线治疗的晚期结直肠癌患者30例的临床资料,患者应用甲磺酸阿帕替尼片500 mg每天1次,28 d为一个给药周期进行治疗,记录分析甲磺酸阿帕替尼治疗疗效、不良反应和分析疗效预测因素。结果 30例甲磺酸阿帕替尼治疗的患者中位无进展生存期(PFS)为4.3个月,中位总生存期(OS)为8.1个月,1年生存率为26.1%,2年生存率为8.7%,ORR为16.7%,DCR 60%,PR为5例,占16.7%,SD13例占43%,PD12例,占40%。血小板减少、血白细胞减少、口腔黏膜炎、贫血、转氨酶升高、手足综合征、蛋白尿、高血压等不良反应事件程度为Ⅰ或Ⅱ度。3例Ⅲ~Ⅳ度高血压(10%),2例Ⅲ~Ⅳ度蛋白尿(7%),3例Ⅲ~Ⅳ度手足综合征(10%)。甲磺酸阿帕替尼治疗PFS与CEA[(<25 ng/mL vs.(≥25 ng/mL)]、CerB2[(++^+++)vs.(-^+)]、Ki-67[(≥50%)vs.(<50%)],差异有统计学意义(P <0.05),提示甲磺酸阿帕替尼疗效与CEA低于25 ng/L,CerB2>++、Ki-67> 50%有潜在关系。结论晚期结直肠癌甲磺酸阿帕替尼三线治疗有改善疗效、生存趋势,不良反应耐受性可,甲磺酸阿帕替尼治疗在CEA值低于25 ng/mL、CerB2>++、Ki-67≥50%的患者疗效有延长趋势,提示CEA、CerB2、Ki-67潜在疗效预测价值。值得进一步前瞻性研究。
Objective To analyze the efficacy of apatinib mesylate in third.line treatment of advanced colorectal cancer after failure of standard second-line treatment and the factors that may affect the prediction of curative effect. Method Clinical data of 30 patients with advanced colorectal cancer who failed or were intolerable in standard second-line treatment from October 2015 to July 2018 were collected and treated with apatinib mesylate in third-line treatment. The patients were treated with apatinib tablets(500 mg/d)28 days for a medication cycle. The efficacy,side effects and predictive factors of apatinib mesylatewere recorded and analyzed. Results The median PFS was 4.3 months,the median OS was 8.1 months,the one-year survival rate was 26.1%,the two-year survival rate was 8.7%,the ORR was 16.7%,DCR was 60%,PR was 5 cases(16.7%),SD was 13 cases(43%), PD was 12 cases(40%). The adverse drug reaction(thrombocytopenia,leukopenia,oral mucositis,anemia, elevated aminotransferase,hand.foot syndrome,proteinuria,etc)were Ⅰ or Ⅱ. There were 3 cases of grade Ⅲ~Ⅳ hypertension(10%),2 cases of grade Ⅲ~Ⅳ proteinuria(7%)and 3 cases of grade Ⅲ~Ⅳ hand-foot syndrome (10%). The PFS treated with apatinib mesylate was significantly different from CEA[(< 25 ng/mL)vs.≥(25 ng/ mL)],CerB2[(++^+++)vs.(-^+)],Ki.67[(≥ 50%)vs.(< 50%)](P < 0.05),suggesting that the efficacy of apatinib was closely related to CEA(< 25 ng/L),CerB2(>++),Ki.67(> 50%). Conclusion The third-line treatment of Apatinib mesylate for advanced colorectal cancer has a tendency to improve curative effect ,survival and tolerable adverse reactions. The efficacy of Apatinib mesylate is better in patients with CEA value lower than 25 ng/mL,CerB2 greater than ++,Ki-67 over 50%,suggesting the potential predictive value of CEA,CerB2 and Ki-67. It is worth further prospective study.
作者
杨冬阳
位俊敏
马冬
李子俊
YANG Dongyang;WEI Junmin;MA Dong;LI Zijun(The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510282,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第10期1607-1612,共6页
The Journal of Practical Medicine
基金
CSCO-默克雪兰诺肿瘤研究基金肿瘤创新研究基金项目(编号:Y-MX 2016-015)
关键词
甲磺酸阿帕替尼
晚期结直肠癌
三线治疗
疗效预测
疗效
安全性
apatinib mesylate
advanced colorectal cancer
third-line treatment
efficacy prediction
efficacy
safety
