盐酸伊立替康对一线标准方案治疗失败小细胞肺癌患者的疗效分析

Efficacy of irinotecan hydrochloride in patients with failed first-line standard regimen for small cell lung cancer

摘要:

目的 探讨盐酸伊立替康对一线标准方案治疗失败小细胞肺癌（SCLC）患者的疗效及对血清神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）的影响。方法 选取2017年2月—2019年2月在联勤保障部队第九〇三医院接受二线治疗的一线标准方案治疗失败的SCLC患者75例。21例仅接受最佳支持治疗（BSC组），54例接受二线化疗（二线化疗组）。其中，19例单用盐酸伊立替康治疗（盐酸伊立替康组），35例盐酸伊立替康加铂类化疗（IP组）。随访观察近期疗效、无进展生存时间（PFS）及总生存时间（OS）。采用酶联免疫吸附试验检测治疗前后血清NSE、CEA、CYFRA21-1水平。结果 二线化疗组的近期客观缓解率（ORR）、疾病控制率（DCR）分别为40.74%、74.07%，高于BSC组的9.52%、28.57%（P <0.05）；二线化疗组的中位PFS和OS分别为4.2个月和11.5个月，长于BSC组的2.2个月、6.0个月（P <0.05）。盐酸伊立替康组的ORR和DCR分别为36.84%、68.42%，IP组分别为42.86%、77.14%，两组比较差异无统计学意义（P >0.05）；盐酸伊立替康组的中位PFS和OS分别为3.7个月、11.0个月，IP组分别为4.3个月、12.2个月，两组比较差异无统计学意义（P >0.05）。盐酸伊立替康组的骨髓抑制发生率低于IP组（P <0.05），但其余副反应发生率比较差异无统计学意义（P >0.05），且多为Ⅰ、Ⅱ度。盐酸伊立替康组和IP组治疗后血清NSE、CEA、CYFRA21-1水平降低的差值均高于BSC组（P <0.05），但盐酸伊立替康组和IP组间比较，差异无统计学意义（P >0.05）。结论 盐酸伊立替康对一线标准方案治疗失败SCLC患者具有较高的疾病控制率，且不良反应多可耐受，较最佳支持治疗具有更好的生存获益，且与铂类药物联用可能延长PFS，但有副反应增加趋势。

Abstract:

Objective To investigate the efficacy of irinotecan hydrochloride in the treatment of small cell lung cancer (SCLC) after first-line standard regimen therapy failure and influence on the serum levels of neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and cytokeratin 19 fragment (CYFRA21-1).Methods From February 2017 to February 2019, 75 patients with SCLC after first-line standard regimen therapy failure in our hospital were collected. Among them, 21 patients received only best supportive care (BSC), and 54 patients received second-line chemotherapy. 19 patients were treated with irinotecan hydrochloride alone, and 35 patients were treated with irinotecan hydrochloride plus platinum (IP) chemotherapy. The short-term efficacy, progression-free survival (PFS), and overall survival (OS) was followed-up. The serum NSE, CEA, and CYFRA21-1 levels were measured before and after treatment.Results The short-term objective response rate (ORR) and disease control rate (DCR) of the second-line chemotherapy group were 40.74% and 74.07%, which were higher than the 9.52% and 28.57% of the BSC group (P < 0.05); the median PFS and OS of the second-line chemotherapy group were 4.2 months and 11.5 months, which were longer than 2.2 months and 6.0 months in the BSC group (P < 0.05). The ORR and DCR of the single-agent irinotecan hydrochloride group were 36.84% and 68.42%, which were lower than 42.86% and 77.14% of the IP group, but the difference was not statistically significant (P > 0.05); the median PFS and OS of the single-agent irinotecan hydrochloride group were 3.7 months and 11.0 months, which were shorter 4.3 months and 12.2 months of the IP group, but the differences were not statistically significant (P > 0.05). The incidence of bone marrow suppression in the single-agent irinotecan hydrochloride group was 42.11%, which was lower than 77.14% in the IP group (P < 0.05), but the incidence of other side effects was not statistically significant between the two groups (P > 0.05), and most wereⅠ, Ⅱdegree. After treatment, the decrease value of NSE, CEA, CYFRA21-1 in the irinotecan hydrochloride group and the IP group were higher than the BSC group (P < 0.05), but there was no significant difference between the the irinotecan hydrochloride group and the IP group (P > 0.05).Conclusion Irinotecan hydrochloride has high disease control rate in the treatment of SCLC after first-line standard regimen therapy failure, and the adverse reactions can be tolerated. It has better survival benefit than BSC, and may prolong PFS when combined with platinum drugs, but there is a tendency to increase side effects.