目的:探讨贝伐单抗联合白蛋白结合型紫杉醇治疗复发性卵巢癌临床疗效和安全性。方法:回顾性分析我院32例复发性卵巢癌经贝伐单抗联合白蛋白结合型紫杉醇治疗的临床资料,总结近期疗效和观察不良反应。结果:肿瘤控制总有效率46.9%,获益率75.0%;降低血清肿瘤标记物表达水平有效率53.1%;临床症状缓解率50.0%;不良反应按系统大致归类,以皮疹发生率最高、达84.2%,其次是消化道反应68.8%、继发高血压65.6%,蛋白尿和肝功能损害相对低,仅21.9%、18.8%,无出血和胃肠穿孔及血栓性事件。结论:贝伐单抗联合白蛋白结合型紫杉醇治疗复发性卵巢癌在控制肿瘤发展、降低血清肿瘤标记物表达水平、缓解临床症状等方面效果良好,不良反应发生率偏高但可耐受,对症处理可减轻,无严重不良事件,安全可行。 Objective: To investigate the clinical efficacy and safety of bevacizumab combined with albumin- bound paclitaxel in the treatment of recurrent ovarian cancer. Method: The clinical data of 32 cases of recurrent ovarian cancer treated with bevacizumab combined with albumin-binding paclitaxel in our hospital were retrospectively analyzed. We summarize the short-term curative effect and ob-serve the adverse reactions. Result: The total effective rate of tumor control was 46.9% and the benefit rate was 75.0%. The effective rate of reducing serum tumor marker expression level was 53.1%. The remission rate of clinical symptoms was 50.0%. The adverse reactions were generally classified according to the system. The incidence of rash was the highest (84.2%), followed by diges-tive tract reaction (68.8%), secondary hypertension (65.6%), proteinuria and liver function im-pairment were relatively low (21.9% and 18.8%), and there was no bleeding or thrombosis caused by gastrointestinal perforation. Conclusion: In the treatment of recurrent ovarian cancer, bevaci-zumab combined with albumin-binding paclitaxel has a good effect in controlling tumor develop-ment, reducing the expression level of serum tumor markers, and alleviating clinical symptoms. The incidence of adverse reactions is high and tolerable, and symptomatic treatment can be allevi-ated. There are no serious adverse events, and it is safe and feasible.
目的:探讨贝伐单抗联合白蛋白结合型紫杉醇治疗复发性卵巢癌临床疗效和安全性。方法:回顾性分析我院32例复发性卵巢癌经贝伐单抗联合白蛋白结合型紫杉醇治疗的临床资料,总结近期疗效和观察不良反应。结果:肿瘤控制总有效率46.9%,获益率75.0%;降低血清肿瘤标记物表达水平有效率53.1%;临床症状缓解率50.0%;不良反应按系统大致归类,以皮疹发生率最高、达84.2%,其次是消化道反应68.8%、继发高血压65.6%,蛋白尿和肝功能损害相对低,仅21.9%、18.8%,无出血和胃肠穿孔及血栓性事件。结论:贝伐单抗联合白蛋白结合型紫杉醇治疗复发性卵巢癌在控制肿瘤发展、降低血清肿瘤标记物表达水平、缓解临床症状等方面效果良好,不良反应发生率偏高但可耐受,对症处理可减轻,无严重不良事件,安全可行。
复发性卵巢癌,贝伐单抗,白蛋白结合型紫杉醇
Chuanqing Ke1, Huiying Fu1, Guangming Luo2, Wenling Chen1*, Enlan Peng1, Yuan Li1, Xie Xiong1
1The 908th Hospital of the Joint Logistic Support Force of the People’s Liberation Army, Nanchang Jiangxi
2Xingren People’s Hospital, Qianxinan Prefecture, Xingren Guizhou
Received: Apr. 27th, 2022; accepted: May 21st, 2022; published: May 31st, 2022
Objective: To investigate the clinical efficacy and safety of bevacizumab combined with albumin-bound paclitaxel in the treatment of recurrent ovarian cancer. Method: The clinical data of 32 cases of recurrent ovarian cancer treated with bevacizumab combined with albumin-binding paclitaxel in our hospital were retrospectively analyzed. We summarize the short-term curative effect and observe the adverse reactions. Result: The total effective rate of tumor control was 46.9% and the benefit rate was 75.0%. The effective rate of reducing serum tumor marker expression level was 53.1%. The remission rate of clinical symptoms was 50.0%. The adverse reactions were generally classified according to the system. The incidence of rash was the highest (84.2%), followed by digestive tract reaction (68.8%), secondary hypertension (65.6%), proteinuria and liver function impairment were relatively low (21.9% and 18.8%), and there was no bleeding or thrombosis caused by gastrointestinal perforation. Conclusion: In the treatment of recurrent ovarian cancer, bevacizumab combined with albumin-binding paclitaxel has a good effect in controlling tumor development, reducing the expression level of serum tumor markers, and alleviating clinical symptoms. The incidence of adverse reactions is high and tolerable, and symptomatic treatment can be alleviated. There are no serious adverse events, and it is safe and feasible.
Keywords:Recurrent Ovarian Cancer, Bevacizumab, Albumin Binding Paclitaxel
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
卵巢癌是女性最常见的恶性肿瘤之一,约占妇科肿瘤20%,由于早期症状不明显且无特异性,待出现明显不适症状时病情已经发展至中晚期,大多存在肿瘤蔓延扩散、盆腔或腹腔转移,治疗以姑息性手术结合全身化疗为主的综合治疗,仅有少数能达到完全缓解,70%在1~2年内复发,5年生存率约39%,治疗不彻底性和肿瘤复发是导致病死率极高的重要原因 [
入组标准:① 影像检查、实验室检查、临床确诊为卵巢癌复发;② 均有手术史和组织病理学诊断依据,且前期经过含铂类药物方案规范化疗;③ 无肝肾功能和凝血功能障碍、无出血倾向、无严重心肺疾患;④ KPS评分大于70分,基本可耐受化疗,预计生存期大于3个月或以上。入组32例,年龄34~67岁,中位年龄54岁;病理类型浆液性腺癌17例、粘液性腺癌8例、子宫内膜样癌5例、未分化癌2例;9例合并腹水和肺转移;血清肿瘤标记物CA125、CEA、CA199、AFP表达水平异常;半年内复发11例、半年后复发21例。排除标准:① 初治病例;② 前期经联合治疗肿瘤未控者。
贝伐单抗(上海罗氏公司)剂量为6~8 mg/kg VD、白蛋白结合型紫杉醇(美国阿博利斯公司) 260 mg/m2 VD,剂量视个体差异适当调整,21天1周期,化疗前作相应处理,以司琼类药物对抗胃肠道反应,2周期后(第3周期化疗前)复查影像和血清肿瘤标记物及结合临床评价疗效。
观察影像检查、血清肿瘤标记物(CA125、CEA、CA199、AFP)表达水平、临床表现、不良反应;影像按RECIST疗效判断标准:完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD),近期总有效率CR + PR,获益率CR + PR + SD;血清肿瘤标记物表达水平以CA125为准,CR:CA125恢复正常,PR:CA125下降幅度超过50%,SD:CA125下降未达50%或上升未超过25%,PD:CA125上升超过25%;临床表现以症状和KPS评分变化为主,缓解:症状减轻和KPS评分上升,稳定:症状和KPS评分无明显变化,加重:症状加重和KPS评分下降;不良反应表现不一,实际发生按系统大致归类统计。
实体瘤影像复查CR 0例(0%)、PR 15例(46.9%)、SD 9例(28.1%)、PD 8例(25.0%),总有效率46.9%,获益率75.0%;血清肿瘤标记物表达水平:CR 0例、PR 17例(53.1%)、SD 8例(25.0%)、PD 7例(21.9%),获益率78.1%;临床症状缓解16例(50.0%)、稳定10例(31.3%)、加重6例(18.8%),获益率81.3%,本组无1例CR,总有效率即PR率。因本组系回顾性总结观察,无对照分析,所有数据未进行统计学处理。
皮疹27例(84.4%)、胃肠道反应22例(68.8%)、继发高血压21例(65.6%)、骨髓抑制13例(40.6%)、蛋白尿7例(21.9%)、肝功能损害6例(18.8%),周围神经炎4例、12.5%,无出血、胃肠穿孔、血栓性事件。
卵巢癌是女性常见的恶性肿瘤,发病率居妇科肿瘤第二,死亡率第一,严重威胁女性的健康和生命,5年生存率仅39% [
肿瘤生长均依赖肿瘤血管的外扩和肿瘤血管的供养,大量新生血管形成是肿瘤生长的基础,阻断和抑制血管形成是控制肿瘤发展最有效手段之一,血管形成与血管内皮细胞和血管内皮生长因子(VEGF)密切相关,相关研究显示肿瘤患者体内VEGF呈高表达 [
江西省卫生健康委科技计划项目(编号SKJP22021940)。
柯传庆,付慧英,罗光敏,陈文玲,彭恩兰,李 苑,熊 勰. 贝伐单抗联合白蛋白结合型紫杉醇治疗复发性卵巢癌疗效观察Efficacy of Bevacizumab Combined with Albumin-Bound Paclitaxel in the Treatment Recurrent of Ovarian Cancer[J]. 临床医学进展, 2022, 12(05): 4929-4933. https://doi.org/10.12677/ACM.2022.125715