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目的:评价依维莫司二线治疗转移性肾细胞癌的疗效和安全性。方法:2010年6月~2010年12月,7例转移性肾细胞癌患者接受依维莫司治疗,男4例,女3例,年龄40~74岁,平均56.5岁。5例不能耐受血管内皮生长因子(VEGF)靶向治疗,2例为VEGF靶向治疗过程中病情进展。既往接受索拉非尼治疗3例,帕唑帕尼治疗4例。7例患者均接受口服依维莫司10mg每日1次的治疗。结果:随访时间截至目前42~48个月,中位时间45.5个月。根据RECIST标准,最佳疗效评价显示疾病稳定(SD)6例(85.71%),疾病进展(PD)1例(14.29%),无完全缓解(CR)及部分缓解(PR)病例。疾病控制率(DCR)为85.71%,中位无进展生存期(PFS)为6.0个月(95%CI:4.4~7.6个月)。不良反应多为1~2级;3级不良反应包括非感染性肺炎1例、贫血1例、血糖升高1例、GGT升高1例;4级不良反应为重度贫血1例。通过对症治疗及药物剂量调整,不良反应大多可以控制并耐受。结论:依维莫司二线治疗转移性肾细胞癌具有较好的疾病控制率,大多数患者可以从治疗中获益,药物不良反应可控。
Objective: To evaluate the efficacy and safety of everolimus second-line treatment of metastatic renal cell carcinoma. Methods: From June 2010 to December 2010, 7 patients with metastatic renal cell carcinoma received everolimus treatment. There were 4 males and 3 females, aged 40-74 years, with an average age of 56.5 years. Five patients were not able to tolerate vascular endothelial growth factor (VEGF) targeted therapy and two patients progressed in the course of VEGF targeted therapy. In the past to accept sorafenib treatment in 3 cases, pazopanib treatment in 4 cases. All 7 patients received oral everolimus 10 mg once daily. Results: The follow-up time was 42 to 48 months till now with a median time of 45.5 months. According to RECIST criteria, the best curative effect evaluation showed stable disease (SD) in 6 cases (85.71%), disease progression (PD) in 1 case (14.29%), and no complete remission (CR) and partial remission (PR) cases. The disease control rate (DCR) was 85.71%, and the median progression-free survival (PFS) was 6.0 months (95% CI: 4.4 to 7.6 months). Grade 1 adverse reactions included 1 case of non-infectious pneumonia, 1 case of anemia, 1 case of hyperglycemia, 1 case of GGT elevation, and 4 cases of grade A adverse reactions as severe anemia. Through symptomatic treatment and drug dose adjustment, most of the adverse reactions can be controlled and tolerated. CONCLUSIONS: Everolimus second-line treatment of metastatic renal cell carcinoma has a good rate of disease control. Most patients benefit from treatment and adverse drug reactions can be controlled.