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目的 研究大剂量三苯氧胺 (tamoxifen ,TAM)逆转治疗对鬼臼乙叉甙 顺铂 (EP)方案耐药 ,且P gp表达阳性的非小细胞肺癌。方法 41例对EP方案耐药 ,且P gp阳性的NSCLC患者随机分为二组 ,逆转组应用TAM 10 0mg ,2次 /日 ,第 1～ 5天 ,然后采用EP方案 ;对照组仅采用EP方案治疗。结果 逆转组CR 1例 ,PR 5例 ,NC 11例 ,PD 4例 ,有效率为 2 8.6% (6/2 1) ,中位生存期为 8.4月 ,1年生存率为 3 8.1% ;对照组NC 9例 ,PD 11例 ,有效率为 0 ,中位生存期为 4.6月 ,1年生存率为 3 5 .0 %。逆转组有效率明显高于对照组 (P =0 .0 12 1) ,中位生存期明显长于对照组 (P <0 .0 1)。逆转组P gp阴转率为 3 3 .3 % (7/2 1) ,对照组无阴转者。主要毒副反应为Ⅱ～Ⅲ度血液学毒性 ,Ⅳ度少见。消化道反应均为Ⅰ～Ⅱ度。两组间毒副反应比较均无显著差异 (P >0 .0 5 )。结论 大剂量三苯氧胺能逆转对EP方案耐药 ,且P gp表达阳性的非小细胞肺癌。
Objective To investigate the effect of high dose tamoxifen (TAM) reversal treatment on non-small cell lung cancer resistant to etoposide cisplatin (EP) regimen and positive P gp expression. Methods Forty-one patients with NSCLC who were resistant to EP regimen and P gp positive were randomly divided into two groups. TAM 10 mg, twice daily, and days 1 to 5 were used in the reversal group, and then EP regimen was used. In the control group, only EP Program treatment. Results In the reversal group, there were 1 CR, 5 PR, 11 NC and 4 PD. The median effective rate was 8.6% (6/2), and the median survival time was 8.4 months. The 1-year survival rate was 8.11% Group NC 9 cases, PD 11 cases, the effective rate was 0, the median survival was 4.6 months, 1-year survival rate was 35.0%. The reversal group was significantly higher than the control group (P = 0.012 1), the median survival was significantly longer than the control group (P <0.01). In the reversal group, the negative conversion rate of P gp was 33.3% (7/2 1), while the control group had no negative conversion. The main side effects of Ⅱ ~ Ⅲ hematological toxicity, Ⅳ degree rare. Gastrointestinal reactions are Ⅰ ~ Ⅱ degree. There was no significant difference in the side effects between the two groups (P> 0.05). Conclusion High-dose tamoxifen can reverse the non-small cell lung cancer that is resistant to EP regimen and has positive P gp expression.