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背景与目的 :美国综合癌症网(National Comprehensive Cancer Net,NCCN)治疗指南推荐贝伐单抗联合化疗治疗复发性恶性胶质瘤。但截至目前,中国脑胶质瘤患者这方面的报道较少。本文总结我们应用贝伐单抗联合化疗治疗12例复发性恶性胶质瘤的临床经验,探讨安全性与疗效。方法:12例复发性恶性胶质瘤均行贝伐单抗联合化疗。贝伐单抗5mg/kg,每两周一次。TMZ化疗方案的选择基于肿瘤组织DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)的免疫组化检测结果,行甲基化特异PCR(MSP-PCR)检测MGMT启动子甲基化程度。MGMT阴性表达(-)者,接受TMZ标准化疗[200 mg(/m2.d),d1-5,四周方案];MGMT阳性表达(+)者,或者MGMT阴性表达(-)者既往已接受标准剂量TMZ治疗但病情进展者,接受TMZ剂量密度方案[75mg(/m2.d),d1-21,四周方案]。结果:12例患者共接受63次贝伐单抗治疗,中位4次(3-10次)。12例患者均可评价客观疗效,完全缓解(complete remission,CR)2例(16.7%),部分缓解(partial remission,PR)2例(16.7%),微效(minimal remission,MR)8例(66.7%),疾病控制率(CR+PR+MR)为100%。中位无进展生存(progression freesurvival,PFS)为4.3个月(95%CI:2.4~7.3),6个月的PFS率为40.6%。最严重不良反应是Ⅲ度粒细胞减少症与白细胞减少症,各1例次(1.6%)。最常见的轻至中度不良反应包括Ⅱ度的腹泻8例次(12.7%)、Ⅱ度疲乏5例次(7.9%)、高血压2例次(3.2%)。结论:贝伐单抗联合化疗治疗国人复发恶性胶质瘤是安全的,疗效也令人满意。
BACKGROUND & AIM: The National Comprehensive Cancer Network (NCCN) guidelines recommend bevacizumab in combination with chemotherapy for recurrent malignant glioma. However, as of now, there are few reports on glioma patients in China. This article summarizes our application of bevacizumab combined with chemotherapy in the treatment of 12 cases of recurrent glioblastoma clinical experience to explore the safety and efficacy. Methods: Twelve patients with recurrent malignant glioma received bevacizumab combined with chemotherapy. Bevacizumab 5mg / kg, once every two weeks. TMZ Chemotherapy Options MGMT promoter methylation was detected by methylation-specific PCR (MSP-PCR) based on the results of immunohistochemistry of tumor tissue DNA methyltransferase (MGMT). Patients with MGMT negative (-) underwent TMZ standard chemotherapy [200 mg (/ m2.d), d1-5, 4 week arms]; those with MGMT positive (+), or MGMT negative Patients with TMZ-treated but disease progression, receiving the TMZ dose-density regimen [75 mg (/ m2.d), d1-21, four week regimen]. RESULTS: Twelve patients received a total of 63 bevacizumab treatments, median 4 (3-10). All of the 12 patients were evaluated for objective curative effect, complete remission (CR) in 2 cases (16.7%), partial remission (PR) in 2 cases (16.7%) and minimal remission (MR) in 8 cases 66.7%), disease control rate (CR + PR + MR) was 100%. The progression-free survival (progression free survival, PFS) was 4.3 months (95% CI: 2.4 to 7.3) with a PFS rate of 40.6% at 6 months. The most serious adverse reactions are grade III neutropenia and leukopenia, 1 case (1.6%). The most common mild-to-moderate adverse reactions included grade II diarrhea in 8 episodes (12.7%), grade II fatigue in 5 episodes (7.9%) and hypertension in 2 episodes (3.2%). Conclusion: Bevacizumab combined with chemotherapy for the treatment of recurrent malignant glioma in Chinese is safe and the curative effect is also satisfactory.