阿帕替尼联合替吉奥二线治疗晚期胃癌的临床观察

吴志伟+蔡俊++陆网坤++马德++侯娟

[摘要]目的 探讨阿帕替尼联合替吉奥二线治疗晚期胃癌的临床效果和安全性。方法 选取2015年12月～2017年2月在我院肿瘤内科住院治疗的28例晚期胃癌患者，随机分为观察组和对照组，各14例。观察组采用阿帕替尼联合替吉奥二线治疗，治疗方法为阿帕替尼500 mg口服，1次/d，替吉奥胶囊40～60 mg口服，2次/d，第1～14天后停药1周，21 d为1个周期，至少完成4个周期治疗。對照组仅给予替吉奥胶囊单药二线化疗，治疗方法为替吉奥胶囊40～60 mg口服，2次/d，第1～14天后停药1周，21 d为1个周期，至少完成4个周期治疗。比较两组患者的治疗效果、营养状况、生活质量和不良反应。结果 观察组的总缓解率和疾病控制率分别为21.4%和92.9%，显著高于对照组的7.1%和71.4%（P<0.01）。治疗后，观察组的生活质量显著低于对照组（P<0.01），营养状况评分情况显著优于对照组（P<0.05）。观察组的胸闷、高血压、蛋白尿、食欲下降、恶心呕吐、周围神经毒性和血红蛋白减少不良反应的发生率显著高于对照组（P<0.01或P<0.05）。结论 阿帕替尼联合替吉奥二线治疗晚期胃癌的临床效果较好，但其不良反应较多，且可能降低患者的营养状况和生活质量，其临床应用需综合考虑慎重选择。

[关键词]阿帕替尼；替吉奥；晚期胃癌；不良反应

[中图分类号] R735.2 [文献标识码] A [文章编号] 1674-4721（2017）08（b）-0069-04

Clinical study of Apatinib combined with Tegafur as second line treating advanced gastric cancer

WU Zhi-wei CAI Jun LU Wang-kun MA De HOU Juan

Department of Internal Medicine-Oncology，Jingjiang People′s Hospital，Jiangsu Province，Jingjiang 214500，China

[Abstract]Objective To evaluate the clinical effect and safety of Apatinib combined with Tegafur as second line treating advanced gastric cancer.Methods 28 patients with advanced gastric cancer treated in the department of internal medicine-oncology of our hospital from December 2015 to February 2017 were selected and randomly divided into observation group and control group，each group contains 14 patients.Observation group was treated with Apatinib of 500 mg，qd，and Tegafur Capsules of 40-60 mg for oral administration，bid，from day 1 to day 14 then withdrawal for one week，and 21 days were one cycles.The whole treatment lasted at least 4 cycles.Control group only received Tegafur Capsulesas second line treatment of 40-60 mg for oral administration，bid，from day 1 to day 14，then withdrawal for one week，and 21 days were one cycles.The whole treatment lasted at least 4 cycles.The treatment effect，the nutritional status，the quality of life，and the adverse reactions between the two groups were compared after treatment.Results The total remission rate and disease control rate of the observation group （21.4% and 92.9%） were significantly higher than those of the control group （7.1% and 71.4%） （P<0.01）.The quality of life in the observation group was significantly lower than that in the control group after treatment （P<0.01）.The nutritional status score in the observation group was significantly better than that in the control group after the treatment（P<0.01）.The incidence of chest tightness，hypertension，proteinuria，appetite loss，nausea and vomiting，peripheral nerve toxicity and hemoglobin reduction in the observation group were significantly higher than those in the control group （P<0.01 or P<0.05）. Conclusion The effect and toxicity of Apatinib combined with Tegafur as second line treatment of patients with advanced gastric cancer is better，but it has more adverse reactions，and may reduce the patients′ nutritional status and quality of life，thus its clinical application should be considered carefully.endprint

[Key words]Apatinib；Tegafur；Advanced gastric cancer；Adverse reaction

胃癌是我国常见的消化道恶性肿瘤，发病率较高，由于其发病隐匿，早期临床症状不明显，因此绝大部分患者就诊时往往已是晚期胃癌，失去了手术的机会，严重影响患者的生活质量和预后[1]。对于晚期胃癌患者只能采用保守治疗和姑息化疗的方法，以期提高患者的生活质量并延长其生存期[2]。目前一线的晚期胃癌化疗方法包括曲妥珠单抗、单药氟尿嘧啶和两种药物或三种药物联合用药等，但临床尚缺乏统一的治疗标准[3]。阿帕替尼是一种新型的小分子抗血管生成靶向口服药物，主要是通过抗VEGFR-2细胞内的ATP；抑制酪氨酸激酶的生成从而抑制肿瘤组织新血管的生成；……