학술논문
基因检测技术指导晚期转移性肾癌个体化靶向治疗的初步经验 / Preliminary experience in guiding individualized targeted therapy of advanced metastatic renal cell carcinoma with gene detection technology
Document Type
Academic Journal
Author
徐达; 潘秀武; 陈佳鑫; 叶剑青; 储传敏; 田毅君; 刘溪; 吕建敏; 崔心刚; Xu Da; Pan Xiuwu; Chen Jiaxin; Ye Jianqing; Chu Chuanmin; Tian Yijun; Liu Xi; Lyu Jianmin; Cui Xingang
Source
中华泌尿外科杂志 / Chinese Journal of Urology. 40(5):365-369
Subject
Language
Chinese
ISSN
1000-6702
Abstract
目的探讨基因检测技术指导晚期转移性肾癌个体化靶向治疗的疗效及对不良反应的耐受性.方法回顾性分析2015年10月至2017年10月收治的62例晚期转移性肾癌患者接受靶向药物治疗前后的临床资料,男36例,女26例.平均年龄(54±13)岁.采用舒尼替尼16例,索拉非尼20例,培唑帕尼26例.根据基因检测结果选择靶向药物组(个性化组)28例,经验性选择靶向药物组(经验组)34例.个性化组男17例,女11例;平均年龄(51.3±15.6)岁;手术患者20例,未手术患者(包括仅行肾穿刺患者)8例;用药前已发生骨转移21例,肺转移7例,肝转移16例,体表转移4例,淋巴结转移14例;纪念斯隆凯特琳癌症中心(MSKCC)危险度分层低危15例,中危7例,高危6例;使用舒尼替尼7例,索拉非尼8例,培唑帕尼13例.经验组男19例,女15例;平均年龄(56.3±10.1)岁;手术患者22例,未手术患者12例;用药前已发生骨转移20例,肺转移5例,肝转移13例,体表转移3例,淋巴结转移15例;MSKCC危险度分层低危20例,中危8例,高危6例;使用舒尼替尼9例,索拉非尼12例,培唑帕尼13例.两组的性别、年龄、是否手术、转移位点、MSKCC危险度比较差异均无统计学意义(P＞0.05).两组患者口服靶向药物均为标准治疗方案,观察两组的疗效、无进展生存期及对不良反应的耐受性.结果本研究62例随访时间4～26个月.靶向治疗12个月后,个性化组和经验组客观缓解分别为13例(46.4％)和7例(20.6％),个性化组的肿瘤控制疗效显著优于经验组(P=0.03).个性化组中位无进展生存时间显著优于经验组[13.2个月(3.7～24.2个月)与12.1个月(2.8 ～22.1个月),P=0.009].个性化组治疗相关不良反应发生率高于经验组,包括血小板减少[46.4％ (13/28)与17.6％ (6/34),P=0.014]、白细胞减少[67.9％ (19/28)与32.4％(11/34),P=0.005]、高血压[71.4％ (20/28)与44.1％ (15/34),P=0.031]、甲状腺功能减低[60.7％(17/28)与29.4％ (10/34),P=0.013].结论相对于经验性用药,应用基因检测技术个性化选择靶向药物治疗晚期转移性肾癌患者的疗效明显,在一定程度上可延长患者无进展生存时间.
Objective To explore the efficacy and tolerance of adverse reactions of gene detection technique in guiding individualized targeted therapy for advanced metastatic renal cell carcinoma.Methods Retrospective analysis was performed on the clinical data of 62 patients with advanced metastatic renal cell carcinoma before and after receiving targeted drug treatment in our department from October 2015 to October 2017.Among the 62 patients,there were 36 males and 26 females,with an average age of (54 ± 13) years old.16 patients were treated with sunitinib,20 patients were treated with sorafenib and 26 patients were treated with pazopanib.A total of 28 patients (individualized group) were selected to receive targeted drug according to the results of gene detection,and 34 patients were treated with targeted drug empirically (empirical group).In individualized group,there were 17 males and 11 females with the average age of (51.3 ± 15.6) years old.20 patients accepted the operation.The distant metastasis included bone metastasis in 21 cases,lung metastasis in 7 cases,liver metastasis in 16 cases,epidermal metastasis in 4 cases and lymphatic metastasis in 14 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 15,7,6,respectively.7 patients were treated with sunitinib,8 patients were treated with sorafenib and 13 patients were treated with pazopanib.In empirical group,there were 19 males and 15 females with the average age of (56.3 ± 10.1) years old.22 patients accepted the operation.The distant metastasis included bone metastasis in 20 cases,lung metastasis in 5 cases,liver metastasis in 13 cases,epidermal metastasis in 3 cases and lymphatic metastasis in 15 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 20,g,6,respectively.9 patients were treated with sunitinib,12 patients were treated with sorafenib and 13 patients were treated with pazopanib.The baseline characteristics of the two groups of patients,including gender,age,whether operation was performed,site of metastasis,and risk of MSKCC,didn't show significant difference.Patients in both groups received the standard treatment regimen and the follow-up duration was 4-26 months to observe the efficacy,progression-free survival and tolerance to adverse reactions of the targeted therapy.Results After 12 months of treatment,15 patients in the individualized group was recorded objective remission.7 patients in the empirical group was recorded objective remission,as well.The tumor control efficacy of the individualized group was significantly better than that of the empirical group (46.4％ vs.20.6％,P =0.03).Meanwhile,the median progression-free survival time (15.2 months,3.7-24.2 months) in the individualized group was significantly longer than that in the empirical group (12.1 months,2.8-22.1 months) (P =0.009).Compared with the empirical group,the higher incidence of targeted treatment-related adverse reactions occurred in the individualized group,including thrombocytopenia (46.4％ vs.17.6％ P =0.014),leukopenia (46.4％ vs.17.6％ P =0.005),hypertension (71.4％ vs.44.1％,P =0.031) and hypothyroidism(60.7％ vs.29.4％,P=0.013).Conclusions Compared with the patients with empirical drugs,the application of gene detection technique to select individualized targeted drugs for the treatment of advanced metastatic renal cancer is obvious curatively effective,and to a certain extent extends the progression-free survival time of patients.
Objective To explore the efficacy and tolerance of adverse reactions of gene detection technique in guiding individualized targeted therapy for advanced metastatic renal cell carcinoma.Methods Retrospective analysis was performed on the clinical data of 62 patients with advanced metastatic renal cell carcinoma before and after receiving targeted drug treatment in our department from October 2015 to October 2017.Among the 62 patients,there were 36 males and 26 females,with an average age of (54 ± 13) years old.16 patients were treated with sunitinib,20 patients were treated with sorafenib and 26 patients were treated with pazopanib.A total of 28 patients (individualized group) were selected to receive targeted drug according to the results of gene detection,and 34 patients were treated with targeted drug empirically (empirical group).In individualized group,there were 17 males and 11 females with the average age of (51.3 ± 15.6) years old.20 patients accepted the operation.The distant metastasis included bone metastasis in 21 cases,lung metastasis in 7 cases,liver metastasis in 16 cases,epidermal metastasis in 4 cases and lymphatic metastasis in 14 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 15,7,6,respectively.7 patients were treated with sunitinib,8 patients were treated with sorafenib and 13 patients were treated with pazopanib.In empirical group,there were 19 males and 15 females with the average age of (56.3 ± 10.1) years old.22 patients accepted the operation.The distant metastasis included bone metastasis in 20 cases,lung metastasis in 5 cases,liver metastasis in 13 cases,epidermal metastasis in 3 cases and lymphatic metastasis in 15 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 20,g,6,respectively.9 patients were treated with sunitinib,12 patients were treated with sorafenib and 13 patients were treated with pazopanib.The baseline characteristics of the two groups of patients,including gender,age,whether operation was performed,site of metastasis,and risk of MSKCC,didn't show significant difference.Patients in both groups received the standard treatment regimen and the follow-up duration was 4-26 months to observe the efficacy,progression-free survival and tolerance to adverse reactions of the targeted therapy.Results After 12 months of treatment,15 patients in the individualized group was recorded objective remission.7 patients in the empirical group was recorded objective remission,as well.The tumor control efficacy of the individualized group was significantly better than that of the empirical group (46.4％ vs.20.6％,P =0.03).Meanwhile,the median progression-free survival time (15.2 months,3.7-24.2 months) in the individualized group was significantly longer than that in the empirical group (12.1 months,2.8-22.1 months) (P =0.009).Compared with the empirical group,the higher incidence of targeted treatment-related adverse reactions occurred in the individualized group,including thrombocytopenia (46.4％ vs.17.6％ P =0.014),leukopenia (46.4％ vs.17.6％ P =0.005),hypertension (71.4％ vs.44.1％,P =0.031) and hypothyroidism(60.7％ vs.29.4％,P=0.013).Conclusions Compared with the patients with empirical drugs,the application of gene detection technique to select individualized targeted drugs for the treatment of advanced metastatic renal cancer is obvious curatively effective,and to a certain extent extends the progression-free survival time of patients.