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阿帕替尼联合多柔比星二线治疗铂类耐药的复发或转移性子宫颈癌效果分析
周春, 段丽君, 吴方, 魏冬林, 刘永刚, 李利玲
中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (9) : 935-939.
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阿帕替尼联合多柔比星二线治疗铂类耐药的复发或转移性子宫颈癌效果分析
Analysis of the efficacy of apatinib combined with pegylated liposomal doxorubicin in the second-line treatment of platinum-resistant recurrent/metastatic cervical cancer
目的 探讨阿帕替尼联合多柔比星脂质体（PLD）二线治疗铂类耐药的复发或转移性子宫颈癌（r/m CC）的临床疗效。方法 选取2021年6月至2024年5月武汉市江夏区人民医院收治的120例r/m CC患者，依据患者治疗意愿及临床医生评估分为对照组（n=68）和研究组（n=52）。对照组给予多柔比星脂质体治疗，研究组在对照组基础上联合阿帕替尼治疗。3周为1个治疗周期，2组均治疗3个周期。比较两组临床疗效、血清肿瘤标志物水平、生存质量、生存预后以及不良反应发生情况。结果 研究组疾病控制率（DCR）、客观缓解率（ORR）及生存质量总改善率均高于对照组（P<0.05）。治疗后两组血清鳞状细胞癌抗原（SCCA）、糖类抗原15-3（CA15-3）、CA724水平均降低，且研究组更低（P<0.05）。研究组中位无进展生存期和中位总生存期均较对照组延长[10.18（9.57~10.78）个月 vs. 8.65（7.81~9.50）个月；11.50（11.01~11.95）个月vs. 9.94（9.10~10.57）个月]（Log-rank χ2=7.739、8.773，P均<0.05）。两组不良反应发生率差异无统计学意义（P>0.05）。结论 阿帕替尼联合PLD二线治疗可在一定程度上提高铂类耐药的r/m CC的治疗效果，降低肿瘤标志物水平，提升患者生存质量，延长生存期。
Objective To analyze the clinical efficacy of apatinib combined with pegylated liposomal doxorubicin（PLD）liposome in the second-line treatment of platinum-resistant recurrent/metastatic cervical cancer（r/m CC）. Methods A total of 120 patients with r/m CC admitted to Wuhan Jiangxia District People's Hospital from June 2021 to May 2024 were selected and divided into a control group（n=68）and a study group（n=52）based on patient treatment preference and clinician assessment. The control group was treated with PLD，while the study group was combined with apatinib on the basis of the control group. One treatment cycle is three weeks，and both groups are treated for three cycles. The clinical efficacy，serum tumor marker levels，quality of life，survival prognosis and occurrence of adverse reactions were compared between the two groups. Results The DCR，ORR，and total improvement rate of quality of life in the study group were all higher than those in the control group（P<0.05）. After treatment，the levels of serum SCCA，CA15-3，and CA724 in both groups decreased，and those in the study group were even lower（P<0.05）. The median PFS and median OS in the study group were both prolonged compared with those in the control group [10.18（9.57-10.78）months vs. 8.65（7.81-9.50）months；11.50（11.01-11.95）months vs. 9.94（9.10-10.57）months [Log-rank χ2=7.739，8.773；both P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. Conclusion The second-line treatment of apatinib combined with PLD can improve the therapeutic effect of platinum-resistant r/m CC to a certain extent，reduce the levels of tumor markers，improve the quality of life of patients，prolong the survival period.
复发或转移性宫颈癌 / 铂类耐药 / 阿帕替尼 / 多柔比星脂质体 / 生存预后
recurrent and metastatic cervical cancer / platinum resistance / apatinib / pegylated liposomal doxorubicin / survival prognosis
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Cervical cancer remains a leading cause of cancer-related mortality among women worldwide, particularly in underdeveloped nations. Despite advances in standard therapies, patients with recurrent metastatic cervical cancer face a poor prognosis and limited treatment options. This study aims to evaluate the efficacy and safety of emerging therapeutic approaches in managing this challenging condition, including immunotherapy, targeted medicines, and chemotherapy. Our review of recent literature and clinical trials highlights the significant progress made in the systematic treatment of metastatic cervical cancer. While each treatment modality has its strengths and limitations, the collective data suggest a trend towards improved patient outcomes with the adoption of these novel therapies. However, the heterogeneity of patient responses underscores the need for personalised treatment strategies. In conclusion, improvements in medical technology and the adoption of tailored treatment approaches have led to promising advancements in the management of recurrent metastatic cervical cancer. To further enhance patient care, there is an urgent need for more extensive clinical trial data and the development of more efficient personalised treatment plans. This study aims to contribute to this effort by comprehensively analysing current therapeutic strategies and identifying areas for future research.
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Cervical cancer continues to be a global threat affecting individuals in resource poor communities disproportionately. The treatment paradigm for this disease is ever evolving with recent innovations propelling oncologic outcomes to a new frontier offering survival benefits for patients struggling with locally advanced disease and metastatic/recurrent carcinoma. Immunologic checkpoint inhibitors and anti-body drug conjugates represent two novel drug classes that have demonstrable activity in this disease, particularly in the first-line and second-line treatment paradigm for recurrence. The tolerability of these novel medicines and associated durable responses underscore regulatory approval by the U.S. Food and Drug Administrations and their implementation in clinic.© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.
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This study aimed to evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) for patients with partially platinum-sensitive, platinum-resistant, or platinum-refractory ovarian cancer.
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To compare response assessment according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria in patients diagnosed with malignant solid tumors and who had received cytotoxic chemotherapy to establish the strength of agreement between each criterion.Sixty patients with malignant solid tumors were included in this retrospective study. The baseline and the sequential follow-up fluorine-18-fluorodeoxyglucose PET/computed tomography (CT) of each patient were evaluated according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria. PET/CT images were used for both metabolic and anatomic evaluation. The concurrent diagnostic CT and MRI images (performed within 1 week of PET/CT) were also utilized when needed. The results were compared using the κ-statistics.The response and progression rates according to the WHO criteria were 37 and 38%, respectively. The same ratios were also found for RECIST 1.1 (κ=1). The response and progression rates according to the EORTC criteria were 47 and 40%, respectively. When PERCIST criteria were used, one patient with progressive disease was upgraded to stable disease (κ=0.976). As we found the same results with WHO and RECIST 1.1 criteria, we used WHO criteria to compare the anatomic and metabolic criteria. When we compared the WHO and EORTC criteria, there was an agreement in 80% of the patients (κ=0.711). With WHO and PERCIST criteria, there was an agreement in 81.6% of the patients (κ=0.736).Significant agreement was detected when the WHO, RECIST 1.1, EORTC, and PERCIST criteria were compared both within as well as between each other.
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For treatment personalization in elderly cancer patients, survival prognoses should be considered. We developed an instrument to estimate survival of elderly patients with brain metastasis from gynecological cancer.In 15 patients, whole-brain radiotherapy regimen, tumor site, age, Karnofsky performance score (KPS), number of brain metastases, extra-cerebral metastases and interval from diagnosis of gynecological cancer until radiotherapy were retrospectively evaluated for survival. Characteristics found significant on multivariate analysis were used for the instrument.In the multivariate analysis, KPS ≥70% (hazard ratio=3.71, p=0.0499) and an interval ≥28 months (hazard ratio=3.71, p=0.030) were significantly associated with better survival. Based on these characteristics, patients received 0 (n=6), 1 (n=3) or 2 points (n=6). Six-month survival rates of the groups 0-1 and 2 points were 0% and 50%, respectively (p=0.007).This instrument helps estimating survival in elderly patients with brain metastases from gynecological cancer and contributes to personalization of their treatment.Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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The activity of the combination of carboplatin and liposomal doxorubicin was tested in a Phase II study of patients with recurrent cervical carcinoma.The combination of carboplatin (area under the concentration curve [AUC], 5) and liposomal doxorubicin (Doxil; starting dose, 40 mg/m(2)) was administered intravenously every 28 days to 37 patients with recurrent squamous cell cervical carcinoma to determine antitumor activity and toxicity profile.Twenty-nine patients were assessable for response, and 35 patients were assessable for toxicity. The overall response rate was 38%, the median time to response was 10 weeks, the median duration of response was 26 weeks, and the median survival was 37 weeks. The main toxic effect was myelosuppression, with Grade 3 and 4 neutropenia in 16 patients, anemia in 12 patients, thrombocytopenia in 11 patients, and neutropenic fever in 3 patients. Four patients had five infusion-related reactions during the infusion of liposomal doxorubicin, leading to treatment discontinuation in three patients. Grade > or = 2 nonhematologic toxicity included nausea in 17 patients, emesis in 14 patients, fatigue in 9 patients, mucositis and/or stomatitis in 8 patients, constipation in 6 patients, weight loss in 5 patients, hand-foot syndrome in 2 patients, and skin reactions in 3 patients.The combination of carboplatin and liposomal doxorubicin has modest activity in patients with recurrent cervical carcinoma.Copyright 2001 American Cancer Society.
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所有作者均声明不存在利益冲突
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