Fenig E, Brenner B, Njuguna E, Katz A, Schachter J, Sulkes A
Institute of Oncology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Am J Clin Oncol. 2000 Feb;23(1):65-7. doi: 10.1097/00000421-200002000-00018.
We describe three patients with advanced Merkel cell carcinoma who were treated with etoposide given orally for recurrent regional lymph node involvement 18 to 30 months after exposure to etoposide given intravenously. Etoposide given orally (100 mg/day) was given for 10 to 14 consecutive days and repeated every 21 to 28 days for a median of three courses (range: two to four). Toxicity was minimal and mainly hematologic. Two patients showed a complete response and one a partial response, all of very rapid onset. All three patients are alive 6, 9, and 42 months from the start of oral treatment. Two remain progression free, and one had a recurrence 1 month after completion of chemotherapy. We suggest that orally administered etoposide, a topoisomerase II inhibitor, has a strong antitumor effect in advanced Merkel cell carcinoma, even in patients previously treated parenterally with the same drug. This action may be explained by the greater dependence of the drug's efficacy on the duration of administration rather than the dose intensity.
我们描述了三名晚期默克尔细胞癌患者，他们在静脉注射依托泊苷18至30个月后，因复发性区域淋巴结受累而接受口服依托泊苷治疗。口服依托泊苷（100毫克/天）连续给药10至14天，每21至28天重复一次，中位疗程为三个疗程（范围：两个至四个）。毒性极小，主要为血液学毒性。两名患者显示完全缓解，一名患者显示部分缓解，所有缓解起效都非常迅速。从口服治疗开始起，三名患者分别存活了6个月、9个月和42个月。两名患者仍无疾病进展，一名患者在化疗完成后1个月复发。我们认为，口服依托泊苷这种拓扑异构酶II抑制剂，对晚期默克尔细胞癌具有强大的抗肿瘤作用，即使是先前接受过同一药物胃肠外给药治疗的患者。这种作用可能是由于药物疗效对给药持续时间的依赖性更强，而非剂量强度。
