Andreopoulou E, Ross P J, O'Brien M E R, Ford H E R, Priest K, Eisen T, Norton A, Ashley S, Smith I E
Lung Unit, Royal Marsden Hospital, Surrey, UK.
Ann Oncol. 2004 Sep;15(9):1406-12. doi: 10.1093/annonc/mdh356.
With the rising incidence of malignant mesothelioma (MM), it is important to optimise treatment to control symptoms, maintain quality of life and, if possible, prolong life. We have analysed prospectively collected data to evaluate a frequently used palliative chemotherapy regimen.
Between October 1986 and May 2002 all patients with inoperable pleural mesothelioma were considered for treatment with MVP (mitomycin C 8 mg/m2 every 6 weeks, vinblastine 6 mg/m2 every 3 weeks and cisplatin 50 mg/m2 every 3 weeks) chemotherapy. Symptoms were assessed by physician assessment at baseline and after each cycle of chemotherapy.
One hundred and fifty patients were treated with MVP for mesothelioma. Forty-three per cent had a performance status (PS) 2 or worse. The response rate was 15.3%, with 68.6% having stable disease. Sixty-nine per cent reported an improvement in symptoms; in particular there were good responses for pain (71%), cough (62%) and dyspnoea (50%). The most common grade 3/4 toxicity was neutropenia (22%). Median overall survival was 7 months, with 1-year survival 31% and 2-year survival 11%. Median survival for patients with PS 0/1 was 10 months, and was 6 months for patients with PS 2/3. Poor prognostic factors in univariate analysis included poor PS, weight loss, mixed or sarcomatoid histology, low haemoglobin and high white blood cell count. Excluding pathological subtype, the prognostic significance of poor PS and weight loss were retained in multivariate analysis.
Palliation of symptoms in MM is achievable with current cisplatin-based treatments.
随着恶性间皮瘤（MM）发病率的上升，优化治疗以控制症状、维持生活质量并尽可能延长生命变得至关重要。我们分析了前瞻性收集的数据，以评估一种常用的姑息化疗方案。
1986年10月至2002年5月期间，所有无法手术的胸膜间皮瘤患者均考虑接受MVP（丝裂霉素C每6周8mg/m²、长春碱每3周6mg/m²和顺铂每3周50mg/m²）化疗。在基线和每个化疗周期后，由医生评估症状。
150例患者接受了MVP治疗间皮瘤。43%的患者体力状况（PS）为2或更差。缓解率为15.3%，68.6%的患者病情稳定。69%的患者报告症状有所改善；尤其是疼痛（71%）、咳嗽（62%）和呼吸困难（50%）有良好的缓解。最常见的3/4级毒性是中性粒细胞减少（22%）。中位总生存期为7个月，1年生存率为31%，2年生存率为11%。PS 0/1患者的中位生存期为10个月，PS 2/3患者为6个月。单因素分析中的不良预后因素包括PS差、体重减轻、混合型或肉瘤样组织学、血红蛋白低和白细胞计数高。排除病理亚型后，PS差和体重减轻在多因素分析中仍具有预后意义。
目前基于顺铂的治疗方法可实现MM症状的缓解。
