Yang Qun-Ying, Chen Li-Kun, Xu Guang-Chuan, Liu Jun-Ling, Liang Ying, Zhang Li-Na
Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China.
Ai Zheng. 2004 Nov;23(11 Suppl):1459-62.
BACKGROUND & OBJECTIVE: Chemotherapy has been rarely considered an important treatment modality for non-small cell lung cancer (NSCLC) with brain metastases (BM) because of the existence of blood-brain barrier (BBB). In the recent years,the studies about BBB suggest that many agents (such as paclitaxel, cisplatin) have increased permeability to BBB once BM occur. Therefore, we addressed the role of this combination with paclitaxel,etoposide, cisplatin (some effective agents to NSCLC) as front-line therapy in NSCLC with BM.
20 chemotherapy-naive patients with documented BM from NSCLC and at least one evaluable extracerebral lesion were treated with paclitaxel (150 mg/m(2)) on day 1, etoposide (60 mg/m(2)) on day 1,3,5,and cisplatin (20 mg/m(2)) on day 1-5. The cycle was repeated every 28 days.
17 patients were evaluated for response and 19 for toxicity. The intracranial objective response rate (ORR) was 41%,the extracranial ORR was 53%. Patients who responded for the brain also had a response at the extracerebral sites. Grade 3-4 myelosuppression occurred in 21% of the patients. The overall medican follow-up was 9 months. The medican survival time for the 9 died patients was 8.5 months.
Paclitaxel and cisplatin combined with etoposide as front-line therapy in NSCLC with BM has some efficacy. The toxicity is mild. This combination chemotherapy seems to achieve responses similar to those for extracranial diseases, and further support the need for reconsideration of the role of chemotherapy in this setting.
由于血脑屏障（BBB）的存在，化疗很少被视为非小细胞肺癌（NSCLC）脑转移（BM）的重要治疗方式。近年来，关于血脑屏障的研究表明，一旦发生脑转移，许多药物（如紫杉醇、顺铂）对血脑屏障的通透性会增加。因此，我们探讨了紫杉醇、依托泊苷、顺铂（对NSCLC有效的一些药物）联合作为NSCLC脑转移一线治疗的作用。
20例未经化疗且有记录的NSCLC脑转移患者，至少有一个可评估的脑外病变，在第1天接受紫杉醇（150mg/m²）治疗，在第1、3、5天接受依托泊苷（60mg/m²）治疗，在第1 - 5天接受顺铂（20mg/m²）治疗。每28天重复一个周期。
17例患者接受疗效评估，19例接受毒性评估。颅内客观缓解率（ORR）为41%，脑外ORR为53%。脑内有反应的患者在脑外部位也有反应。21%的患者发生3 - 4级骨髓抑制。总体中位随访时间为9个月。9例死亡患者的中位生存时间为8.5个月。
紫杉醇和顺铂联合依托泊苷作为NSCLC脑转移的一线治疗有一定疗效。毒性较轻。这种联合化疗似乎能取得与脑外疾病相似的反应，并进一步支持重新考虑化疗在此情况下的作用。
