Feun L G, Maor M, Stewart D J, Leavens M E, Savaraj N, Bodey G P
Section of Neurology, University of Texas System Cancer Center, MD Anderson Hospital and Tumor Institute, Houston.
Oncology. 1990;47(5):389-92. doi: 10.1159/000226854.
A pilot study was performed administering PCNU with radiation therapy to treat patients with high-grade astrocytomas and to explore the toxic effects of this drug regimen. PCNU at an initial dose of 110 mg/m2 i.v. was administered to 14 patients within 4 weeks after completion of cranial irradiation. Courses were repeated every 6-8 weeks upon recovery from myelosuppression. Radiation therapy consisted of 5,000 rad to the whole brain followed by an additional 1,500 rad to the tumor site. Patients were followed by CT scan and neurologic examination. The median survival for the group was 80 weeks. Larger, randomized trials comparing PCNU to other nitrosoureas will be needed to assess its value as adjuvant therapy in patients with malignant gliomas. Myelosuppression, particularly, thrombocytopenia, was the main toxic effect in this study. Pulmonary infiltrates developed in 2 patients and was progressive and fatal in 1 patient after a total cumulative PCNU dose of 850 mg/m2. Hepatic dysfunction with hyperbilirubinemia also developed in 1 patient. PCNU can produce pulmonary and hepatic toxicity similar to that reported for other nitrosoureas. Regular monitoring of pulmonary and hepatic function tests should be performed during treatment with PCNU in future trials.
开展了一项初步研究，对高级别星形细胞瘤患者给予丙卡巴肼（PCNU）联合放射治疗，以探究该药物方案的毒性作用。14例患者在颅脑照射完成后的4周内静脉注射初始剂量为110mg/m²的PCNU。骨髓抑制恢复后，每6 - 8周重复一个疗程。放射治疗包括全脑照射5000拉德，随后肿瘤部位再追加1500拉德。对患者进行CT扫描和神经学检查随访。该组患者的中位生存期为80周。需要开展更大规模的、将PCNU与其他亚硝基脲类药物进行对比的随机试验，以评估其在恶性胶质瘤患者中作为辅助治疗的价值。在本研究中，骨髓抑制尤其是血小板减少是主要的毒性作用。2例患者出现肺部浸润，1例患者在PCNU累计总剂量达到850mg/m²后病情进展并死亡。1例患者还出现了伴有高胆红素血症的肝功能障碍。PCNU可产生与其他亚硝基脲类药物报道类似的肺和肝毒性。在未来使用PCNU治疗的试验中，应定期进行肺和肝功能检查监测。
