男性高危生殖细胞肿瘤。顺铂、长春碱、博来霉素和依托泊苷治疗反应率高但毒性严重。
High-risk germ cell tumors in men. High response rate and severe toxicity with cisplatin, vinblastine, bleomycin, and etoposide.
作者信息
Blayney D W, Goldberg D A, Leong L A, Margolin K A, Burke J S, Doroshow J H
机构信息
Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California.
出版信息
Cancer. 1993 Apr 1;71(7):2351-7. doi: 10.1002/1097-0142(19930401)71:7<2351::aid-cncr2820710729>3.0.co;2-h.
BACKGROUND
In an attempt to improve the complete remission and cure rate of advanced, bulky, high-risk germ cell cancer in men, a "high-dose" cisplatin, vinblastine, bleomycin, and etoposide (PVeBV) regimen was introduced.
METHODS
Ten men with biopsy-proven germ cell tumors who had one or more poor prognostic features were treated with PVeBV.
RESULTS
Six of the 10 had complete remissions and are long-term survivors. The most devastating toxicity, which resulted in the death of three patients, was progressive respiratory failure. It was postulated that renal tubular injury prolonged the renal clearance of bleomycin, intensifying the patient's pulmonary exposure to this drug and increased the susceptibility to pulmonary injury at lower than expected cumulative doses of bleomycin.
CONCLUSIONS
Modifications of the regimen to reduce toxicity without diminishing the efficacy should be considered before PVeBV is adopted for general use.
背景
为提高男性晚期、巨大、高危生殖细胞癌的完全缓解率和治愈率，引入了一种“高剂量”顺铂、长春碱、博来霉素和依托泊苷（PVeBV）方案。
方法
对10例经活检证实患有生殖细胞肿瘤且具有一个或多个不良预后特征的男性患者采用PVeBV方案进行治疗。
结果
10例患者中有6例完全缓解，为长期存活者。最严重的毒性反应是进行性呼吸衰竭，导致3例患者死亡。据推测，肾小管损伤延长了博来霉素的肾脏清除时间，增强了患者肺部对该药物的暴露，并在低于预期累积剂量的博来霉素时增加了肺部损伤的易感性。
结论
在将PVeBV方案广泛应用之前，应考虑对该方案进行调整以降低毒性而不降低疗效。
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