Small E J, Fippin L J, Ernest M L, Carroll P R
Department of Medicine, University of California, San Francisco, USA.
Cancer. 1996 Oct 15;78(8):1775-80. doi: 10.1002/(sici)1097-0142(19961015)78:8<1775::aid-cncr18>3.0.co;2-v.
Many patients with advanced transitional cell carcinoma are unable to receive cisplatin-based therapy. The efficacy and toxicity of a carboplatin-based regimen in the treatment of patients with advanced transitional cell carcinoma was therefore evaluated.
Twenty-three patients with advanced transitional cell carcinoma were treated. Metastatic disease was present in 19 of 23 patients (83%) whereas 4 patients with T4, and/or N1, disease were treated. Patients were treated every 28 days with methotrexate, 30 mg/m2 intravenously (i.v.) on Days 1 and 15, along with leucovorin, 15 mg/m2 orally every 6 hours, 3 times daily beginning 24 hours after each methotrexate dose; vinblastine, 3 mg/m2 i.v. on Days 1 and 15; mitoxantrone, 15 mg/m2 i.v. on Day 1; and carboplatin, 300 mg/m2 i.v. on Day 1, adjusted for creatinine clearance (MVNCa). Dosage in subsequent cycles was adjusted according to hematologic toxicity.
Median age was 70 years (range, 52-83 years) and median pretreatment creatinine clearance was 50 mL/min (range, 30-106 mL/min). Of 23 patients, 8 (34.8%) obtained a complete response, and 5 (21.7%) obtained a partial response. The overall response proportion was 56.5% (95% confidence interval, 34.5-76.8%). Median survival was 10 months (range, 1-44+ months). Toxicity was moderate. Grade 4 neutropenia occurred in 10 of 107 (9.3%) administered treatment cycles; Grade 4 thrombocytopenia occurred in 11 of 107, (10.3%). There were 4 episodes of febrile neutropenia (3.7% of cycles). Renal, neurologic, or otic toxicity were not observed. Age older than 70 did not appear to impact on response proportion, survival, and toxicity.
The carboplatin-based MVNCa regimen is active in the treatment of patients with advanced transitional cell carcinoma and is well tolerated. Therapy with this regimen may be a less toxic alternative for patients for whom treatment with cisplatin is not an option.
许多晚期移行细胞癌患者无法接受以顺铂为基础的治疗。因此，评估了以卡铂为基础的方案治疗晚期移行细胞癌患者的疗效和毒性。
对23例晚期移行细胞癌患者进行治疗。23例患者中有19例（83%）存在转移性疾病，4例T4期和/或N1期疾病患者接受了治疗。患者每28天接受一次治疗，第1天和第15天静脉注射甲氨蝶呤30mg/m²，同时在每次甲氨蝶呤给药24小时后开始口服亚叶酸钙，15mg/m²，每6小时一次，每日3次；第1天和第15天静脉注射长春碱3mg/m²；第1天静脉注射米托蒽醌15mg/m²；第1天静脉注射卡铂300mg/m²，根据肌酐清除率进行调整（MVNCa）。后续周期的剂量根据血液学毒性进行调整。
中位年龄为70岁（范围52 - 83岁），预处理时的中位肌酐清除率为50mL/min（范围30 - 106mL/min）。23例患者中，8例（34.8%）获得完全缓解，5例（21.7%）获得部分缓解。总体缓解率为56.5%（95%置信区间，34.5 - 76.8%）。中位生存期为10个月（范围1 - 44 +个月）。毒性为中度。107个给药周期中有10个（9.3%）出现4级中性粒细胞减少；107个周期中有11个（10.3%）出现4级血小板减少。有4次发热性中性粒细胞减少发作（占周期的3.7%）。未观察到肾脏、神经或耳部毒性。年龄大于70岁似乎不影响缓解率、生存率和毒性。
以卡铂为基础的MVNCa方案在治疗晚期移行细胞癌患者中具有活性，且耐受性良好。对于无法选择顺铂治疗的患者，该方案治疗可能是一种毒性较小的替代方案。
