Patients at risk of chemotherapy-associated toxicity in small cell lung cancer.
Patients at risk of chemotherapy-associated toxicity in small cell lung cancer.
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DOI：
10.1038/bjc.1989.167
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发表时间：
1989-05
影响因子：
8.8
通讯作者：
Spiro, S G
中科院分区：
文献类型：
--
作者：
Morittu, L;Earl, H M;Souhami, R L;Ash, C M;Tobias, J S;Geddes, D M;Harper, P G;Spiro, S G
在一项针对小细胞肺癌 (SCLC) 化疗持续时间的临床试验中，610 名患者中有 71 名 (11.6%) 在前 3 周内死亡。化疗包括环磷酰胺 1 g m-2 静脉注射。第 1 天，依托泊苷 100 mg t.d.s.口服第 1-3 天，长春新碱 2 mg 静脉注射第 1 天。死亡时间在第一个化疗周期内呈非随机分布，在化疗后第 7 天至第 12 天之间发生率最高。患者与对照组相匹配，对照组是下一个进入研究的病例，且在前 3 周内没有死亡。早亡的患者更有可能出现临床肝肿大（P小于0.0001），且ECOG评分大于或等于1（P小于0.00001）。与对照组相比，这些患者的碱性磷酸酶水平较高（P 小于 0.0002），血尿素水平升高（P 小于 0.00001），血清白蛋白水平较低（P 小于 0.0001）。当血细胞计数较低时，感染很可能导致这些已经患病的患者死亡。在另外两项使用依托泊苷等治疗方案的大型试验中，也发现了早期死亡的情况。预防性使用抗生素或调整剂量可以防止这些高危患者过早死亡。
During a clinical trial of duration of chemotherapy in small cell lung cancer (SCLC), 71 of 610 patients (11.6%) died in the first 3 weeks. Chemotherapy consisted of cyclophosphamide 1 g m-2 i.v. day 1, etoposide 100 mg t.d.s. orally days 1-3, vincristine 2 mg i.v. day 1. The time of death was found to be nonrandomly distributed within the first chemotherapy cycle, with a peak incidence between days 7 and 12 after chemotherapy. Patients were matched with controls who were the next cases entered into the study who did not die in the first 3 weeks. Patients dying early were more likely to have clinical hepatomegaly (P less than 0.0001), and ECOG score greater than or equal to 1 (P less than 0.00001). As a group these patients also had a higher alkaline phosphatase (P less than 0.0002), an elevated blood urea (P less than 0.00001) and a lower serum albumin (P less than 0.0001) than controls. It is probable that infection contributes to the death of these already ill patients at a time when the blood count is low. Early deaths have been noted in two other large trials using regimens including etoposide. Prophylactic antibiotics or dosage modification may prevent the early death of these high risk patients.