晚期肾上腺皮质癌的联合化疗

Combination Chemotherapy in Advanced Adrenocortical Carcinoma
作者:Fassnacht, M... 【View at publisher】 【全球专家评论】
期刊: NEW ENGL J MED2012年11月期366卷 专家评级: 循证评级:A

Background:

Adrenocortical carcinoma is a rare cancer that has a poor response to cytotoxic treatment.

Methods:

We randomly assigned 304 patients with advanced adrenocortical carcinoma to receive mitotane plus either a combination of etoposide (100mg per square meter of body-surface area on days 2 to 4), doxorubicin (40mg per square meter on day 1), and cisplatin (40mg per square meter on days 3 and 4) (EDP) every 4weeks or streptozocin (streptozotocin) (1g on days 1 to 5 in cycle 1; 2g on day 1 in subsequent cycles) every 3weeks. Patients with disease progression received the alternative regimen as second-line therapy. The primary end point was overall survival.

Results:

For first-line therapy, patients in the EDP–mitotane group had a significantly higher response rate than those in the streptozocin–mitotane group (23.2% vs. 9.2%, P<0.001) and longer median progression-free survival (5.0months vs. 2.1months; hazard ratio, 0.55; 95% confidence interval [CI], 0.43 to 0.69; P<0.001); there was no significant between-group difference in overall survival (14.8months and 12.0months, respectively; hazard ratio, 0.79; 95% CI, 0.61 to 1.02; P=0.07). Among the 185 patients who received the alternative regimen as second-line therapy, the median duration of progression-free survival was 5.6months in the EDP–mitotane group and 2.2months in the streptozocin–mitotane group. Patients who did not receive the alternative second-line therapy had better overall survival with first-line EDP plus mitotane (17.1months) than with streptozocin plus mitotane (4.7months). Rates of serious adverse events did not differ significantly between treatments.

Conclusions:

Rates of response and progression-free survival were significantly better with EDP plus mitotane than with streptozocin plus mitotane as first-line therapy, with similar rates of toxic events, although there was no significant difference in overall survival. (Funded by the Swedish Research Council and others; FIRM-ACT ClinicalTrials.gov number, NCT00094497.)

学科代码:内分泌学与糖尿病 肿瘤学   关键词:腺皮质癌
来源: Eclips
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