재발성 자궁경부암에서 TIP (Paclitaxel, ifosfamide, cisplatin)항암 화학요법의 효과에 관한 연구
The efficacy of combination of paclitaxel, ifosfamide,and cisplatin for the treatment of recurrent carcinoma of the uterine cervix
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목적 : 재발성 자궁경부암에서 paclitaxel, ifosfamide, 그리고 cisplatin은 각각 효과적인 약제로 알려져 있다. 이에 본 저자들은 재발성 자궁경부암에서 위 약제들의 복합 화학요법 (TIP)의 효과를 알아보고자 본 연구를 시행하게 되었다. 연구 방법 : 전체 대상 환자는 43명 이었으며 첫째 날에는 ifosfamide 1.5 g/m2과 paclitaxel 135 mg/m2를 3시간에 걸쳐서 정맥 주사하였으며 cisplatin 50 mg/m2를 30분에 걸쳐서 정맥 주사하였다. 둘째 날과 셋째 날에는 ifosfamide를 투여하였고 매 3주 간격으로 투여하였다. 결과 : 35명에서 최소 3회 이상의 치료를 받았고 이들의 반응을 평가할 수 있었다. 완전 관해 5.7%, 부분 관해 45.7%를 포함하여 51.4%에서 (18명) 반응을 나타내었다. 중앙 반응 기간과 생존률은 각각 8개월과 16개월이었다. 재발된 위치와 조직 유형에 따른 반응율과 생존율의 차이는 없었다. 재발된 후 TIP 복합 화학 요법 투여 이전에 다른 항암 화학 요법을 받았던 환자에서 낮은 반응율과 (28.6% vs 66.6%, p=0.027) 감소된 생존기간 (14개월 vs 25개월, p=0.028)을 보였다. Grade 3이나 4의 혈액학적 부작용으로는 중성구 감소증이 13%, 빈혈이 8%, 혈소판 감소증이 5%를 나타내었다 결론 : TIP 복합 항암 화학요법은 재발성 자궁경부암 환자에서 비교적 심각한 부작용 없이 투여될 수 있었으며 그 반응율은 51%이었다. 이전 항암 화학요법의 과거력이 없는 경우에 더 높은 반응율과 생존율을 나타내었다.
Abstract
Objective : Paclitaxel, ifosfamide, and cisplatin have moderate single-agent activity in patients with metastatic or recurrent cancer of the uterine cervix. We administered a combination of these three agents (TIP) to patients with recurrent cervical carcinoma to evaluate its activity. Methods : Forty-three patients were treated with ifosfamide (I) 1500 mg/m2 intravenously over 3 hours on Days 1-3, paclitaxel (T) 135 mg/m2 as a 3-hour intravenous infusion and cisplatin (P) 50 mg/m2 intravenously over 30 min on Day 1. The chemotherapy was repeated every 3 weeks. Results : Thirty-five patients received at least three courses of treatment and were evaluable for response. Eighteen patients (51.4%) achieved an objective response, including 5.7% complete and 45.7% partial responses. The median time to progression and overall survival for all patients were 8.0 and 16.0 months, respectively. The site of recurrence relative to prior radiation field and histopathology (squamous vs other pathology) did not affect the response rate and survival. Patients treated with another chemotherapy regimen before the initiation of TIP regimen showed lower response rate (28.6% vs 66.6%, p=0.027) and shorter survival (14 month vs 25 month, p=0.028). Grade 3 or 4 toxicity included granulocytopenia in 13% of patients, anemia in 8%, thrombocytopenia in 5%. Conclusion : The TIP regimen is relatively well tolerated and moderately active in patients with recurrent carcinoma of the uterine cervix. Patients more likely to benefit are those who received TIP regimen for the first time after recurrence.
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