肿瘤
词汇介绍
拓展阅读
解析
Vincristine 英 /vɪn'krɪstiːn/ 美 /vɪn'krɪs,tin/
释 义 n. [药] 长春新碱(一种抗肿瘤药)
例 句 The resistance cell line, ACC/VCR, was induced in the ACC cell line in vitro by progressive concentrations of vincristine (VCR), a drug of choice in the treatment of adenoid cystic carcinoma. 以长春新碱(VCR)为诱导剂,通过浓度递增间断刺激法对人腺样囊性癌细胞系(ACC)进行体外诱导耐药,建立耐VCR的腺样囊性癌细胞系ACC/VCR。
概述
概述
长春新碱又称醛基长春碱,从夹竹桃科多年生亚灌木长春花的全草中提取的一种生物碱,是一种抗肿瘤植物药。长春花又名雁来红、日日新、四时春、三万花,是夹竹桃科植物长春花的全草,长春碱、长春新碱是长春花中具有抗肿瘤活性的二聚吲哚类生物碱,在抗击癌症方面有显著疗效,其硫酸盐已广泛用于临床30余年,迄今仍是主要的肿瘤用药之一。
制备
国内外对提取分离长春碱类的研究由来已久,由于长春花全草中生物碱种类较多,而长春碱、长春新碱在植物内的含量偏低,一般都在万分之几,成为长春类药物市场化的瓶颈问题。通过考察提取剂、提取方法、提取时间、料液比对长春碱、长春新碱提取率的影响,确定了其提取及纯化的最佳工艺条件。从长春花中提取长春碱、长春新碱的最佳工艺条件为:以苯为提取剂,超声强化15 min (功率1000 W),按料液比1∶6. 5提取,提取液通过LSD-21型大孔吸附树脂,以80%乙醇洗脱,流速3 mL/min,洗脱液经浓缩、真空、干燥后,得到长春碱、长春新碱精品。长春碱的提取率为78.4%,纯度为88.2%,长春新碱的提取率为62.2%,纯度为85.8%。
药理作用
抗肿瘤作用靶点是微管,主要抑制微管蛋白的聚合而影响纺锤体微管的形成,使有丝分裂停止于中期。还可干扰蛋白质代谢及抑制RNA多聚酶的活力,并抑制细胞膜类脂质的合成和氨基酸在细胞膜上的转运。长春新碱对移植性肿瘤的抑制作用大于长春花碱。除对长春花碱敏感的瘤株有效外,对小鼠Ridgeway成骨肉瘤、Mecca淋巴肉瘤、X-5563骨髓瘤等也有作用。长春新碱、长春花碱和长春地辛三者间无交叉耐药现象,长春新碱神经毒性在三者中最强。
临床应用和适应症
急性白血病,尤其是儿童急性白血病,对急性淋巴细胞白血病疗效显著;恶性淋巴瘤;生殖细胞肿瘤;小细胞肺癌,尤文肉瘤、肾母细胞瘤、神经母细胞瘤;乳腺癌、慢性淋巴细胞白血病、消化道癌、黑色素瘤及多发性骨髓瘤等。
用法用量
成人剂量1~2 mg(或1.4mg/m2)最大不大于2 mg,年龄大于65岁者,最大每次1 mg。儿童75 μg/kg或2.0 mg/ m2,每周1次静脉注射或冲入。联合化疗是连用2周为一周期。
不良反应
剂量限制性毒性是神经系统毒性,主要引起外周神经症状,如手指、神经毒性等,与累积量有关。足趾麻木、腱反射迟钝或消失,外周神经炎。腹痛、便秘,麻痹性肠梗阻偶见。运动神经、感觉神经和脑神经也可受到破环,并产生相应症状。神经毒性常发生于40岁以上者,儿童的耐受性好于成人,恶性淋巴瘤病人出现神经毒性的倾向高于其他肿瘤病人。骨髓抑制和消化道反应较轻。有局部组织刺激作用,药液不能外漏,否则可引起局部坏死。可见脱发,偶见血压的改变。
晚期霍奇金淋巴瘤 (RATHL) 患者响应适应治疗后卵巢功能的决定因素: 一项随机3期试验的二次分析
发表时间:2018-09-03
影响指数:35.4
作者: Richard A Anderson
期刊:Lancet Oncol
We recruited female participants from the randomised phase 3 RATHL trial, aged 18-45 years, based on availability of participants at recruiting sites in the UK. The RATHL trial key inclusion criteria were histologically confirmed classic Hodgkin's lymphoma, stage IIB-IV or IIA with adverse features (bulky disease or more than two sites of involvement), no previous treatments, and a performance status of 0-3. As part of RATHL, participants were treated with two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or AVD followed by an interim PET-CT scan. Participants who had negative interim scans (PET score of 1 to 3 according to the Lugano classification) were randomly assigned (1:1) by use of minimisation, stratified by interim PET score and study centre, to continue ABVD or AVD for four more cycles. Participants with positive scans (PET score of 4 or 5) were escalated to treatment with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (BEACOPP-14 or escalated BEACOPP) for four cycles. For the protocol-driven prospective cohort substudy, ovarian function was assessed before treatment, during chemotherapy, and then annually for 3 years by use of serum antimüllerian hormone and follicle-stimulating hormone measurements. The RATHL study is registered with ClinicalTrials.gov, number NCT00678327.
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