改良FOLFOXIRI方案一线治疗晚期结直肠癌的疗效及生存预后分析

目的:观察改良FOLFOXIRI方案一线治疗晚期结直肠癌的近期疗效、远期生存及不良反应.方法:采用前瞻性观察研究方法对47例晚期结直肠癌患者采用mFOLFOXIRI方案一线化疗.伊立替康(IRI)165mg/m2静脉滴注90min d 1,奥沙利铂(OXA)85mg/m2静脉滴注2h d 1,亚叶酸钙400mg/m2静脉滴注2h d 1,5-FU 2400~2800mg/m2持续静脉滴注48h,每2周为一周期.观察该方案的近期疗效及不良反应,并通过长期随访进行生存分析.结果:47例晚期结直肠癌患者治疗的总有效率(ORR)为51.1%,疾病控制率(DCR)为85.1%,中位无进展生存期(PFS)8.4个月(95%CI:6.6~10.2个月),中位总生存期(OS)20.7个月(95%CI:15.3~26.1个月).根据年龄及ECOG PS评分将患者分为体力状况较好组及体力状况中等组,两组近期疗效及PFS、OS均无显著统计学差异.亚组分析显示肿瘤早期缓解患者较非早期缓解患者的PFS及OS延长且具有统计学意义(PFS:11.0个月vs 7.1个月,P=0.044;OS:29.7个月vs 20.7个月,P=0.036);原发灶位于左半结肠/直肠者较右半结肠者的PFS及OS延长且具有统计学意义(PFS:10.6个月vs 3.7个月,P=0.002;OS:27.3个月vs 14.2个月,P=0.021).全组不良反应较轻,以I-II级为主,III-IV级不良反应主要为中性粒细胞减少及延迟性腹泻,但均为可控,无治疗相关死亡.结论:改良FOLFOXIRI三药联合方案作为晚期结直肠癌的一线治疗方案,其有效率高、不良反应可耐受,并可达到较长的生存时间,原发灶部位及是否达到早期缓解与患者预后生存可能有关,值得进一步临床研究.     

FOLFOXIRI方案一线治疗转移性结直肠癌的研究进展

转移性结直肠癌的主要治疗手段是全身化疗。目前5-氟尿嘧啶、奥沙利铂及伊立替康仍然是治疗结直肠癌最基本也是最有效的化疗药物,这三种药物联合的化疗方案（FOLFOXIRI）较两药联合的方案可以显著延长患者的生存时间,但同时也增加了患者的毒副反应。如何在确保疗效的前提下减少化疗药物的相关毒副反应成为治疗的关键。     

改良FOLFIRI方案治疗晚期胃癌

胃癌是我国最常见的恶性肿瘤之一，早期诊断、早期治疗是提高治愈率的关键。然而胃癌患者中Ⅳ期胃癌占37％～39％，Ⅰ～Ⅲ期可切除的胃癌患者有半数以上术后复发转移变成晚期胃癌。晚期胃癌失去彻底手术切除、治愈疾病的机会，以化疗为主的内科综合疗法显得尤为重要。收集我院2004年5月～2007年5月24例晚期胃癌，采用改良FOLFIRI方案化疗取得一定疗效，现报告如下。     

FOLFOX和FOLFOXIRI方案在Ⅲ期结肠癌辅助化疗中的疗效

目的:比较FOLFOX和FOLFOXIRI两种辅助化疗方案在Ⅲ期结肠癌患者中的疗效及安全性。方法:回顾性分析2007年4月至2011年7月结肠癌根治术后接受FOLFOX或FOLFOXIRI两种化疗方案的58例Ⅲ期结肠癌患者,观察不良反应发生情况,比较两种方案患者的3年无病生存期和总生存期,采用Kaplan-Merier进行生存分析。结果:对接受FOLFOX或FOLFOXIRI两种不同辅助化疗方案的58例患者,FOLFOXIRI组在白细胞减少及腹泻方面有更高的不良事件发生率,其余不良反应与FOLFOX组相似。两组3年无病生存率分别为50%、46.7%,3年总生存率分别为32.1%和30%,P值分别为0.64和0.91,两组间差异无统计学差异。但在亚组分析中,FOLFOXIRI组的Ⅲc期患者3年无病生存期明显提高,P值为0.03,存在差异。结论:FOLFOX和FOLFIXIRI两种辅助化疗方案治疗结肠癌总体安全性较好,两组之间生存差异无显著性,但在Ⅲc期亚组分析DFS中,后者更具生存优势。     

替吉奥联合奥沙利铂一线治疗晚期胃癌的疗效和安全性

目的评价替吉奥胶囊联合奥沙利铂(SOX方案)一线治疗局部晚期不可切除或转移性胃癌患者的疗效和安全性。方法奥沙利铂(130 mg/m2)第1天静脉滴注,替吉奥胶囊(40 mg/m2,2次/天),连用14天休7天,每3周重复。治疗至疾病进展或出现不能耐受的不良反应。结果共61例患者,所有患者均可评价安全性和生存期,46例患者可评价客观缓解率。缓解率为56.5%,疾病控制率76.1%。中位无进展生存时间(PFS)7.5月(95%CI:5.1～9.7月),1年生存率62.9%,估计的中位生存时间(OS)16月(95%CI:13.2～18.8月)。主要的3/4级不良反应为中性粒细胞下降(13.1%)和血小板下降(18%)。结论中国晚期胃癌患者中应用SOX方案是安全、有效的。     

FOLFIRI方案一线治疗晚期胃癌临床观察

目的观察我科2009年1月．2010年7月收治30例晚期胃癌患者以伊立替康联合氟尿嘧啶、亚叶酸钙双周（FOLFIRI）方案治疗,观察其近期疗效及安全性。方法CPT-11：180mg／m^2静滴60．90mind1;CF：200mg／m^2静滴2hd1,d2;CF静滴结束后立即5FU400mg／m^2静脉推注d1;5-FU：600mg／m^2持续微泵静脉推注22h,d1,d2。每2周重复,28天为1个周期,每2个周期评价疗效,不足2周期的观察毒性,获CR及PR患者4周后确认。结果全组29例可评价疗效,CR4例（13．79％）,PR10例（34．48％）,SD11例（37．93％）,PD4例（13．79％）。有效率RR（CR＋PR）14（48．27％）;不良反应较轻,以I,II度多见。结论以CPT-11为主的（FOLFIRI方案）一线化疗晚期胃癌具有较高的疾病控制率,且安全性好,不良反应可控制,值得临床进一步验证。     

晚期胃癌一线化疗失败后不同解救化疗方案的疗效比较

目的　回顾性分析不同化疗方案对一线化疗失败的晚期胃癌患者进行解救治疗的疗效和安全性,探讨晚期胃癌二线治疗适宜的化疗方案。方法　８８例一线化疗失败的晚期胃癌患者,分为紫杉类组（３２例）：多西紫杉醇６０～７５ｍｇ／ｍ^２或紫杉醇１３５～１７５ｍｇ／ｍ^２,分ｄ_１、ｄ_８;５-ＦＵ５００ｍｇ／ｍ^２ｄ_１～ｄ_５或顺铂２０ｍｇｄ_１～ｄ_５,２１天为１周期。奥沙利铂组（３１例）：奥沙利铂８５ｍｇ／ｍ^２ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。伊立替康组（２５例）：伊立替康１５０～１８０ｍｇ／ｍ^２,ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。结果　８８例均可评价不良反应,８２例可评价客观疗效。紫杉类组、奥沙利铂组以及伊立替康组总有效率分别为３.２％、１４.３％和１７.４％,疾病控制率分别为４８.４％、６０.７％和６５.２％;中位ＰＦＳ分别为２个月（１.３９～２.６１个月）、３个月（２.１６～３.８４个月）和３个月（２.４６～３.５４个月）,差异无统计学意义（Ｐ＝０.１９５）;中位ＯＳ为６个月（４.２１～７.７９个月）、７个月（６.１２～７.８８个月）和７个月（５.０８～８.９２个月）,差异无统计学意义（Ｐ＝０.３９３）。３组不良反应易耐受,主要为１～２级血液学毒性。伊立替康组腹泻发生率较高,为４８％,但３级以上发生率较低,仅为８％。奥沙利铂组外周神经毒性为４８％。结论　晚期胃癌一线治疗失败后采用目前常用的化疗方案解救治疗有一定的客观缓解率和临床受益率,但疗效有限,需要进一步积极探索有效的治疗方案。     

IF方案治疗晚期胃癌的临床观察

目的:评价IF方案在晚期胃癌治疗中的有效性及安全性.方法:21例晚期胃癌患者,以伊立替康 80mg/ m2静脉滴注半小时,随后亚叶酸500mg/ m2静脉滴注2小时,接着开始持续静脉滴注氟脲嘧啶2000 mg/ m2 22个小时,每周1次,连用6周,休息1周后重复.结果:19例可评价患者中,没有CR病例,PR 7例(36.8%),PR+SD 78.9%.中位生存期10月.不良反应以血液学不良为主,多为I-II度(87.0%).结论:IF方案对晚期胃癌有一定疗效,不良反应可以耐受.     

mFOLFOX6和FOLFIRI方案分别一线和二线治疗晚期胃癌疗效对比观察北大核心CSCD

目的观察m FOLFOX6和FOLFIRI方案分别一线和二线方案治疗晚期胃癌的疗效及不良反应。方法将62例晚期胃癌患者分为二组,对照组32例患者,一线采用m FOLFOX6方案治疗,疾病进展后,有25例患者二线采用FOLFIRI方案;观察组30例患者,一线采用FOLFIRI方案治疗,疾病进展后,有25例患者二线采用m FOLFOX6方案。对两组的疗效和不良反应做对比观察。结果对照组和观察组一线、二线治疗晚期胃癌ORR分别为37.5%、24.0%和40.0%、16.0%,差异均无统计学意义(P=0.801,P=0.662),中位无疾病进展时间分别为(5.0±0.25)月、(2.0±0.36)月和(6.0±0.81)月、(2.0±0.27)月,差异均无统计学意义(P=0.178,P=0.803)。二组OS无明显差别,分别为(10.0±1.06)月和(11.0±1.17)月(P=0.500)。两组不良反应以骨髓抑制、胃肠道、周围神经炎为主。其中一线治疗过程中,对照组外周神经炎发生率比观察组高,而观察组的腹泻发生率高于对照组。结论 m FOLFOX6和FOLFIRI方案分别一线和二线治疗晚期胃癌患者疗效相当,均可延长患者生存,不良反应可以耐受。     

奥沙利铂或伊立替康联合希罗达治疗晚期胃癌的临床比较分析

目的 观察并比较奥沙利铂联合希罗达与伊立替康联合希罗达治疗晚期胃癌的近期疗效和毒副反应.方法 59例晚期胃癌随机分为两组,A组31例应用奥沙利铂联合希罗达,B组28例应用伊立替康联合希罗达.均化疗2个周期以上.结果 A组中CR 1例,PR 14例,有效率为48.39%,中位无进展生存期为6.3个月;B组中CR 0例,PR 13例,有效率为46.43%.中位无进展生存期为5.9个月.两组有效率及巾位无进展生存期比较差异均无统计学意义(P>0.05).两组主要毒副反应为骨髓抑制和胃肠道反应,A组神经毒性较重,B组腹泻较重;两组均无化疗相关性死亡.结论 两种方案对晚期胃癌均有较好的疗效,且疗效相当;毒副反应均可耐受.     

Phase II study of irinotecan, 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer

BACKGROUND: We evaluated the efficacy and tolerability of a modified biweekly irinotecan, 5-fluorouracil and leucovorin regimen (modified Douillard regimen) as the first-line therapy in patients with advanced colorectal cancer. METHODS: A total of 80 patients (41 male, 39 female) with recurrent or metastatic colorectal cancer were enrolled between April 2001 and December 2003. The treatment cycle consisted of irinotecan 150 mg/m(2) as a 90 min infusion on day 1, leucovorin 20 mg/m(2) intravenous bolus, immediately followed by a 48 h continuous infusion of 5-fluorouracil 3000 mg/m(2) on day 1. The primary end-point was response rate, and the secondary end-points were time to progression and toxicity profile. RESULTS: An overall objective response rate of 38.7% [95% confidence interval (CI) 27.84-49.66%] was achieved. The median time to progression was 6.1 months (95% CI 4.63-7.57 months) and the median overall survival time was 20.2 months (95% CI 15.50-24.90 months). The median duration of follow-up for patients was 16.9 months. The toxicity profile was more favorable than for the conventional Douillard regimen. CONCLUSION: We conclude that the modified Douillard regimen may be a practical and more tolerable treatment option in patients with advanced colorectal cancer.     

奥沙利铂联合表柔吡星和5-Fu治疗晚期胃癌疗效和安全性研究

目的REAL2研究中使用奥沙利铂的EOF方案由于较好的疗效和安全性获得了广泛关注,但中国胃癌患者对REAL2研究中的三药联合EOF方案耐受性较差,本研究使用了改良的EOF方案,将氟尿嘧啶（5-Fu）由原来的静脉输注21天改为5天,观察奥沙利铂联合5-Fu／LV、表柔吡星治疗晚期胃癌的疗效及不良反应。方法30例晚期胃癌患者,初治19例,复治11例。表柔吡星50mg／m^2静脉注射d1,奥沙利铂130mg／m^2静脉滴注2小时d1,5-Fu375～425mg／（m^2·d）d1～5静脉持续输注120小时,每3周重复,每化疗2个疗程评价1次疗效。结果30例患者中,总缓解率43．33％,完全缓解1例,部分缓解12例。初治病例缓解率52．63％（10／19）,略高于REAL2研究中标准EOF方案的42．4％缓解率,复治病例缓解率27．33％（3／11）。KPS评分提高10分以上者10例（33．33％）。在治疗中,主要的Ⅲ～Ⅳ度不良反应为：中性粒细胞减少33．3％（10／30）,血小板减少10％（3／30）,贫血13．33％（4／30）,恶心呕吐23．33％（7／30）．RE．A12研究中标准EOF方案的Ⅲ～Ⅳ度中性粒细胞减少29．9％,与本研究类似,标准EOF方案中的Ⅲ～Ⅳ度血小板减少4．3％,贫血6．5％,恶心呕吐13．8％,略低于本研究,但在本研究中没有观察到Ⅲ～Ⅳ度发热性中性粒细胞减少及血栓栓塞等严重不良反应,而REAL2研究中,发热性中性粒细胞减少和血栓栓塞均为8．5％。结论奥沙利铂联合5-Fu及表柔吡星的改良EOF方案治疗晚期胃癌疗效较好,毒副作用可以很好耐受,值得临床进一步应用。     

Docetaxel + 5-fluorouracil + cisplatin 3-day combination chemotherapy as a first-line treatment in patients with unresectable gastric cancer

BACKGROUND: Our objective was to verify the efficacy and safety of "docetaxel + 5-fluorouracil + cisplatin" 3-day combination chemotherapy as a first-line treatment in patients with unresectable gastric cancer. METHODS: Between January and November 2002, we enrolled 43 patients [males 31; median age 55 years (range 24-74)] with inoperable gastric cancer who had not been seen previously in Seoul National University Hospital. The regimen used was docetaxel 70 mg/m(2) on day 1, cisplatin 40 mg/m(2) on days 2 and 3, and 5-fluorouracil 1200 mg/m(2) over 10 h on days 1-3, every 3 weeks. RESULTS: A total of 168 cycles were administered. Mean cycle number per patient was 3.9. The administered dose intensity of docetaxel was 21.23 mg/m(2)/week, 5-FU 1092.14 mg/m(2)/week and cisplatin 23.82 mg/m(2)/week, which corresponded to 91.1, 91.0 and 89.5% of planned doses. Of the 43 patients, response evaluation was possible in 40 and, of these patients, 17 (42.5%) achieved a partial response, 13 (32.5%) stable disease, and 10 patients (25%) showed progressive disease. The median time to progression was 5.6 months [95% confidence interval (CI) 4.6-6.6 months]. Median overall survival was 9.0 months. (95% CI 4.8-13.2 months). Leukopenia occurred during 21.4% of cycles (36 of 168 cycles); 14.3% grade 1, 5.3% grade 2 and 1.8% grade 3. Anemia occurred in 16.7% (28 of 168 cycles); 11.3% grade 1, 4.8% grade 2 and 0.6% grade 3. Thrombocytopenia was not observed. Diarrhea, stomatitis and hypersensitivity occurred in 4.7% (two out of 43 patients), respectively. Neutropenic fever occurred in two patients (4.7%) and myalgia in three (7.0%). CONCLUSION: "Docetaxel + 5-fluorouracil + cisplatin" 3-day combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with unresectable gastric cancer.     

A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients

The aim of the study was to assess the toxicity and the clinical activity of biweekly oxaliplatin in combination with infusional 5-fluorouracil (5-FU) and folinic acid (FA) administered every 2 weeks (FOLFOX-4 regimen) in patients with advanced gastric cancer (AGC). A total of 61 previously untreated AGC patients were treated with oxaliplatin 85 mg m(-2) on day 1, FA 200 mg m(-2) as a 2 h infusion followed by bolus 5-FU 400 mg m(-2) and a 22 h infusion of 5-FU 600 mg m(-2), repeated for 2 consecutive days every 2 weeks. All patients were assessable for toxicity and response to treatment. Four (7%) complete responses and 19 partial responses were observed (overall response rate, 38%). Stable disease was observed in 22 (36%) patients, with progressive disease in the other six (10%) patients. Median time to progression (TTP) and median overall survival (OS) were 7.1 and 11.2 months, respectively. National Cancer Institute Common Toxicity Criteria grade 3 and 4 haematologic toxicities were neutropenia, anaemia and thrombocytopenia in 36, 10 and 5% of the patients, respectively. Grade 3 peripheral neuropathy was recorded in three (5%) patients. FOLFOX-4 is an active and well-tolerated chemotherapy. Response rate (RR), TTP and OS were comparable with those of other oxaliplatin-based regimens, suggesting a role for this combination in gastric cancer.     

奥沙利铂联合卡培他滨一线治疗进展期胃癌的临床疗效观察

背景与目的：奥沙利铂联合卡培他滨（XELOX方案）是治疗进展期胃癌（advanced gastric cancer,AGC）的有效方案,但是该方案作为一线方案治疗AGC患者的疗效和安全性尚不确定。本研究旨在探讨XELOX方案作为一线方案治疗AGC的疗效及安全性。方法：33例既往未接受过化疗的AGC患者采用XELOX方案化疗．奥沙利铂130mg／m^2,静脉滴注2h,d1;卡培他滨2000mg／m^2,分2次口服．d1～14,21天为一个周期。患者最多接受8个周期化疗。结果：33例患者共接受159个周期的化疗,中位化疗周期数为5个。31例患者可评价疗效,其中完全缓解1例（3．2％）,部分缓解16例（51．6％）,稳定8例（25．8％）,进展6例（19．4％）。客观有效率54．8％（95％可信区间37．3％-72．3％）,临床获益率80．6％（95％可信区间66．7％～94．5％）。平均随访10．5个月,中位疾病进展时间5．9个月（95％可信区间4．7～7．1个月）,中位生存时间10．4个月（95％可信区间7．9～12．9个月）。常见不良反应有骨髓抑制、外周神经毒性、胃肠道反应、手足综合征等,经对症治疗后均好转．无治疗相关性死亡。结论：XELOX方案一线治疗AGC疗效显著,耐受性良好。     

Phase II study of capecitabine and irinotecan combination chemotherapy in patients with advanced gastric cancer

The present study was conducted to evaluate the efficacy and safety of a combination regimen of capecitabine plus irinotecan in patients with advanced gastric cancer. Patients with previously untreated metastatic or recurrent, measurable gastric cancer received oral capecitabine 1000 mg m(-2) twice daily from day 1 to 14 and intravenous irinotecan 100 mg m(-2) on days 1 and 8, based on a 3-week cycle. Forty-one patients were enrolled in the current study, among whom 38 were assessable for efficacy and 40 assessable for toxicity. Three complete responses and 16 partial responses were confirmed, giving an overall response rate of 46.3%. At a median follow-up of 269 days, the median time to progression and overall survival were 5.1 and 8.6 months, respectively. Grade 3/4 neutropenia occurred in four patients and grade 3 febrile neutropenia was observed in two patients. Grade 3 diarrhoea and grade 2 hand-foot syndrome occurred in six patients and eight patients, respectively. The combination of capecitabine and irinotecan was found to be well tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as one of first-line treatment options for advanced gastric cancer.     

Challenges in first line chemotherapy and targeted therapy in advanced gastric cancer

Chemotherapy prolongs survival in advanced gastric cancer (AGC). The challenges involved in this procedure are providing a framework to aid in determining the best single or combined chemotherapy protocols for targeted agents in front-line therapy for patients in a clinical setting. A review of Phase II-III studies published or referenced in major oncology congress publications from 1970 to 2013 was performed. Cisplatin and fluoropyrimidine remain the reference regimen. Fluoropyrimidine combined with oxaliplatin or irinotecan may also be employed in special situations. There are no comparative studies of the same regimens with or without anthacyclines; thus, the effectiveness of anthacyclines remains under debate. The introduction of trastuzumab in the front-line therapy of HER2-positive patients and ramucirumab in refractory patients ushered in an age of targeted therapy for this disease.     

Randomized phase II study of irinotecan, leucovorin and 5-fluorouracil (ILF) versus cisplatin plus ILF (PILF) combination chemotherapy for advanced gastric cancer.

BACKGROUND: Irinotecan, in combination with 5-fluorouracil (5-FU) or cisplatin, has demonstrated efficacy against advanced gastric cancer (AGC). PATIENTS AND METHODS: Chemotherapy-naive AGC patients were randomly assigned to receive irinotecan 150 mg/m(2) on day 1, leucovorin 20 mg/m(2) and a 22-h infusion of 5-FU 1000 mg/m(2) on days 1 and 2 (ILF) or ILF plus cisplatin 30 mg/m(2) on day 2 (PILF). Treatment was repeated every 2 weeks. RESULTS: Of 91 registered patients, 45 patients were treated with ILF and 45 with PILF. For both arms, 687 chemotherapy cycles were delivered (median = 7 for ILF and 8 for PILF). Both ILF and PILF were generally well tolerated and there was no relevant difference in the occurrence of overall grade 3/4 toxic effects between the two arms. Four patients died during treatment: one in the ILF and three in the PILF arm. The objective response rate was 42% for both arms. There was no significant difference in therapeutic efficacy between ILF and PILF with respect to progression-free survival (4.8 versus 6.2 months; P = 0.523) and overall survival (10.7 versus 10.5 months; P = 0.850). CONCLUSION: Both ILF and PILF are active as first-line chemotherapy for AGC. The addition of cisplatin, however, has no clear advantage over ILF.     

Oxaliplatin, 5-fluorouracil/leucovorin and epirubicin as first-line treatment in advanced gastric carcinoma: a phase II study

The association between oxaliplatin and 5-fluorouracil (5-FU) has been extensively reported to improve prognosis of gastric cancer patients. The present study is aimed at evaluating response rate and the toxicity profile of the association with oxaliplatin, 5-FU/lecovorin and epirubicin in gastric cancer patients with locally advanced or metastatic disease. Thirty-six patients have been enrolled and 35 evaluated. The treatment schedule was oxaliplatin (100 mg m(-2)), 5-FU (400 mg m(-2)), leucovorin (40 mg m(-2)) and epirubicin (60 mg m(-2)) intravenously. administered every 3 weeks for 6 months, for a total of 185 therapy cycles . Response rate and toxicity were assessed according to the international WHO criteria. Every patient received a mean of 5.3 therapy cycles in a day-hospital setting. Sixteen of 35 patients (46%) showed an objective response, two complete response and 14 partial response. Median time to progression was 33 weeks with an overall median survival of 49 weeks. During the study, anaemia grade 3 and neutropenia grade 3 were observed in 9 and 11% of patients respectively. A grade 3 periferic sensorial neuropathy was observed in 6% of patients. No life threatening or cardiac toxicity was recorded. The regimen used showed anticancer activity against gastric carcinoma, a tolerable toxicity profile and excellent patient compliance.     

多西他赛为主的两药联合方案与三药联合方案一线治疗晚期胃癌的疗效和安全性比较

目的:评价多西他赛(TXT)为主的两药联合方案和三药联合方案一线治疗局部晚期不可切除或转移性胃癌患者的疗效及安全性.方法:回顾性分析我科2009年1月至2012年12月收治的86例晚期胃癌患者,根据化疗方案分为两组.三药联合组41例,采用DOF方案:TXT 75 mg/m2静滴,d1,奥沙利铂(L-OHP)85mg/m2静滴,d,,氟尿嘧啶(5-FU)2400mg/m2静滴48小时;两药联合组45例,采用DO或DF方案:TXT75mg/m2静滴,d,,L-OHP 85mg/m2静滴,d1或5-FU 2400mg/m2静滴48小时.两组均21天为一周期,化疗两个周期后评价疗效及毒副反应,并随访生存情况.结果:86例患者均可评价疗效及毒副反应.三药联合组与两药联合组相比,有效率(RR 43.9％ vs 37.8％),疾病控制率(DCR 68.3％ vs 64.4％),中位无进展生存期(PFS 6.9个月vs5.8个月),中位生存期(OS 10.9个月vs9.8个月),差异均无统计学意义(P＞0.05).两药联合组Ⅲ-Ⅳ级中性粒细胞减少发生率明显低于三药联合组(8.9％vs 34.1％),差异有统计学意义(P =0.004).结论:以多西他赛为主的两药联台方案与三药联合方案治疗晚期胃癌的疗效相近,前者安全性更好.