沙利度胺联合CAPIRI方案治疗晚期结直肠癌的临床研究

目的:观察沙利度胺联合希罗达和伊立替康(CAPIRI方案)治疗晚期结直肠癌的临床疗效和不良反应.方法: 沙利度胺200mg,睡前顿服,d1-14;伊立替康150mg/m2,静脉滴注90min,d1;希罗达1000mg/m2,每日2次,连服14天 ;每3周重复,2周期后评定疗效.结果: 全组12例均可评价疗效,其中完全缓解(CR)0例,部分缓解(PR)6例(50%),稳定(SD )4例(33.33%),病情进展(PD) 2例(16.67%),总有效率(ORR)50%,疾病控制率(DCR) 83.33%.主要不良反应为腹泻7例(58.33%),中性粒细胞减少5例(41.67%),恶心呕吐4例(33.33%).结论: 该方案治疗晚期结直肠癌有效率高,不良反应能耐受.     

FOLFIRI方案联合沙利度胺治疗晚期结直肠癌的临床观察

目的:评价FOLFIRI方案联合沙利度胺对晚期结直肠癌的疗效和耐受性.方法:选择21例患者行FOLFIRI方案化疗,均联合沙利度胺口服,40d后观察疗效,并评价副作用,肿瘤标记物CA72-4,CEA变化.结果:疗效为CR O,PR 6例(28.6%),SD13例(61.9%),PD 2例(9.5%),副作用主要为延迟性腹泻,腹痛,Ⅲ-Ⅳ分别为2例(9.5%),1例(4.8%).化疗后CEA,CA72-4下降(P＜0.05).结论:FOLHRI方案联合沙利度胺对晚期结直肠癌的疗效较满意,耐受性好.     

全身热疗联合奥沙利铂方案治疗晚期结直肠癌

[目的]评价全身热疗(whole body hyperthermia,WBH)联合奥沙利铂、氟尿嘧啶(5-Fu)、醛氢叶酸(CF)治疗晚期结直肠癌的近期疗效和不良反应.[方法]实验组22例既往单纯化疗方案治疗效果不佳的晚期结直肠癌患者采用全身热疗联合奥沙利铂、5-Fu、CF进行治疗1周期后,再采用奥沙利铂联合5-Fu、CF化疗1周期;对照组27例为同时期就诊患者中随机抽取的未经治疗的晚期结直肠癌患者,采用奥沙利铂联合5-Fu和CF化疗2周期.3周为一个周期,完成2周期化疗后4周评价疗效.[结果]实验组有效率为63.6%,对照组有效率为33.3%;常见毒副反应为胃肠道反应、神经毒性及白细胞减少,但均较轻微.[结论]WBH联合奥沙利铂、5-Fu、CF治疗晚期结直肠癌具有显著的治疗效果,并且毒性可耐受.     

沙利度胺联合方案治疗晚期结直肠癌临床观察

目的探讨沙利度胺联合方案治疗晚期结直肠癌的疗效及安全性。方法45例经病理证实的晚期结直肠癌患者随机分为治疗组和对照组。治疗组22例接受沙利度胺联合卡培他滨和奥沙利铂治疗,对照组23例仅接受卡培他滨联合奥沙利铂治疗。3周为1周期,至少2周期化疗,评价疗效。研究无进展生存期(PFS)、客观有效率（ORR）、疾病控制率（DCR）,并观察安全性及不良反应。结果治疗组DCR为68.2%,而对照组为43.5%,差异有统计学意义（P＜0.05）, PFS 、ORR及患者生活质量两组间差异无统计学意义(P＞0.05)。结论沙利度胺联合方案治疗晚期结直肠癌可显著提高疾病控制率且耐受性良好,值得临床进一步研究。     

希罗达联合奥沙利铂治疗老年晚期结直肠癌的临床观察

目的观察希罗达联合奥沙利铂治疗老年晚期结直肠癌的疗效及毒副反应。方法采用希罗达联合奥沙利铂治疗28例老年晚期结直肠癌患者,奥沙利铂130 mg.m-2,d1;希罗达1 000 mg.m-2,连用14d,21 d为1周期,每2周期评价疗效。结果 28例患者中,CR 1例(3.6%),PR 12例(42.9%),SD 11例(39.3%),PD 4例(14.3%),有效率为46.4%,中位肿瘤进展时间为7.3个月。主要毒副反应为骨髓抑制、消化道反应、周围神经毒性、手足综合征。结论希罗达联合奥沙利铂治疗老年晚期结直肠癌有效且安全。     

卡培他滨联合伊立替康二线治疗19例晚期结直肠癌

[目的]评价卡培他滨联合伊立替康二线方案治疗晚期结直肠癌(ACRC)的疗效与安全性.[方法]卡培他滨联合伊立替康二线治疗19例晚期结直肠癌,每3周重复,完成4个周期(12周)后判定疗效.[结果]无完全缓解(CR),部分缓解(PR)4例(21.0%),疾病稳定(SD)8例(42.1%),疾病进展(PD)7例(36.8%),有效率(RR)21.0%(4/19),中位疾病进展时间4.2个月,中位生存期19.6个月.19例中不良反应为Ⅲ或Ⅳ度者7例,其中白细胞减少6例(31.6%),乏力1例(5.3%).无化疗相关死亡.[结论]卡培他滨联合伊立替康方案二线治疗晚期结直肠癌疗效高,不良反应可耐受.     

卡培他滨联合沙利度胺化疗对结直肠癌组织胸苷磷酸化酶表达的影响

目的:探讨卡培他滨联合沙利度胺治疗晚期结直肠癌的近期疗效及癌组织胸苷磷酸化酶的表达。方法:比较卡培他滨联合沙利度胺和5-氟尿嘧啶 亚叶酸 奥沙利铂(FOLFOX4)方案治疗晚期结直肠癌的疗效、不良反应,并采用ELISA方法测定两组患者癌组织中TP含量。结果:卡培他滨联合沙利度胺组疗效优于FOLFOX4组,总有效率分别为50.0%和36.3%(P<0.05);卡培他滨联合沙利度胺组TP浓度均数(211.2±30.5μg/L)显著低于FOLFOX4组(323.4±28.3μg/L)(P<0.005)。结论:卡培他滨联合沙利度胺治疗晚期结直肠癌疗效肯定,安全性较好。     

XELOX联合沙利度胺一线治疗转移性结直肠癌的Ⅱ期随机对照研究

目的:评价XELOX方案(奥沙利铂+卡培他滨)联合沙利度胺一线治疗晚期转移性结直肠癌(MCRC)的疗效及安全性.方法:89例符合入组条件的晚期转移性结直肠癌患者随机分为治疗组和对照组.治疗组44例接受XELOX方案联合沙利度胺治疗,对照组45例仅接受XELOX方案化疗.每21d为1个周期,每个病例至少治疗2个周期.主要研究无进展生存期,其次研究客观有效率、疾病控制率,并观察药物安全性及患者的生活质量.结果:治疗组的无进展生存期为5.6个月,对照组为5.2个月,差异无统计学意义(P=0.307);客观有效率两组间无统计学差异(34.1% vs 26.7%,P=0.446);XELOX基础上加用沙利度胺后显著提高了疾病控制率(63.6% vs 42.2%,P=0.043).治疗组伴有肝转移的24例患者中有2例治疗后达到可手术切除标准,而对照组伴有肝转移的23例患者则无1例达到标准.应用沙利度胺治疗的患者Ⅲ～Ⅳ级便秘发生率显著升高(20.5%vs4.4%,P=0.022),但未造成治疗中断;嗜睡发生率升高,但无统计学差异(13.6% vs 4.4%,P=0.130).患者的生活质量两组间无统计学差异.结论:在XELOX方案基础上加用沙利度胺一线治疗晚期结直肠癌耐受性良好并可显著提高疾病控制率,但未能提高无进展生存期,值得扩大样本进一步研究.     

健择加顺铂联合化疗治疗晚期膀胱癌38例

[目的]观察健择与顺铂联合化疗治疗晚期膀胱癌的疗效和毒性.[方法]38例晚期膀胱癌患者行健择1000mg/m2静脉滴注30分钟,第1、8天;顺铂25mg/m2,第1～3天.21天为一周期.2周期以上评价疗效.[结果]38例共行化疗134个周期.平均用药3.5周期.其中CR4例(10.5%).PR13例(34.2%),SD11例(28.9%),PD10例(26.3%).总有效率为44.7%.中位缓解期5个月.主要毒副反应以骨髓抑制为主.Ⅲ～Ⅳ度白细胞下降39.5%(15/38).Ⅲ～Ⅳ度血小板减少23.7%(9/38).Ⅲ～Ⅳ度贫血18.4%(7/38).消化道反应、脱发、肝肾功能损伤等均较轻.[结论]健择联合顺铂是治疗晚期膀胱癌的有效方案且毒性较低.     

沙利度胺联合FOLFIRI方案治疗晚期结肠直肠癌的临床观察

目的观察沙利度胺联合FOLFIRI方案治疗晚期结直肠癌的疗效及安全性。方法26例符合入组条件的晚期结肠直肠癌患者采用伊立替康（CPT-11）＋5-氟尿嘧啶（5-Fu）＋亚叶酸钙（LV）方案（即FOLFIRI方案）联合沙利度胺化疗。结果本组CR3例,PR9例,NC8例,有效率（CR＋PR）为46.15%（12/26）,临床获益率为76.92%;中位疾病进展时间（TTP）为4.5个月;主要毒副作用为恶心呕吐、粘膜炎、腹痛、腹泻、血液学毒性。结论沙利度胺联合FOLFIRI方案治疗晚期结肠直肠癌疗效确切,患者耐受性好。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.