吉非替尼联合卡铂与吉西他滨联合卡铂治疗晚期非小细胞肺癌的疗效

目的探讨吉非替尼或吉西他滨联合卡铂治疗晚期非小细胞肺癌(NSCLC)的临床疗效和安全性。方法将137例晚期NSCLC患者随机分为两组,试验组71例,给予吉非替尼联合卡铂治疗;对照组66例,给予吉西他滨联合卡铂治疗。对两组患者的治疗效果和生存质量进行评价,并统计不良反应发生情况。结果试验组和对照组NSCLC患者的总有效率分别为76.1%和47.0%,差异有统计学意义(P<0.05),疾病控制率分别为87.3%和78.8%(P>0.05)。试验组患者的中位生存期为14.5个月,与对照组患者(11.8个月)比较,差异有统计学意义(P<0.05)。试验组患者的不良反应主要为痤疮样皮疹、腹泻、恶心、呕吐以及食欲不振,对照组患者主要为血液学和胃肠道不良反应,所有患者均可耐受。结论吉非替尼联合卡铂治疗晚期NSCLC患者的临床疗效优于吉西他滨联合卡铂,其血液学和消化道不良反应发生率低,患者的耐受性较好,是晚期NSCLC患者较为合适的二线治疗方案。     

达可替尼一线治疗EGFR Exon19/21突变型晚期非小细胞肺癌的临床疗效观察

目的:观察达可替尼一线治疗EGFR突变型晚期非小细胞肺癌的临床疗效。方法:前瞻性纳入2017年1月至2018年12月我科收纳的44例表皮生长因子受体（EGFR）突变型晚期非小细胞肺癌（NSCLC）患者资料,随机数字法将患者分为两组,接受达可替尼一线治疗患者22例设为达可替尼组,接受吉非替尼一线治疗患者22例设为吉非替尼组。统计并比较两组患者治疗后近期疗效;消化道不良反应、甲沟炎、痤疮、口腔炎和转氨酶升高等不良反应发生情况;采用无进展生存时间（PFS）评价患者远期疗效。结果:达可替尼组DCR为86.4%,显著优于吉非替尼组54.5%,差异有统计学意义（P＜0.05）,达可替尼组ORR为45.5%优于吉非替尼组31.8%,但比较无统计学差异（P＞0.05）;达可替尼组发生消化道不良反应患者较多,且Ⅲ、Ⅳ度痤疮不良反应的人数明显增加,与吉非替尼组相比差异有统计学意义（P＜0.05）;达可替尼组患者中位PFS为13.0个月,吉非替尼组患者中位PFS为9.6个月,两组间PFS曲线比较差异有统计学意义（P＜0.05）。达可替尼组患者中位OS为32.5个月,吉非替尼组患者中位OS为23.5个月,两组间OS比较差异无统计学意义（P＞0.05）。结论:达可替尼可作为EGFR突变型晚期非小细胞肺癌患者一线治疗的重要选择,相较于吉非替尼,其近期疗效理想,PFS也更有优势,但其消化道和皮肤的毒性反应更为显著。     

GP 方案和吉非替尼单药一线治疗非小细胞 肺癌疗效比较

 目的　对比分析以铂类为基础的GP(吉西他滨+ 顺铂) 联合化疗和单药吉非替尼( IRESSA) 一 线治疗ⅢB2 Ⅳ期非小细胞肺癌的近期疗效和毒副作用。方法　60 例ⅢB～ Ⅳ期从未接受过化疗的非小 细胞肺癌患者中,单用吉非替尼治疗26 例,GP 方案治疗34 例。吉非替尼组为吉非替尼250 mg/ d ; GP 组为吉西他滨1 250 mg/ m2 ,第1 ,8 天,顺铂75 mg/ m2 ,第1 天。每三周为一周期,两周期后评价客观疗 效及不良反应。结果　两组总有效率吉非替尼组26. 9 %(7/ 26) ,GP 组29. 4 %(10/ 34) , P > 0. 05 ;疾病控 制率吉非替尼组76. 9 %(20/ 26) ,GP 组50. 0 %(17/ 34) , P < 0. 05 。GP 组主要存在骨髓抑制和胃肠道反 应毒性( P < 0. 05) ,吉非替尼组的毒性反应主要为皮疹和腹泻。结论　GP 方案和吉非替尼单药一线治 疗非小细胞肺癌(NSCLC) 可获得一致的客观有效率,但吉非替尼单药的疾病控制率显著高于GP 组,且 其毒副反应较GP 组轻微,患者均可完全耐受。吉非替尼单药口服可考虑作为治疗晚期化疗难耐受的 NSCLC 患者的一线方案。     

化疗交替靶向药物治疗对 EGFR 突变阳性的晚期 NSCLC 患者PFS及 OS的影响

目的：观察化疗交替靶向药物治疗对EGFR突变阳性的晚期非小细胞肺癌患者PFS及OS的影响。方法选取100例EGFR突变阳性的晚期NSCLC患者作为研究对象,将患者分为2组,A组为吉西他滨＋顺铂／卡铂化疗交替吉非替尼组,B组为单用吉非替尼组。比较患者治疗过程中的耐受情况、不良反应的发生率和总缓解率（ ORR）;对比A、B组患者的肿瘤无进展生存期（ PFS）、总生存期（ OS）和患者生活质量评分（ QoL）。结果2组患者的不良反应发生率无统计学差异（P＞0．05）,治疗期间A组5例患者因无法耐受不良反应而退出,B组4例患者退出。 A组患者ORR为68．89％,B组ORR为47．86％,差异具有统计学意义（P＜0．05）。 A组患者的PFS、OS和QoL高于B组,差异具有统计学意义（ P＜0．05）。结论化疗交替靶向药物在晚期EGFR突变阳性的NSCLC的治疗中具有显著的临床疗效,值得在临床上进行推广和应用。     

吉非替尼联合康莱特注射液治疗晚期非小细胞肺癌探讨

目的:探讨吉非替尼联合康莱特注射液治疗晚期非小细胞肺癌的临床疗效.方法:选取我院收治的非小细胞肺癌患者,随机分为观察组和对照组.对照组患者给予吉非替尼口服治疗,观察组患者在此基础上加用康莱特静脉滴注,两组患者均以治疗21天为一个疗程,治疗持续3个疗程.结果:治疗后观察组患者的治疗有效率(69.1％)和疾病控制率(87.3％)均高于对照组(47.3％、63.6％),治疗后观察组患者生活质量的改善率(52.7％)高于对照组(27.3％),差异均有统计学意义(P＜0.05);而两组患者的毒副反应发生率间差异无统计学意义(P＞0.05).结论:吉非替尼联合康莱特注射液治疗晚期非小细胞肺癌效果显著,值得临床推广.     

吉非替尼联合同步放疗治疗EGFR突变型转移性非小细胞肺癌的疗效及安全性

目的探讨吉非替尼联合同步放疗治疗EGFR突变型转移性非小细胞肺癌的疗效及安全性。方法选取2013年12月至2014年12月间扬州大学附属靖江市人民医院收治的80例EGFR突变型转移性非小细胞肺癌患者,采用随机数表法分为观察组和对照组,每组40例。观察组患者在调强放射治疗基础上采用吉非替尼治疗,对照组患者采用调强放射治疗。比较两组患者的临床疗效及不良反应,随访25个月,观察两组患者生存情况。结果治疗4周期后,观察组患者治疗有效率(57.5%)及疾病控制率(80.0%)均显著高于对照组的35.0%和62.5%,差异均有统计学意义(均P<0.05)。两组患者常见的不良反应包括白细胞减少、血小板减少、贫血、恶心、呕吐、食欲不振和皮疹等,以Ⅰ~Ⅱ级为主,观察组患者不良反应发生率为95.0%(38/40),与对照组的90.0%(36/40)比较,差异无统计学意义(P>0.05)。观察组患者中位生存时间为15.4个月,对照组为12.3个月。观察组患者1年生存率为71.1%,对照组为60.4%。结论吉非替尼联合同步放射治疗,能够提高EGFR突变型转移性非小细胞肺癌的临床疗效,且安全性较好。     

阿帕替尼治疗晚期非小细胞肺癌的疗效观察

目的探讨阿帕替尼治疗晚期非小细胞肺癌患者的临床疗效及用药安全。方法选取2016年1月至2017年12月间淮安市淮阴医院收治的60例晚期非小细胞肺癌患者,采用随机数表法分为对照组和阿帕替尼组,每组30例。对照组患者采用培美曲塞联合卡铂治疗,阿帕替尼组患者在对照组基础上辅以阿帕替尼,两组均治疗8周,比较两组患者治疗前后血清肿瘤标志物水平、临床治疗效果和不良反应发生情况。结果阿帕替尼组患者临床总有效率为70. 0%,对照组为46. 7%,两组比较,差异有统计学意义(P <0. 05)。治疗后,阿帕替尼组患者糖类蛋白50 (CA50)、CA199、CA125和癌胚抗原(CEA)水平均低于对照组患者,差异均有统计学意义(均P <0. 05)。阿帕替尼组患者不良反应发生率为23. 3%,对照组为53. 3%,两组比较,差异有统计学意义(P <0. 05)。结论常规培美曲塞联合卡铂辅以阿帕替尼治疗晚期非小细胞肺癌,可有效降低患者血清肿瘤标志物水平,提高临床疗效,且临床用药安全性良好,有良好的临床应用价值。     

安罗替尼三线治疗晚期非小细胞肺癌的临床研究

目的探讨安罗替尼三线治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法选取2018年6月至2019年6月间盐城市第二人民医院收治的46例晚期非小细胞肺癌患者,依据临床治疗方案不同分为研究组和对照组,每组23例。采用吉西他滨联合顺铂方案治疗的纳入对照组,采用盐酸安罗替尼胶囊治疗的纳入研究组,比较两组患者的临床疗效、不良反应及血气指标变化情况。结果研究组患者的有效率为73. 9%,高于对照组的43. 5%,差异有统计学意义(P <0. 05)。研究组患者不良反应发生率的13. 0%,低于对照组的39. 1%,差异有统计学意义(P <0. 05)。研究组患者治疗后的Pa CO2低于对照组,Pa O2和Sa O2高于对照组,差异均有统计学意义(均P <0. 05)。结论采用安罗替尼对晚期NSCLC患者行三线治疗,临床疗效甚佳,不良反应较低,可有效改善患者血气指标,值得在临床中普及应用及深层次多中心研究。     

吉非替尼一线与二线治疗E GF R突变型晚期非小细胞肺癌的疗效比较

目的：观察吉非替尼用于表皮生长因子受体（epidermal growth factor receptor,EGFR）突变型晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）一线或二线治疗对患者近期疗效及生存期的影响,分析吉非替尼的最佳治疗时机。方法：回顾性分析61例EGFR突变型（外显子19或21突变）晚期NSCLC患者的病历和随访资料,其中31例患者接受吉非替尼一线治疗,30例患者接受吉非替尼二线治疗;应用Kaplan-meier法进行生存分析。结果：两组患者的性别（P＝0．717）、年龄（P＝0．849）、吸烟史（P＝0．173）、病理类型（P＝0．573）和临床分期（P＝0．668）的差异无统计学意义。吉非替尼一线较二线治疗EGFR突变型NSCLC的近期有效率及疾病控制率明显提高（RR：64．5％ vs 23．3％,P＝0．001;DCR：87．1％ vs 60．0％,P＝0．016）。吉非替尼一线和二线治疗的中位无进展生存期分别为7．6和6．4个月（P＝0．392）,中位总生存期分别为16．0和17．6个月（P＝0．606）。另外,在最终获得疾病控制的患者中,吉非替尼一线治疗组为27例,二线治疗组为18例,2组中位无进展生存期及总生存期也无明显差异（PFS：8．0 vs 9．7个月,P＝0．777;OS：17．0 vs 20．0个月,P＝0．196）。结论：吉非替尼用于EGFR突变型晚期NSCLC患者,一线较二线治疗的近期疗效明显提高,但生存获益无明显差异。     

培美曲塞联合卡铂和吉西他滨联合卡铂一线治疗晚期非鳞非小细胞肺癌的疗效观察

目的探讨培美曲塞联合卡铂治疗晚期非鳞非小细胞肺癌的临床效果和安全性。方法选取晚期非鳞非小细胞肺癌患者90例,随机分为两组,对照组43例,给予吉西他滨联合卡铂治疗;观察组47例,给予培美曲塞联合卡铂治疗。对两组患者治疗效果进行评价,并统计不良反应发生情况。结果观察组与对照组患者全部完成2、4或者6个周期化疗,对照组患者中有2例因消化道不良反应严重而终止治疗。观察组患者临床有效率明显高于对照组,差异有统计学意义(P<0.05),两组患者疾病控制率差异无统计学意义(P>0.05)。观察组患者粒细胞减少和肝功能损害者明显少于对照组,且不良反应发生率明显少于对照组,两组差异有统计学意义(P<0.05)。结论与吉西他滨联合卡铂的治疗方案相比,培美曲塞联合卡铂治疗晚期非鳞非小细胞肺癌的临床疗效更好,安全性也更高。     

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.