吉西他滨联合奥沙利铂或顺铂治疗晚期非小细胞肺癌的随机对照研究

目的:评价吉西他滨联合奥沙利铂(GO组)与吉西他滨联合顺铂(GP组)治疗晚期非小细胞肺癌(NSCLC)的疗效及毒副反应.方法:121例经病理或细胞学确诊的Ⅲ～Ⅳ期NSCLC,随机分为GO组61例,GP组60例.GO组:吉西他滨1000mg/m2,溶入0.9%NS100mL,30min静脉滴入,d1、d8;奥沙利铂135mg/m2,加入5%葡萄糖500mL中,静脉滴入2h,d2.GP组:吉西他滨1000mg/m2,溶入0.9%NS100mL,30min静脉滴入,d1、d8;DDP25mg/m2,静脉滴入,d1～d3.以上方案均每21d为1个周期,2个周期评估疗效.结果:GO组:部分缓解24例,稳定25例,总有效率为39.3%.初治有效率为45.7%,复治有效率20.0%.GP组:完全缓解1例,部分缓解21例,稳定24例,总有效率为36.7%.初治有效率为41.7%,复治有效率16.7%.两组近期疗效比较差异无统计学意义,X2=0.190,P=0.663.最常见的不良反应为骨髓抑制、消化道反应、肾功能损害及神经毒性等,其中GP组Ⅲ～Ⅳ度白细胞下降、胃肠道反应和肾毒性高于GO组;周围神经炎发生率GP组低于GO组.结论:吉西他滨联合奥沙利铂治疗晚期NSCLC的疗效与吉西他滨联合顺铂疗效相当,毒副反应轻于GP方案,可作为晚期NSCLC较理想的化疗方法之一.     

吉西他滨联合铂类治疗64例晚期非小细胞肺癌临床疗效研究

目的:比较吉西他滨(gemcitabine)联合顺铂(cisplatin)、卡铂(carboplatin)和奥沙利铂(oxaliplatin)三种化疗方案对晚期非小细胞肺癌(NSCLC)的疗效和毒性反应。方法:经病理和细胞学证实的64例晚期NSCLC患者随机分为吉西他滨 顺铂(gemcitabine cisplatin,Gcis)、吉西他滨 卡铂(gemcitabine carbopl-atin,Gcarb)和吉西他滨 奥沙利铂(gemcitabine oxaliplatin,GLOHP)三组。三组均选用吉西他滨1000mg/m2静脉滴注第1、8天。GCis组:顺铂70mg/m2静脉滴注,第1天;GCarb组:卡铂AUC4～6(初治6,复治4～5),静脉滴注,第1天;GLOHP组:奥沙利铂LOHP130mg/m2静脉滴注,第1天。三组均21天为一周期,连续使用2～3周期评价疗效和毒副反应。结果:Gcis、Gcarb、GLOHP三种方案治疗晚期非小细胞肺癌的有效率分别为52.38%(11/21)、50.00%(10/20)和60.87%(14/23)(P>0.05)。三种方案毒副反应主要为可耐受的骨髓抑制、消化道反应、脱发和外周神经毒性等。结论:吉西他滨联合三种不同铂类的化疗方案均为治疗晚期非小细胞肺癌较为安全有效的化疗方案。     

吉西他滨联合奥沙利铂治疗老年晚期非小细胞肺癌观察

观察吉西他滨联合奥沙利铂治疗老年晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的近期疗效及毒副反应。初治的Ⅲ~Ⅳ期老年NSCLC22例,以21d为1个周期,吉西他滨1000mg/m2,静脉滴入,d1、d8;奥沙利铂100mg/m2,静脉滴入,d1。连用2个周期后评价疗效。全组22例均可评价,有效率为40·9%(9/22),毒副反应主要为骨髓抑制及外周神经感觉异常。初步研究结果提示,吉西他滨联合奥沙利铂治疗老年晚期NSCLC有一定的疗效,毒性较小可以耐受。     

奥沙利铂联合吉西他滨治疗晚期非小细胞肺癌疗效观察

目的 了解奥沙利铂联合吉西他滨治疗晚期非小细胞肺癌的疗效及毒副反应.方法 对96例晚期非小细胞肺癌随机分为治疗组和对照祖,治疗组给予奥沙利铂130 mg/m2,d1,静脉输注,吉西他滨1 000 mg/m2,d1,8,静脉输注;对照组给予顺铂75 mg/m2,d1,静脉输注;吉西他滨1 000 mg/m2.d1,8,静脉输注.21 d为1个周期,完成2周期治疗后评价疗效.结果 两组患者的总有效率分别为45.83%和43.75%,差异无统计学意义.两组的主要毒副反应为骨髓抑制和恶心呕吐,但治疗组明显较对照组轻.结论 奥沙利铂联合吉西他滨治疗晚期非小细胞肺癌与顺铂联合吉西他滨的疗效基本相同,但其化疗的毒副反应轻,在治疗过程中具有一定的优势,值得推广.     

多西他赛或吉西他滨联合顺铂治疗晚期非小细胞肺癌的临床比较研究

目的 比较多西他赛联合顺铂与吉西他滨联合顺铂治疗晚期非小细胞肺癌(NSCLC)的临床疗效及毒副反应.方法 将112例晚期NSCLC随机分为多西他赛加顺铂组(DC组)56例和古西他滨+顺铂组(GC组)56例.DC组:多西他赛75 mg/m2,d1,顺铂75 mg/m2,d1-3;GC组:吉西他滨1 250 mg/m2,d1,8;顺铂75 mg/m2,d1～3.两组均为每21 d一个周期重复.结果 人组的112例中110例可评价疗效,DC组和GC组有效率分别为43.6%和41.8%,1年生存率分别为47.2%和43.6%,两组之间有效率和1年生存率均无统汁学意义(P>0.05).毒副反应主要为骨髓抑制和消化道反应.结论 DC和GC方案治疗晚期NSCLC均具有较好的疗效,且两者的疗效相似,毒副反应可以耐受,可以做为临床一线治疗.     

吉西他滨联合奥沙利铂治疗晚期肝内胆管细胞癌28例

[目的]观察吉西他滨联合奥沙利铂治疗晚期肝内胆管细胞癌临床效果及毒副作用。[方法]28例肝内胆管细胞癌患者均给予吉西他滨1000mg/m2,d1、8;奥沙利铂85mg/m2,d1,21d为1个疗程。观察近期疗效、疼痛缓解程度和毒副反应。[结果]化疗后PR6例(21.43%),SD12例(42.86%),PD10例(35.71%),化疗期间无死亡病例。疼痛程度化疗前后比较差异有统计学意义(P<0.05)。毒副作用以血液系统多见,其次为胃肠道反应和外周神经毒性。[结论]吉西他滨联合奥沙利铂治疗晚期肝内胆管细胞癌具有较好的近期疗效,能缓解患者疼痛,且毒副反应可以耐受。     

吉西他滨联合奥沙利铂治疗老年晚期非小细胞肺癌观察

观察吉西他滨联合奥沙利铂治疗老年晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）的近期疗效及毒副反应.初治的Ⅲ～Ⅳ期老年NSCLC 22例,以21 d为1个周期,吉西他滨1000 mg/m^2,静脉滴入,d1、d8;奥沙利铂100mg/m^2,静脉滴入,d1.连用2个周期后评价疗效.全组22例均可评价,有效率为40.9%（9/22）,毒副反应主要为骨髓抑制及外周神经感觉异常.初步研究结果提示,吉西他滨联合奥沙利铂治疗老年晚期NSCLC有一定的疗效,毒性较小可以耐受.     

吉西他滨联合顺铂治疗26例复发性卵巢癌

[目的]评价吉西他滨联合顺铂治疗复发性卵巢癌的疗效和毒副反应。[方法]2007年10月至2009年6月经手术和病理证实的复发性卵巢癌患者26例,采用吉西他滨1000mg/m2,静脉滴注30min,第1、8d;顺铂75mg/m2,分为第1、2、3d静脉滴注,每21d为1个疗程。观察近期疗效和毒副反应。[结果]随访3～17个月,总有效率38.46%（10/26）,其中CR3例,PR7例,SD8例,PD8例。最常见的毒副反应是骨髓抑制和胃肠道毒性,主要为Ⅰ度、Ⅱ度。无化疗毒性相关性死亡。[结论]吉西他滨联合顺铂治疗复发性卵巢癌有一定的疗效,毒副反应可耐受。     

吉西他滨固定剂量率静滴联合奥沙利铂治疗晚期胆道癌的临床研究

[目的]评价吉西他滨固定剂量率静滴联合奥沙利铂（GEMOX方案）治疗晚期胆道癌的疗效和毒副作用。[方法]47例晚期胆道癌患者均接受吉西他滨1 000mg/m2,10mg/（m2.min）静滴,d1、8;奥沙利铂130mg/m2,静脉滴注2h,d1;每3周重复。至少化疗3个周期。[结果]47例患者均可评价疗效,无完全缓解病例,部分缓解9例（19.2%）,稳定22例（46.8%）,进展16例（34.0%）,总有效率（CR＋PR）为19.2%（9/47）。中位无进展生存期（PFS）4.7个月,中位总生存期（OS）9.3个月。主要毒副反应为中性粒细胞减少、血小板减少,恶心、呕吐,肝肾和外周神经毒性等。[结论]吉西他滨固定剂量率静滴联合奥沙利铂治疗晚期胆道癌有效,但其血液学毒性需引起重视。     

顺铂联合吉西他滨与联合紫杉醇治疗晚期非小细胞肺癌疗效分析

目的:观察顺铂联合吉西他滨以及顺铂联合紫杉醇治疗晚期非小细胞肺癌疗效以及毒副反应。方法:经病理组织学或细胞学证实的200例晚期非小细胞肺癌患者,随机分为吉西他滨组(GP组)与紫杉醇组(TP组)各100例。GP组:吉西他滨1000mg/m2,d1与d8,顺铂50mg/m2,d2-d4,均静脉滴注;TP组:紫杉醇150mg/m2,d1,顺铂60mg/m2,d1-d3。两组患者均每21天为一个周期,连用二个周期以上。结果:TP组总有效率(PR+CR)为50%,1年生存率为41%;GP组总有效率(PR+CR)为30%,1年生存率为36%。两组患者有效率有显著性差异(P=0.035),1年生存率无显著差异(P=0.745)。两组主要毒副反应不同,GP组血小板减少显著高于TP组,而TP组肌肉关节疼痛与呕吐显著高于GP组。结论:顺铂联合紫杉醇方案治疗效果优于顺铂联合吉西他滨方案,但是毒副反应较强。     

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.