去甲长春花碱,异环磷酰胺和顺铂动静脉给药治疗46例非小细？…

目的：观察去甲长春花碱（ＮＶＢ）、异环磷酰胺（ＩＦＯ）和大剂量顺铂（ＤＤＰ）联合动、静脉给药治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的疗效及不良反应。方法：４６例ＮＳＣＬＣ随机分为供瘤动脉给药组（Ａ组）和静脉给药组（Ｂ组）。Ａ组：２６例,ＮＶＢ３０ｍｇ／ｍ＾２,ＤＤＰ８０ｍｇ／ｍ＾２,供瘤支气管动脉灌注,第１天;Ｂ组：２０例,ＮＶＢ３０ｍｇ／ｍ＾２,ＤＤＰ８０ｍｇ／ｍ＾２,静脉点滴,第１天。２组均用ＩＦ     

去甲长春碱加顺铂治疗非小细胞肺癌的临床观察

目的：观察去甲长春碱（Ｎａｖｅｌｂｉｎｅ,ＮＶＢ）加顺铂（Ｃｉｓｐｌａｔｉｎ,ＤＤＰ）治疗非小细胞肺癌（ｎｏｎ ｓｍａｌｌ ｃｅｌｌ ｌｕｎｇ ｃａｎｃｅｒ,ＮＳＣＬＣ）的疗效和安全性。方法：治疗ＮＳＣＬＣ２６例,采用ＮＶＢ３０ｍｇ／ｍ＾２静脉推入,第１、８天;ＤＤＰ２０ｍｇ静脉点滴,连用５天。结果：部分缓解（ＰＲ）１０例,稳定（ＳＤ）８例,进展（ＰＤ）４例,总有效率４５．４％。ＮＶＢ的主要毒性反     

顺铂联合泰素,异长春花碱治疗非小细胞肺癌临床分析

比较抗肿瘤药泰素（Ｔａｘｏｌ）加顺铂及异长春花碱（Ｎａｖｅｌｂｉｎｅ）加顺铂治疗非小细胞肺癌（ＮＳＣＬＣ）的临床疗效及毒性反应。方法ＤＤＰ－Ｔａｘ：Ｔａｘｏｌ１３５ｍｇ／ｍ＾２静脉点滴，第１天，３ｈ内输注，用泰素前常规做防过敏治疗，ＤＤＰ７５ｍｇ／ｍ＾２静脉点滴，第２天、第３天、ＤＤＰ－ＮＶＢ：ＮＶＢ２５ｍｇ／ｍ＾２静脉点滴，第１天，第８天，ＤＤＰ７５ｍｇ／ｍ＾２静脉点滴，第２天、第３天结果ＤＤＰ     

MVP方案治疗非小细胞肺癌21例临床分析

（目的）评价以ＶＤＳ为主的ＭＶＰ方案治疗非小细胞肺癌（ＮＳＣＬＣ）的疗效和毒副反应。（方法）每一病人给予２周期ＭＶＰ方案进行化疗,每周期用ＶＤＳ３ｍｇ／ｍ＾２静注第１,８天,ＤＤＰ３０ｍｇ／ｍ＾２静滴第１－３天,ＭＭＣ６ｍｇ／ｍ＾２静注第１天。（结果）３例完全缓解,８例部分缓解,总有效率５２．３８％,不同病期之间,不同组织类型之间的疗效差别无显著性差异（Ｐ〉０．０５）,本方案主要毒副反应为骨髓抑制     

MVP方案与CAP方案治疗晚期非小细胞肺癌的疗效比较

「目的」对比ＭＶＰ方案与ＣＡＰ方案治疗ＮＳＣＬＣ的疗效。「方法」７４例病人随机分为ＭＶＰ组和ＣＡＰ组。ＭＶＰ组：ＭＭＣ６ｍｇ／ｍ＾２，ｄ１，ＶＤＳ３ｍｇ／ｍ＾２，ｄ１，ｄ８，ＰＤＤ３０ｍｇ／ｍ＾２，ｄ１￣ｄ３。ＣＡＰ组：ＣＴＸ６００ｍｇ／ｍ＾２，ｄ１，ＡＤＭ（３０￣４０）ｍｇ／ｍ＾２，ｄ１，ＰＤＤ（２０￣３０）ｍｇ／ｍ＾２，ｄ１－３。两方案皆以２１天为一周期，使用二个周期后进行评价。「结果」ＭＶＰ     

异长春花碱,长春地辛联合方案治疗72例晚期非小细胞肺癌的临床对比 …

目的 比较ＮＰ和ＭＶＰ方案治疗Ⅲ、Ⅳ期ＮＳＣＬＣ的临床疗效和毒性。方法 选择病理证实Ⅲ、ⅣＳＣＬＣ７２便,随机分成２组,３４例为ＮＰ组,３８例为ＭＶＰ组。ＮＶＢ剂量为２５ｍｇ／ｍ＾２,ＰＤＤ２５ｍｇ／ｍ＾２,ＶＤＳ３ｍｇ／ｍ＾２,ＭＭＣ６ｍｇ／ｍ＾２,３周重复,２周期后评价疗效。用上述方案进行对比治疗。结果 ＮＰ组和ＭＶＰ组缓解率分别为４７．１％,两级差异无显著性。Ⅲ、Ⅳ期缓解率分别是５０％、４２     

泰素及顺铂联合治疗晚期非小细胞肺癌

目的：观察抗肿瘤新药泰素（紫彬醇，Ｐａｃｌｉｔａｘｅｌ）加顺铂治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的疗效扩毒性反应。方法：泰素１８０ｍｇ／ｍ＾２静滴第１天，用泰素前给予抗过敏处理。顺铂２５ｍｇ／ｍ＾２静滴第２￣４天。第三周重复，每例均完成二周期化疗。结果：１４例晚期ＮＳＣＬＣ病人中，部分缓解（ＰＲ）４例，稳定（ＮＣ）７例，进展（ＰＤ）３例。总有效率２８．６％。初治有效率４０％（２／５），复治有效率２     

去甲长春花碱加顺铂治疗晚期非小细胞肺癌42例

目的观察抗肿瘤新药去甲长春花碱（Ｎａｖｅｌｂｉｎｅ,ＮＶＢ）加顺铂（Ｃｉｓｐｌａｔｉｎ,ＤＤＰ）联合化疗治疗晚期非小细胞肺癌（Ｎｏｎｓｍａｌｃｅｌｌｕｎｇｃａｎｃｅｒ,ＮＳＣＬＣ）的疗效。方法治疗ＮＳＣＬＣ４２例。男性３３例,女性９例。病理类型以腺癌为主（２７例）,ⅢＢ期１７例,Ⅳ期２５例。２４例初治,１８例复治。结果部分缓解（ＰＲ）２０例,稳定（Ｓ）１８例,进展（Ｐ）４例,总有效率４７．６％。每周ＮＶＢ≥２５ｍｇ／ｍ２的有效率为５４．２％,＜２５ｍｇ／ｍ２的有效率３８．９％。中位缓解期３．３个月,中位生存期８．５个月。ＮＶＢ的剂量限制毒性为骨髓抑制,白细胞下降占１００．０％,其中Ⅲ、Ⅳ度为６６．６％。注射局部静脉毒性发生率４０．５％。结论以ＮＶＢ为主的联合化疗治疗晚期ＮＳＣＬＣ有效率高,毒性可以耐受,是一个有前途的抗肿瘤新药。     

口服或静滴VP-16联合DDP方案治疗非小细胞肺癌的临床观察

目的：比较口服ＶＰ－１６联合ＤＤＰ与静滴ＶＰ－１６联合ＤＤＰ方案（ＥＰ方案）治疗非小细胞肺癌（ＮＳＣＬＣ）的临床疗效和毒性。方法：选择经病理证实的ＮＳＣＬＣ７８例,随机分为两组。治疗组（４０例）：ＶＰ－１６ １００ｍｇ,静滴,ｄ１,ＶＰ－１６ １００ｍｇ,口服ｄ２－１１,ＤＤＰ８０ｍｇ／ｍ＾２,静滴,ｄ１。对照组（３８例）：ＶＰ－１６ １００ｍｇ,静滴,ｄ１－５,ＤＤＰ剂量及用法同治疗组。两组均每     

重组人血管内皮抑制素联合化疗治疗４６例晚期非小细胞肺癌的临床观察

目的：观察重组人血管内皮抑制素（恩度）联合常规化疗方案治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的疗效和毒副反应。方法：经病理学检查证实的４６例初治ⅢＢ和Ⅳ期ＮＳＣＬＣ患者,包括鳞癌１７例,腺癌２３例,其他类型６例,均采用恩度联合常规化疗,其中联合ＴＰ方案１２例,联合ＧＰ方案１５例,联合ＮＰ方案１９例。恩度剂量为１５ｍｇ／次,加入生理盐水５００ｍｌ中静滴３～４小时,第１～１４天连续给药。ＴＰ方案：紫杉醇（ＰＴＸ）１７５ｍｇ／ｍ^２第１天,顺铂（ＣＤＤＰ）２５ｍｇ／ｍ^２第１～３天;ＧＰ方案：吉西他滨（ＧＥＭ）１ ０００ｍｇ／ｍ^２第ｌ、８天,ＣＤＤＰ２５ｍｇ／ｍ^２第１～３天;ＮＰ方案：长春瑞滨（ＮＶＢ）２５ｍｇ／ｍ^２第１、８天,ＣＤＤＰ２５ｍｇ／ｍ^２第１～３天。均２１天为１周期。所有患者至少完成２个周期,根据ＷＨＯ疗效评定及毒副反应分级标准,观察其近期疗效、１年生存率、肿瘤进展时间（ＴＴＰ）及毒副反应。结果：４６例初治晚期ＮＳＣＬＣ,获ＣＲ２例（４.３５％）,ＰＲ１７例（３６.９６％）,ＳＤ１４例（３０.４３％）,ＰＤ１３例（２８.２６％）,客观反应率（ＲＲ）为４１.３１％,疾病控制率（ＤＣＲ）７１.７４％。中位ＴＴＰ为５.１个月,１年生存率为３８.２％。治疗相关毒副反应主要为食欲不振,疲乏,轻度的心脏毒副反应,包括心悸、胸闷、血压升高等,全组无心律失常及出血发生。骨髓抑制、Ⅰ ～Ⅱ度胃肠道及外周神经毒性均可耐受。结论：恩度联合常规化疗方案治疗晚期ＮＳＣＬＣ的近期客观疗效较高,安全性好,但远期疗效仍需进一步观察。     

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.