奥沙利铂联合表柔比星和5-FU治疗多发转移性胃癌的临床观察

为了观察奥沙利铂联合表柔比星及5-FU(FA)F方案)对多发转移性胃癌的近期疗效及安全性,对病理确诊的36例多发转移性胃癌患者进行化疗.化疗方案:奥沙利铂100 mg/m2静脉滴入2 h,d1;5-FU 500 mg/m2持续静脉滴入4 h,d1～d5;表柔比星50 mg/m2,静脉推注,d1,每2周重复,至少完成2个周期判效.36例可评价疗效及不良反应,治疗总周期数125个周期,平均4.5个周期.CR 3例(8.3%),PR 16例(44.4%),总缓解率RR 52.6%,SD 22.2%(8/36),PD 25%(9/36),KPS评分提高>20者38.9%(14/36),CBR改善者占50.0%.Ⅲ度/Ⅳ度主要不良反应为中性粒细胞减少19.4%(7/36),血小板减少11.1%(4/36),贫血8.3%(3/36).恶心、呕吐8.3%(3/36),腹泻2.8%(1/36),末梢神经感觉异常11.1%(4/36).初步研究结果提示,奥沙利铂联合表柔比星和5-FU治疗多发转移性胃癌疗效肯定,不良反应能够耐受.     

大剂量化疗联合G-CSF治疗难治或复发性非霍奇金淋巴瘤的临床观察

目的:观察大剂量化疗联合应用粒细胞集落刺激因子在没有干细胞支持情况下,治疗难治或复发性非霍奇金淋巴瘤(NHL)的疗效和不良反应。方法:采用大剂量化疗方案,DIAEM方案:异环磷酰胺1 500 mg/m2,静脉滴入,d1～d5;美斯纳800 mg/次,于异环磷酰胺后0、4和8 h静脉滴入,并同时水化;依托泊苷200 mg/m2,静脉滴入,d1～d5;表柔比星60 mg/m2,静脉滴入,d1。地塞米松20 mg,静脉滴入,d1～d5。ESHAP方案:顺铂25 mg/m2,静脉滴入,d1～d4;替尼泊苷(Vm-26)100 mg,静脉滴入,d1～d4;甲基泼尼松龙500 mg,静脉滴入,d1～d4;阿糖胞苷1 500 mg/m2,d5。两方案交替进行,粒细胞集落刺激因子5～10μg/(kg.d)于每周期化疗结束后24 h开始应用,至白细胞达2.0×109L-1且持续3 d停用。结果:大剂量化疗总有效率61.1%(22/36),其中CR12例(33.3%),PR10例(27.8%),SD 4例,PD 10例,1例于大剂量化疗后第7天死于颅内出血。主要不良反应为骨髓抑制,白细胞和血小板降到最低的中位时间分别为6和5 d,其恢复时间分别为10和12 d;27例(76.5%)出现发热性粒细胞减少,中位时间为6 d。结论:在无干细胞支持的情况下,采用大剂量化疗辅以粒细胞集落刺激因子支持是治疗难治或复发性NHL的有效措施。     

全身化疗联合局部热疗治疗晚期胃癌的疗效观察

目的:研究FOLFOX4方案联合射频热疗治疗晚期胃癌的疗效和不良反应.方法:33例患者接受FOLFOX4方案化疗的同时给以热疗.L-OHP(85-100)mg/m2,静脉滴入2h, d1;CF 200mg/m2静脉滴入2h, d1、d2;氟尿嘧啶(5-FU) 400 mg/m2,静脉推注d1、d2,600 mg/m2持续静滴22h,d1、d2;每2周重复, 28天为1周期.热疗每周2次,每次60分钟.3个周期化疗后评价疗效.结果:33例患者 CR 4例(12.1 %) 、PR 13例( 39.4 %) , 有效率(CR+PR)51.5%.不良反应主要为胃肠反应、骨髓抑制和感觉神经毒性.结论: FOLFOX4方案化疗联合热疗应用于晚期胃癌疗效肯定,不良反应能耐受.     

紫杉醇联合FUDR治疗晚期胃癌的临床观察

为了观察紫杉醇(PTX)联合脱氧氟尿苷(FUDR)/亚叶酸钙(CF)方案治疗晚期胃癌近期疗效及其不良反应,将58例晚期胃癌患者,采用PTX135mg/m2,静脉滴入3h,d1,CF100mg/m2,静脉滴入2h,d1～d5,FUDR425mg/m2,静脉滴入2h,d1,再续滴入FUDR350mg/(m2.d),微量化疗泵24h持续滴入(civ)d1～d5,21d为1个周期,至少完成2个周期。58例晚期胃癌患者,CR3例(5.2%),PR30例(51.7%),SD13例(22.4%),PD12例(20.7%),总有效率(CR PR)达56.9%。主要不良反应为骨髓抑制、脱发和肌肉酸痛,无化疗相关死亡。初步研究结果提示,PTX联合FUDR/CF方案一线治疗晚期胃癌具有较好的疗效和安全性。     

TE与TC方案新辅助化疗治疗三阴乳腺癌的对比研究

目的比较TE与TC方案用于三阴乳腺癌（triple-negative breast cancer,TNBC）新辅助化疗的疗效及不良反应。方法收集术前接受新辅助化疗的三阴性乳腺癌患者82例,随机分为TE组和TC组。TE组接受紫杉醇联合表柔比星（44例）,方案为：表柔比星75 mg/m2,d1;紫杉醇175 mg/m2,d2。TC组接受紫杉醇联合卡铂（38例）,方案为：紫杉醇175 mg/m2,d1;卡铂AUC=5,d2。两组均21天为1周期,完成化疗2周期后疗效评定,决定是继续化疗还是手术治疗。结果除2例中途退出,所有患者均可评价疗效。TE组与TC组的有效率分别为66.7%（28/42）和65.8%（25/38）。其中常见的不良反应有骨髓抑制、恶心、呕吐、周围神经毒性,均可耐受,无化疗相关死亡。结论紫杉醇联合表柔比星与紫杉醇联合卡铂治疗三阴乳腺癌新辅助化疗的疗效相当,不良反应均可耐受。     

多西紫杉醇联合氟脲嘧啶和顺铂方案治疗晚期胃癌临床观察

目的 观察多西紫杉醇联合氟脲嘧啶和顺铂方案(DCF方案)治疗晚期胃癌的近期疗效和毒副反应.方法 对28例晚期胃癌采用DCF方案化疗,多西紫杉醇75 mg/m2静脉滴入1 h,d1,DDP 25 mg/m2静脉滴入,d1-3,5-Fu 400 mg/m2静脉推注,d1-2,1 200mg/m2微量输液泵持续静脉滴注44 h,至少化疗2个周期评价疗效.结果 28例完全缓解(CR)2例,部分缓解(PR)14例,总有效率(RR)为57.14%,中位缓解期为6.5个月,中位生存期为11.6个月,1年生存率为46.3%;毒副反应主要为骨髓抑制、消化道反应和脱发,大部分为Ⅰ～Ⅱ度,耐受良好,骨髓抑制为剂量限制性毒性,Ⅲ度以上白细胞减少6例.结论 多西紫杉醇联合氟脲嘧啶和顺铂方案治疗晚期胃癌的近期疗效好,毒副反应轻,耐受性好.     

多西他赛联合表柔比星、环磷酰胺治疗转移性乳腺癌的临床观察

目的:观察多西他赛联合表柔比星、环磷酰胺治疗转移性乳腺癌的临床疗效及不良反应。方法:回顾性分析40例转移性乳腺癌患者的化疗资料,采用国产多西他赛75mg/m2,表柔比星70-90mg/m2静脉滴注,环磷酰胺500mg/m2每3周1次。观察每次化疗后的不良反应,完成4个疗程后观察疗效。结果:全部病例均按计划完成4个周期的化疗。完全缓解(CR)3例,部分缓解(PR)20例,稳定(SD)12例,进展(PD)5例。总有效率(CR+PR)为57.5%,控制率(CR+PR+SD)87.5%。主要不良反应为中性粒细胞减少、恶心、呕吐、腹泻等。结论:多西他赛联合表柔比星、环磷酰胺治疗转移性乳腺癌临床疗效较好,不良反应患者可以耐受。     

热疗联合FOLFIRI化疗治疗晚期结直肠癌的临床观察

目的:观察热疗联合FOLFIRI全身化疗治疗晚期结直肠癌的疗效和不良反应.方法:将2005年5月～2009年8月在我院住院治疗的53例晚期结直肠癌患者,随机分为A、B两组,A组(治疗组,26例)接受热疗联合FOLFIRI全身化疗,肿瘤局部区域热疗,温度43℃,每次60分钟,每周2次;B组(对照组,27例)接受常规FOLFIRI全身化疗.化疗方案为伊立替康180mg/m2,静脉滴入90 min,d1;亚叶酸钙 200mg/m2,静脉滴入2h,d1,2;5-氟尿嘧啶400mg/m2,静脉推注,d1,2,600mg/ m2,持续静滴22h,d1,2;14天为1个周期;治疗4个周期后,评价疗效及不良反应.结果:与常规全身化疗相比,热疗联合全身化疗组(A组)有效率、疾病无进展生存时间(PFS)及总生存期(OS)有明显提高,差异有统计学意义(P＜0.05),不良反应未增加.结论:对晚期结直肠癌患者,热疗联合FOLFIRI化疗疗效较好,不良反应能耐受.     

FOLFOX4方案联合表柔比星治疗晚期胃癌的临床研究

目的:比较FOLFOX4方案联合表柔比星与FOLFOX4方案治疗晚期胃癌的疗效和不良反应.方法:103例晚期胃癌患者随机分2组,治疗组51例.采用FOLFOX4方案联合表柔比星化疗:表柔比星50 mg/m2,静脉滴入,d1;草酸铂85 mg/m2,持续静脉滴入2 h,d1;亚叶酸钙200 mg/m2,持续静脉滴入2 h,d1、d2;继以氟尿嘧啶400 mg/m2,静脉滴入,d1、d2,氟尿嘧啶600 mg/m2,持续静脉泵输注22h,d1、d2.每3周为1个周期.对照组52例,采用FOLFOX4方案,每2周为1个周期.2个周期后进行全面评价.结果:治疗组与对照组的缓解率分别为49.0%(25/51)和42.3%(23/52),差异无统计学意义,P>0.05;1年生存率分别为43.0%和35.0%,差异无统计学意义,P>0.05;中位疾病进展时间(TTP)分别为6.5和5.3个月;主要的不良反应为骨髓抑制、轻度周围神经毒性、消化道反应和腹泻.结论:FOLFOX4方案联合表柔比星治疗晚期胃癌,相对FOLFOX4方案具有一定优势,有进一步临床研究的价值.     

紫杉醇联合奈达铂或顺铂治疗晚期食管癌的临床观察

目的:探讨紫杉醇联合奈达铂或顺铂治疗晚期食管癌的临床疗效及不良反应.方法:回顾性分析94例经病理确诊的Ⅳ期食管癌,随机分为紫杉醇联合奈达铂组(TN组)与紫杉醇联合顺铂组(TP组),TN组42例,紫杉醇135 mg/m2,静脉滴入,d1;奈达铂25 mg/m2,静脉滴入,d1～d3,21 d为1个周期.TP组52例,紫杉醇135 mg/m2,静脉滴入,d1;顺铂25 mg/m2,静脉滴入,d1～d3,21 d为1个周期.结果:TN组和TP组有效率分别为53.3%和55.4%(x2=0.11,P=0.743),疾病控制率分别83.6%和86.2%(x2=0.2,P=0.660),1年生存率分别为33.3%和36.5%(x2=0.1,P=0.750);不良反应方面:TP组比TN组Ⅰ～Ⅱ恶心、呕吐(67.3%vs 28.6%,x2=13.9,P=0.000),Ⅲ～Ⅳ恶心、呕吐(15.4%vs 2.4%,x2=4.54,P=0.033)及外周神经毒性(46.2%vs21.4%,x2=6.325,P=0.013)发生率更高.结论:紫杉醇联合奈达铂是治疗晚期食管癌的有效方案,可取得与紫杉醇联合顺铂相似的有效率与生存,在不良反应方面具有一定的优势.     

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.     

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     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。     

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.     

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.