晚期大肠癌ERCC5基因启动子-763A〉G多态性与铂类药物疗效相关性的研究

目的：探讨ERCC5基因启动子区单核苷酸多态性与中国汉族晚期大肠癌奥沙利铂疗效的相关性。方法：收集以奥沙利铂为主化疗的105例晚期大肠癌患者化疗开始前静脉血,提取基因组DNA,应用PCR-LDR方法检测ERCC5基因3个SNP位点-1415C〉T（rs2094258）-7、63A〉G（rs2016073）及-413C〉T（rs943245）多态性,分析不同基因型与疾病控制率、无进展生存期（PFS）的相关性。结果：携带ERCC5-763GG-、763AG和-763AA基因型的患者化疗疾病控制率分别为86.7%、69.2%和52.6%,其中携带-763GG基因型的患者疾病控制率显著高于携带-763AA基因型的患者,P=0.028。携带-763AA基因型的患者中位PFS（36/95例,6个月）低于携带-763AG基因型（48/95例,8个月）及携带-763GG基因型（11/95例,10个月）的患者,差异有统计学意义,χ^2=9.205,P=0.002。-1415C〉T多态性与化疗疾病控制率和PFS之间均无显著相关性。-413C〉T位点未发现遗传多态。结论：ERCC5启动子区-763A〉G单核苷酸多态性与晚期大肠癌奥沙利铂临床疗效相关。     

DNA修复基因多态性影响晚期胃癌卡培他滨联合奥沙利铂化疗的临床预后

目的:探讨DNA修复基因(ERCC1、ERCC2、XRCC1)单核苷酸多态性对胃癌患者卡培他滨联合奥沙利铂化疗敏感性的相关性.方法:本回顾性研究选取XELOX作为一线化疗方案的100例晚期胃癌患者为研究对象,检测分析三个基因六个单核苷酸多态性位点(ERCC1 rs11615;ERCC2 rs13181,rs1799793;XRCC1 rs25487,rs25489,rs1799782),同时分析其与临床预后的关系.结果:XRCC1 rs25487的A/G等位基因频率、AG/AA/GG基因分布频率均与疾病化疗敏感性和无进展生存期有关,携带GG基因型患者疗效好(P<0.05),中位PFS为8.00个月(95%CI:6.34~9.66);ERCC2 rs13181的G/T等位基因频率、GG/GT/TT基因分布频率与疾病化疗敏感性和无进展生存期明显相关,携带TT基因型患者疗效好(P<0.05),中位PFS为7.46个月(95%CI:6.45~8.48).COX比例风险模型显示ERCC2 rs13181 G/T基因型是晚期胃癌无进展生存期的独立风险因素之一(HR=0.72,95%CI:0.53~0.97,P=0.025).结论:ERCC2 rs13181基因多态性可能是评估接受XELOX化疗晚期胃癌患者预后的关键指标.     

ERCC2 rs1799793多态性与三阴性乳腺癌铂类化疗疗效的关系

背景与目的:DNA修复基因的多态性可以影响DNA损伤修复能力,从而影响患者的化疗疗效。切除修复交叉互补基因2(excision repair cross-complementing group 2,ERCC2)参与核苷酸切除修复和基因转录,在DNA损伤修复中起重要作用。本研究旨在初步探讨ERCC2单核苷酸多态性与三阴性乳腺癌铂类药物化疗疗效的关系。方法:全组患者中位年龄46岁,中位化疗周期数为4个周期。60例接受铂类药物化疗的晚期或局部晚期三阴性乳腺癌患者,收集其临床病理资料和随访信息,采用高通量MassARRAY时间飞行质谱生物芯片系统分析入组患者ERCC2基因候选位点的单核苷酸多态性,观察比较不同基因型与化疗疗效之间的关系。结果:接受含铂方案治疗的总体有效率为66.7%。60例中53例获得ERCC2 rs1799793位点检测结果,ERCC2rs1799793位点等位基因型有GG、GA 2种,频率分别为81.1%、18.9%。GG基因型患者化疗有效30例,无效13例;GA基因型患者化疗有效3例,无效7例。两组的化疗有效率分别为69.8%和30.0%,疗效差异有统计学意义(P=0.030),携带GG基因型的患者化疗敏感性高于携带GA基因型患者。结论:ERCC2基因rs1799793多态性与三阴性乳腺癌患者接受铂类药物化疗的临床疗效有关。     

切除修复交叉互补基因1和X线修复交叉互补基因1及谷胱甘肽巯基转移酶π 1多态性与晚期胃癌患者生存期的关系

目的 探讨切除修复交叉互补基因1(ERCC1)、X线修复交叉互补基因1(XRCC1)和谷胱甘肽巯基转移酶π1(GSTP1)多态性与中国晚期胃癌患者接受含奥沙利铂方案一线化疗后生存期的关系.方法 85例晚期胃癌患者接受奥沙利铂+5-氟尿嘧啶为基础的联合化疗方案化疗,并在化疗前抽取患者静脉血,提取基因组DNA,以实时荧光定量PCR法行多态性检测,比较不同基因型与患者生存期的关系.结果 85例患者中位至疾病进展时间为5.3个月,中位生存期为8.0个月.ERCC1-118 C/C、XRCC1-399 G/G和GSTP1-105 A/G+G/G基因型为优势基因型,携带3个、2个、1个、0个优势基因型患者的中位生存期分别为12.5、10.0,6.5和4.5个月,组间差异有统计学意义(χ2=35.54,P<0.01).结论 ERCC1-118、XRCC1-399和GSTP1-105基因多态性与中国晚期胃癌患者接受含奥沙利铂化疗方案一线化疗后的生存期相关,可预测患者的预后.     

汉族晚期大肠癌ERCC1和XRCC1基因多态性与奥沙利铂化疗敏感相关性的研究

目的:探讨ERCC1Asn118Asn和XRCC1Arg399Gln多态性与中国汉族晚期大肠癌患者对奥沙利铂(Oxaliplatin,L-OHP)一线化疗临床效果的关系。方法:62例晚期大肠癌患者化疗前抽取静脉血并提取DNA,以RT-PCR法对ERCC1、XRCC1基因进行SNP分型。患者接受奥沙利铂为主的化疗方案化疗,比较不同基因型与化疗效果的关系。结果:ERCC1Asn118Asn基因突变频率为:C/C53.23%(33/62),C/T37.10%(23/62),T/T9.67%(6/62);XRCC1Arg399Gln基因突变频率为:G/G50.00%(31/62),G/A37.10%(23/62),A/A12.90%(8/62)。62例患者化疗2～3个周期后评价临床获益率为54.84%。ER-CC1基因Asn118Asn基因型C/C与C/T T/T在化疗获益组和化疗不敏感组中分布差异有统计学意义,χ2=6.289,P=0.021。XRCC1基因Arg399Gln基因型G/G与G/A A/A在化疗获益组和化疗不敏感组中分布差异也有统计学意义,χ2=6.513,P=0.021。两者联合多态性分析发现,同时携带ERCC1C/C和XRCC1G/G基因型患者化疗敏感性是同时携带ERCC1C/T T/T和XRCC1G/A A/A基因型患者的11.333倍,P=0.002。结论:ERCC1Asn118Asn、XRCC1Arg399Gln基因多态性与中国汉族晚期大肠癌患者接受奥沙利铂一线化疗后的临床效果有关。     

DICER基因多态性与食管癌淋巴结转移危险因素的关系

目的探讨中国汉族人群中DICER基因rs3742330多态性与食管癌淋巴结转移危险因素的关系。方法采用以医院为基础的病例-病例研究方法,采用基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)技术分析85例有淋巴结转移的食管癌和270例无淋巴结转移的食管癌DICER基因rs3742330基因多态性,计算各种基因型与食管癌淋巴结转移的发生风险及其95%可信区间。结果DICER rs3742330 A>G多态三种基因型AA、AG、GG在食管癌淋巴结转移组的频率分别为31.76%、61.18%、7.06%,在无淋巴结转移组的频率分别为34.44%、48.15%、17.41%,与携带DICER rs3742330 AA基因型的个体相比较,DICER rs3742330 GG基因型显著减少食管癌淋巴结转移发生的危险。结论DICER rs3742330 A>G基因多态性可能是食管癌淋巴结转移的保护性因素。     

ERCC1和XRCC1基因多态性与接受奥沙利铂化疗晚期大肠癌患者生存期的关系

目的:探讨DNA损伤修复基因ERCC1 Asn118Asn和XRCC1 Arg399Gln多态性与接受奥沙利铂一线化疗的中国晚期大肠癌患者生存期的关系.方法:99例晚期大肠癌患者化疗前抽取静脉血并提取DNA,以real-time PCR法对ERCC1、XRCC1基因进行SNP分型.患者接受奥沙利铂为主的化疗方案化疗,比较不同基因型与患者生存期的关系.结果:ERCC1 Asn118Asn基因位点在所研究的中国大肠癌患者中的突变频率为:C/C 50.51%、C/T 41.41%、T/T8.08%;XRCC1 Arg399Gln基因突变频率为:G/G 52.53%、G/A 38.38%、A/A 9.09%.99例晚期大肠癌患者中位TTP为7个月.ERCC1C/C基因型患者中位TTP 10个月,C/T T/T型患者中位TTP 5个月,二者有显著统计学差异(P<0.01);XRCC1G/G基因型中位TTP 10个月,G/A A/A基因型中位TTP 5个月,二者比较差异有显著性(P<0.01).两个基因联合多态性分析发现,同时携带ERCC1 C/C和XRCC1 G/G基因型、ERCC1 C/C和XRCC1 G/A A/A基因型、ERCC1 C/T T/T和XRCC1 G/G基因型、以及ERCC1 C/T T/T和XRCC1 G/A A/A基因型的患者中位TTP分别为11个月、6个月、5个月和5个月,4组比较差异有显著性(P<0.01).结论:ERCC1 Asn118Asn、XRCC1 Arg399Gln基因多态性与中国晚期大肠癌患者接受奥沙利铂一线化疗后的生存期有关.     

PD1多态性与晚期非小细胞肺癌铂类化疗敏感性及骨髓抑制的关系

目的： 探讨程序性细胞死亡受体1( programmed cell death 1，PD1)单核苷酸多态性(single nucleotide polymorphism，SNP)与晚期非小细胞肺癌(non-small cell lung cancer，NSCLC)患者铂类药物化疗疗效及化疗后骨髓抑制的相关性。方法： 对103例接受铂类药物化疗的晚期NSCLC患者进行临床疗效及骨髓抑制评价。采用RT-PCR法对PD1基因rs36084323A/G、rs2227982C/T多态性位点进行基因型分析。探讨不同基因型与铂类药物化疗效果、骨髓抑制之间的关系。结果： rs2227982C/T多态性与晚期NSCLC铂类化疗敏感性密切相关，随着等位基因T数目的增加，患者的化疗有效率逐渐升高(CC：20.0%、CT：46.3%、 TT：64.7%)。至少携带一个等位基因T的患者(CT+TT)化疗反应率为CC型的2.58倍(95%CI:1.370-4.880，χ2=10.84，P=0.001)。rs36084323A/G多态性与化疗后骨髓抑制之间存在密切关联，随着等位基因G数目的增加， III-IV度骨髓抑制的发生率逐渐升高(AA：12.2%、AG：35.0%、 GG：40.9%)。携带G等位基因患者(AG+GG) III-IV度骨髓抑制的发生率是AA型的3.04倍(95%CI: 1.258-7.356，χ2=7.625，P=0.006)。结论：PD1基因多态性与晚期NSCLC铂类化疗临床反应、骨髓抑制之间存在关联，携带rs2227982 T等位基因的患者有更高的化疗反应率，而rs36084323 G等位基因携带者更容易出现III-IV度骨髓抑制，PD1基因多态性检测有可能作为晚期NSCLC铂类化疗敏感性及化疗后骨髓抑制的预测指标。     

ERCC5基因+25A＞G多态性与晚期结直肠癌铂类药物疗效的相关性

目的 探讨切除修复交叉互补基因5(ERCC5)基因单核苷酸多态性与中国汉族晚期结直肠癌患者铂类药物疗效的相关性.方法 应用PCR-LDR法检测以奥沙利铂为主化疗的105例晚期结直肠癌患者ERCC5基因位点+25A＞G (rs751402)、+202C＞T (rs2296147)及+372C＞T (rs2296148)的...     

ERCC1基因多态性与晚期非小细胞肺癌患者铂类化疗疗效的关系

背景与目的有关ERCC1基因多态性是否影响接受含铂化疗的晚期非小细胞肺癌患者疗效及生存的研究结果不相一致。本研究前瞻性研究90例接受含铂方案化疗的初治晚期非小细胞肺癌患者ERCC1基因C8092A和第118位密码子多态性与疗效的关系。方法全部患者均接受含铂联合方案化疗,采用测序法对患者基因型进行分型,比较不同基因型与疗效的关系。结果ERCC1C8092A基因型频率分别为CC40.0%(36/90)、CA48.9%(44/90)、AA11.1%(10/90),第118密码子基因型频率分别为CC58.9%(53/90)、CT34.4%(31/90)、TT6.7%(6/90)。C8092ACC基因型有效率与CA、AA基因型无统计学差异(33.3%vs29.6%,P=0.71),ERCC1118CC基因型患者有效率与CT和TT基因型无统计学差异(32.1%vs24.3%,P=0.43)。C8092ACC基因型患者与CA和AA基因型PFS无统计学差异(5.2个月vs5.4个月,P=0.62),ERCC1118CC基因型患者CT和TT基因型PFS无统计学差异(5.5个月vs5.3个月,P=0.59)。结论ERCC1C80...     

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.     

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.     

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.     

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     

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.     

Concomitant radiotherapy with chemotherapy in patients with glioblastoma

Glioblastomas are the most frequent and the most aggressive primary brain tumors in adults. Therapeutic strategy is challenging because of radioresistance and chemoresistance explaining the poor prognosis (median survival of 12 months). Standard therapy consisted until recently of surgery and postoperative radiotherapy while the impact of chemotherapy (investigated as adjuvant, neo adjuvant therapy or concomitant with irradiation) was a matter of debate. However a recent phase III study has concluded to the benefit of adjuvant temozolomide administered during and after radiotherapy. This strategy is yet to become a standard.