CAF方案和CAP方案治疗晚期乳腺癌疗效

目的　比较CAF方案和CAP方案治疗晚期乳腺癌的疗效以及毒性反应。方法　选择 42例晚期乳腺癌患者随机分为两组 ,A组接受CAF方案治疗 (CTX、ADM、FUDR)。B组接受CAP方案治疗(CTX、ADM、DDP)。结果　A、B两组有效率分别为 6 8 1%和 6 0 0 % ,无显著性差异 (P >0 .0 5 ) ;两组毒性反应主要是骨髓抑制、消化道反应和心脏毒性 ,而消化道反应A组明显低于B组有显著性差异 (P<0 .0 1)。结论　CAF方案和CAP方案均为治疗晚期乳腺癌的有效方案 ,但CAF方案的毒性小 ,病人易于耐受。     

TCF方案与PF方案治疗晚期食管癌的临床研究

目的:观察比较紫杉醇联合顺铂、氟尿嘧啶(TCF方案)与顺铂加氟尿嘧啶(PF方案)两个方案治疗晚期食管癌的临床疗效和毒性反应。方法:共69例患者,分别用TCF、PF方案化疗,28天为1个周期。2个周期以后按照WHO标准进行疗效评价。结果:TCF方案可评价疗效者32例,CR2例,PR15例,有效率53.1%。中位疾病进展时间为5.4个月,中位生存时间10.1个月。可评价毒副反应33例。主要不良反应为脱发、中性粒细胞降低,恶心、呕吐也较常见。PF方案可评价疗效者29例,PR14例,有效率48.3%。中位疾病进展时间3.9个月,中位生存期8.7个月。主要不良反应为恶心、呕吐。结论:TCF方案对晚期食管癌疗效好,毒副反应可耐受,可以考虑作为治疗晚期食管癌的主要治疗方案。     

FOLFOX方案与EPLF方案治疗晚期胃癌疗效比较

目的观察FOLFOX方案(草酸铂、四氢叶酸钙和5-Fu)与EPLF方案(表阿霉素、顺铂、四氢叶酸钙和5-Fu)治疗晚期胃癌的近期疗效和毒副作用。方法54例Ⅲb和Ⅳ期胃癌患者依入院次序分组,接受FOLFOX方案与EPLF方案治疗两周期后评价疗效。结果FOLFOX方案组有效率51.9%(14/27),EPLF方案组有效率44.4%(12/27),但两组差异无显著性(P>0.05);FOLFOX组Ⅲ Ⅳ度白细胞减少(6/27)与FOLFOX组(0/27)相比差异有显著性(χ2=6.087,P=0.0166)。FOLFOX方案组周围感觉神经炎的发生率较EPLF方案组高,恶心、呕吐、脱发的发生率较FOLFOX低,两组差异有显著性(P<0.05)。结论两种方案疗效肯定,均可作为胃癌化疗的临床一线方案应用,对一些年老体弱或多次化疗后骨髓耐受差的患者可能更适合FOLFOX方案。而在临床方案选择时,提示可根据不同的患者的实际情况选择。     

IN方案与CAV方案治疗EP方案耐药广泛期小细胞肺癌的临床观察

目的探讨EP方案耐药广泛期小细胞肺癌安全有效的二线化疗方案。方法根据治疗方案将87例EP方案耐药广泛期小细胞肺癌患者分为观察组(45例)与对照组(42例),观察组接受IN方案治疗,对照组接受CAV方案治疗。化疗2个周期后进行疗效评价,同时采用抗肿瘤药物不良反应分级标准(WHO标准)进行安全性评价。结果 1观察组治疗效果显著优于对照组,差异有统计学意义(P<0.05)。22组患者骨髓抑制、呕吐等不良反应分级差异无统计学意义(P>0.05);观察组腹泻程度显著重于对照组,差异有统计学意义(P<0.05)。所有发生不良反应的患者经对症支持治疗后均得到缓解。结论 IN方案治疗EP方案耐药广泛期小细胞肺癌具有安全、有效等特点,值得临床应用及推广。     

肿瘤基因治疗方案

本文就目前报道较多的肿瘤基因治疗方案进行了综述。这些方案涉及表达细胞因子的肿瘤浸润淋巴细胞和肿瘤细胞、抑癌基因与原癌基因、多抗药性基因、肿瘤相关性抗原、Ｂ７共刺激分子基因以及自杀基因等。     

CAF方案和CAP方案治疗晚期乳腺癌疗效

目的：比较CAF方案和CAP方案治疗晚期乳腺癌的疗效以及毒性反应，方法：选择42例晚期乳腺癌患随机分为两组，A组接受CAF方案治疗（CTX，ADM，FUDR），B组接受CAP方案治疗（CTX、ADM、DDP）。结果：A、B两组有效率分别为68．1％和60．0％，无显性差异（P＞0．05），两组毒性反应主要是骨髓抑制，消化道反应和心脏毒性，而消化道反应A组明显低于B组有显性差异（P＜0．01），结论：CAF方案和CAP方案均为治疗晚期 乳腺癌的有效方案，但CAF方案的毒性小，病人易于耐受。     

ViVACCy化疗方案

作者设计出ViVACCy化疗方案治疗晚期肿瘤,方案组成如下。第1天,阿霉素32mg/m~2iv;环磷酰胺320mg/m~2iV;第5～12天连续并用长春硷0.3～1.2mg/m~2/日,顺氯氨铂3～12mg/m~2/日,长春新硷0.04～0.16mg/m~2/日。28天为一个疗程。18例晚期肿瘤病人共治疗37个疗程,表明后三种药物连续静注是安全的。曾用过丝裂霉素-c的病人易发生骨髓抑制,其他副作用有中度恶心呕吐,暂时血清硷     

FOLFOX4方案ELFP方案治疗晚期胃癌的疗效比较

目的比较FOLFOX4方案和ELF方案治疗晚期胃癌的临床疗效及不良反应。方法将40例经病理确诊的晚期胃癌病人随机分为两组。治疗组20例，采用FOLFOX4方案化疗：奥沙利铂（L—OHP）85mg/m^2，静脉滴注2h，d1；亚叶酸钙（cF）200mg/m^2，静脉滴注2h，d1、d2；氟尿嘧啶（5-FU）400mg/m^2，静脉推注，d1、d2；氟尿嘧啶600mg／m^2，持续静脉泵输注22h，d1、d2。每2wk为一疗程。对照组20例，采用ELCP方案化疗：足叶乙甙（Vp-16）120mg/m^2，静脉滴注，d1-d5；亚叶酸钙（CF）200mg/m^2，静脉滴注，d1-d3；氟尿嘧啶（5-Fu）500mg／m^2，静脉滴注5h以上，d1-d5；顺铂（DDP）20mg/m^2，静脉滴注2h，d1司5。每4wk为1周期。对两组的缓解率、生活质量改善率、不良反应发生率进行分析比较。结果治疗组与对照组的缓解率分别为60％和50％，无显著性差异（P〉0．05）；生活质量改善率分别为75％和45％，有显著性差异（P〈0．05）；两组主要不良反应白细胞减少、口腔溃疡、神经毒性和脱发等指标的差异具有显著性（P〈0．05）。结论FOLFOX4方案和ELCP方案治疗晚期胃癌近期疗效较好，不良反应较轻；在生活质量改善方面，FOLFOX4方案优于ELCP方案（P〈0．05）。     

GP方案与FLEP方案治疗晚期胰腺癌的疗效比较

 目的比较ＧＰ（健择＋ＤＤＰ）与ＦＬＥＰ（ＣＦ、５－Ｆｕ、ＥＰＩ、ＤＤＰ）方案治疗晚期胰腺癌的近期疗效与不良反应。方法将４０例晚期胰腺癌随机分为治疗组和对照组，分别给予ＧＰ与ＦＬＥＰ方案化疗２个周期，按ＷＨＯ标准评定疗效和不良反应。结果两组有效率（ＣＲ＋ＰＲ）分别为３０％和１５％，治疗组高于对照组（Ｐ＜０．０５），两组的毒副反应相似。不良反应主要为骨髓抑制和胃肠道反应。结论健择加顺铂是治疗晚期胰腺癌的一种安全有效的化疗方案。     

FOLFOX4方案和ECF方案治疗晚期胃癌的比较

目的：比较FOLFOX4方案和ECF方案治疗晚期胃癌的临床疗效及不良反应。方法：将50例经病理确诊的晚期胃癌患者随机分为两组。治疗组25例，采用FOLFOX4方案化疗：草酸铂85mg／m^2，静脉滴注2h，d1；亚叶酸钙200mg／m^2，静脉滴注2h，d1、d2；氟尿嘧啶400mg／m^2，静脉推注，d1、d2，氟尿嘧啶600mg／m^2，持续静脉泵输注22h，d1、d2。每2周为1周期。对照组25例，采用ECF方案化疗：表柔比星50mg／m^2，静脉推注，d1；氟尿嘧啶400mg／m^2，静脉滴注，d1～d5；顺铂20mg／m^2，静脉滴注，d1～d3。每3周为1周期。对两组的缓解率、生活质量改善率、不良反应进行分析比较。结果：治疗组与对照组的缓解率分别为56％（14／25）和52％（13／25），无显著性差异（χ^2=0．73，P〉0．05）；生活质量改善率分别为76％（19／25）和48％（12／25），有显著性差异（χ^2=6．23，P〈0．05）；两组主要不良反应白细胞减少、腹泻、口腔炎、神经毒性和脱发等指标的差异具有显著性（P〈0．05）。结论：FOLFOX4方案和ECF方案治疗晚期胃癌近期疗效较好，不良反应较轻；在生活质量改善方面，FOLFOX4方案优于ECF方案。     

局部晚期鼻咽癌同期放化疗顺铂单药每周方案剂量递增临床研究

Objective  

The purpose of this study was to define the maximum tolerated dose (MTD) by describing the doselimiting toxicity (DLT) of weekly cisplatin concurrently with conventional plus 3-dimensional conformal radiotherapy (CT + 3DCRT) in patients with loco-regionally advanced nasopharyngeal carcinoma (NPC).     

Comparison of concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil versus cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma

Objective

The aim of this study was to compare survival outcomes and toxicities between concurrent radiotherapy with cisplatin plus 5-fluorouracil and that with cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma.

Methods

We retrospectively reviewed data from 93 locally advanced cervical carcinoma patients (stage IB to IVA) who had been treated by concurrent radiotherapy with cisplatin plus 5-fluorouracil (CF, n=45) vs. cisplatin plus paclitaxel (CP, n=48) as primary therapy. Toxicities and survival outcomes were compared.

Results

In the CP group, there were higher frequencies of severe (grade 3 or 4) leukopenia (79.2%, as compared to 11.1% in the CF group), severe neutropenia (77.1%, as compared to 8.9% in the CF group) and severe peripheral neuropathy (12.5%, as compared to 2.2% in the CF group). In the CF group, there were higher frequencies of severe nausea (33.3%, as compared to 14.6% in the CP group) and severe hyponatremia (11.1%, as compared to 0% in the CP group). Five-year DFS of the CF and CP groups was 67.4% and 79.1%, respectively (p=NS). Five year OS of the CF and CP groups was 79.6% and 80.9%, respectively (p=NS).

Conclusion

Concurrent radiotherapy with cisplatin plus paclitaxel showed increased leukopenia, neutropenia and peripheral neuropathy, but less gastrointestinal toxicity (nausea) than that with cisplatin plus 5-fluorouracil. Survival outcome between these two groups was not statistically different in this study. Large prospective randomized controlled studies will be needed to confirm this result.     

Phase II study of docetaxel and vinorelbine as adjuvant chemotherapy for resected non-small cell lung cancers

Purpose

For patients with resected stage II–III non-small cell lung cancers (NSCLCs), adjuvant cisplatin-based chemotherapy improves survival over surgery alone. For cisplatin ineligible patients, there is no standard adjuvant option. We evaluated drug delivery and toxicity of docetaxel and vinorelbine in patients who could not receive cisplatin.

Methods

Patients with completely resected stage IB–III NSCLCs were treated with up to 4 cycles of docetaxel and vinorelbine at the recommended phase II dose. The primary endpoint was drug delivery compared to historical delivery of adjuvant cisplatin plus vinorelbine. Secondary endpoints were toxicity and feasibility.

Results

Twenty-five patients were enrolled. Overall, 13/25 (52 %, 95 % CI 34–70) completed 4 cycles, and 19/25 (76 %, 95 % CI 60–87) completed ≥3 cycles. Twenty of 25 patients (80 %) experienced a Grade 3 or 4 adverse event.

Conclusions

Delivery of this dose and schedule of docetaxel and vinorelbine was difficult with a dose delivery comparable to cisplatin plus vinorelbine, and cisplatin plus docetaxel, used in this setting.     

Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma

Introduction

The National Institute for Health and Clinical Excellence (NICE) has previously recommended pemetrexed plus cisplatin for the treatment of patients with advanced malignant pleural mesothelioma (MPM) and WHO performance status 0-1. Subsequent to this appraisal, randomised controlled trial (RCT) data for raltitrexed plus cisplatin and comparing chemotherapy to active symptom control (ASC) has become available, allowing a more complete analysis of the comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM.

Methods

An adjusted indirect comparison is used to estimate the relative efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A cost-effectiveness model is used to assess the lifetime costs and health outcomes associated with these comparators and ASC. Patient level data from the EORTC 08983 trial are used to estimate baseline progression and survival rates. Relative treatment effects are taken from RCTs; cost and utility data from the literature.

Results

Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically significantly different with respect to overall response, progression free survival or overall survival. The cost-effectiveness analysis found raltitrexed plus cisplatin to be cost-effective at a cost per quality adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC. Pemetrexed plus cisplatin is dominated by raltitrexed plus cisplatin as the raltitrexed combination offers marginally higher quality adjusted life years (QALYs) and life years (LYs) at a substantially lower total cost.

Conclusion

Raltitrexed plus cisplatin is a cost-effective first-line treatment for MPM. This conclusion was maintained across a number of sensitivity analyses.     

The efficacy and safety of gemcitabine plus cisplatin regimen for patients with advanced urothelial carcinoma after failure of M-VAC regimen

Background  

Our aim was to study the efficacy and safety of combination chemotherapy with gemcitabine plus cisplatin (GC) for patients with advanced urothelial carcinoma (UC) after failure of methotrexate, vinblastin, adriamycin, and cisplatin (M-VAC) chemotherapy.     

Concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil (5-FU) and cisplatin for locally advanced resectable esophageal cancer

Background

Neoadjuvant concurrent chemoradiotherapy (CCRT) has become the standard treatment for esophageal cancer (EC) in North America. The cisplatin/5-flurouracil (5-FU) combination has been the most commonly used regimen. For the last 15 years we incorporated a daily continuous infusion of 5-FU and 2 doses of cisplatin into our neoadjuvant CCRT for potentially resectable EC.

Patients and methods

Between July 1997 and June 2012, 129 patients with locally advanced EC (T3 or N1 and higher), received neoadjuvant CCRT with cisplatin 75 mg/m² on day 1 and day 29 and continuous infusion of 5-FU (225 mg/m²/day) on the days of radiation.

Results

The median age of patients was 63 years, 85% had adenocarcinoma, 29, 74 and 26 patients had stage II, III and IVa disease respectively, 110 patients had N1 disease based on the American Joint Committee on Cancer (AJCC) 6^th edition, 118 patients experienced weight loss during treatment. All patients completed treatment. Treatment was well tolerated with 14% of patients having ≥ grade 3 toxicity and 18 patients requiring hospital admission. Sixty-four percent of patients had surgical resection following CCRT, with disease progression and patient refusal being the most common reasons for not proceeding with surgery. An R0 resection was achieved in 96% of patients. A pathological complete response (pCR) was achieved in 45% of patients. With a median follow up of 26 months (1.2-144 months), 48/129 patients recurred and 60/129 died of their disease.

Conclusions

Our study has its limitation, however, and compared to the conventional chemotherapy regimens containing the cisplatin/5-FU doublet, our treatment strategy for locally advanced EC CCRT seems to be feasible and well tolerated.     

GP方案治疗RRM1蛋白低表达的晚期非小细胞肺癌的疗效观察(英文)

Objective:The aim of this study was to observe the efficacy of gemcitabine combined with cisplatin(GP)in advanced non-small cell lung cancer(NSCLC)patients with low expression of ribonucleotide reductase 1(RRM1)protein using immunohistochemistry.Methods:RRM1 protein expression in tumor tissue was detected by streptavidin-peroxidase (SP)method of immunohistochemistry.GP regimen(gemcitabine 1000-1250 mg d1,d8,cisplatin 75 mg/m2)was given to advanced NSCLC patients with low expression of RRM1 protein.Results:I...     

Salvage treatment with irinotecan/cisplatin versus pemetrexed/cisplatin in patients with non-small cell lung cancer pre-treated with a non-platinum-based regimen in the first-line setting: a randomized phase II study of the Hellenic Oncology Research Group (HORG)

Background

Platinum-based chemotherapy is the standard front-line treatment for patients with advanced non-small cell lung cancer (NSCLC). However, non-platinum combinations of third-generation chemotherapeutic agents are considered an alternative therapeutic option for patients who cannot tolerate the toxic effects of platinum compounds. In this study, the efficacy and toxicity of the combination of irinotecan plus cisplatin (IC) was compared to pemetrexed plus cisplatin (PC) regimen, in platinum-naïve patients with advanced NSCLC, who had been previously treated with the combination of a taxane plus gemcitabine.

Patients and methods

A total of 124 patients with locally advanced or metastatic NSCLC were randomly assigned to either irinotecan 110 mg/m² on day 1 and 100 mg/m² on day 8 plus cisplatin 80 mg/m² on day 8 every 3 weeks (IC arm) or pemetrexed 500 mg/m² plus cisplatin 80 mg/m² on day 1 every 3 weeks (PC arm). The primary endpoint of the study was the overall response rate (ORR).

Results

The ORR and median progression-free survival (PFS) in the IC arm were 18 % and 3.3 months, respectively, while in the PC arm were 19 % and 4.2 months (p = ns). Median overall survival (OS) was significantly higher in patients with PC (6.9 vs. 10.9; p = 0.013). PC regimen had a better toxicity profile compared to IC, with a statistically significant lower incidence of grade 3/4 neutropenia (3 vs. 31 %; p = 0.0001) and diarrhea (1.6 vs. 14.7 %, p = 0.018).

Conclusions

In patients with advanced NSCLC pretreated with docetaxel/gemcitabine, the combination of pemetrexed/cisplatin is associated with increased OS and is better tolerated than the combination of irinotecan/cisplatin and should be considered as a valid therapeutic option for platinum-naive, previously treated patients.

ClinicalTrials.gov Identifier

NCT00614965.

     

Comparison of concurrent chemoradiation therapy with weekly cisplatin versus monthly fluorouracil plus cisplatin in FIGO stage IIB-IVA cervical cancer

Objective

Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer.

Methods

We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen.

Results

Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237).

Conclusion

Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.