晚期结直肠癌三种化疗方案的成本-效果分析

目的:探讨晚期结直肠癌不同化疗方案临床疗效和经济学效果。方法:92例晚期结直肠癌患者,根据不同治疗方案分为3组。FOLFOX方案:奥沙利铂85 mg·m-2,iv,d1;亚叶酸钙200 mg·m-2,iv,d1～2;氟尿嘧啶400 mg·m-2,iv,d1～2,600 mg·m-2·d-1,44 h持续静脉点滴,d1～2。14 d为一周期。FOLFIRI方案:伊立替康180 mg·m-2,iv,d1;亚叶酸钙200 mg·m-2,iv,d1～2;氟尿嘧啶400 mg·m-2,iv,d1～2,600 mg·m-2·d-1,44 h持续静脉点滴,d1～2。14 d为一周期。XELOX方案:卡培他滨2 000 mg·m-2·d-1,po,d1～14;奥沙利铂130 mg·m-2,iv,d1。21 d为一周期。运用药物经济学成本-效果分析方法,对3组治疗方案进行分析和评价。结果:FOLFOX方案、FOL- FIRI方案、XELOX方案的有效率分别为40．0％,48．6％,11．8％。化疗一个疗程住院费用分别为4 704．60元、11 167．25元、6 387．97元。在FOLFOX方案的基础上,每增加一个单位效果,FOLFIRI方案和XELOX方案所追加的成本分别为751．47元和-59．69元。结论:根据本研究结果表明,FOLFOX方案为晚期结直肠癌化疗的较好方案。     

IP方案治疗35例复发和难治性非霍奇金淋巴瘤疗效分析

目的：观察IP方案治疗复发和难治性非霍奇金淋巴瘤的疗效和毒性反应。方法：对35例复发和难治性非霍奇金淋巴瘤患者采用IFO 1．5g／m^2，静滴，第1～5天；Mesna 0．4g，静注，于IFO静滴后0．4h各1次，第1～5天；DDP30mg／m^2。静滴。第1～3天。以上方案每3～4周重复1次，连用2～3个周期。结果：全组35例。CR5例,PR23例，总有效率80．O％。毒副反应主要是血液学毒性，白细胞和血小板下降发生率分别为77．1％、34．3％，白细胞Ⅲ、Ⅳ度毒性为25．7％、11．4％。结论：IP方案治疗复发和难治性非霍奇金淋巴瘤的疗效比较满意，其毒性能够耐受。经对症处理均能恢复。     

根除胃幽门螺旋杆菌感染方法比较

目的 寻找经济、高效治疗胃幽门螺旋杆菌(HP)感染方法。方法将经内镜检查、尿素酶试验和病理学检查证实有HP感染的132例病人随机分为2组，A组67人，接受奥美拉唑 替硝唑 庆大霉素缓释片(OTG)治疗1周；B组65人，接受洛赛克 克拉霉素 阿莫西林(LCA)治疗1周。停药后1月和6个月进行随访，随访时对患者行C^14呼吸试验确定HP根除率，必要时进行胃镜和尿素酶试验。结果 132例患者两种方案初次随访，HP清除率分别为86．5％和92．3％；6个月后第二次随访两种方案HP清除率分别为79．3％和87．7％。二者比较差异无显著性。结论 治疗HP感染相关性胃炎和胃溃疡患者，OTG和LCA方案疗效相当，而OTG费用低，安全性好，是一种值得推广的方案。     

OHLF3和FOLFOX4方案治疗晚期胃癌疗效观察

目的探讨OHLF3和FOLFOX4方案治疗晚期胃癌的临床疗效及毒副反应,。方法将65例经病理确诊的晚期胃癌患者随机分为2组。治疗组34例,采用OHLF3方案化疗草酸铂135mg/m2,静脉点滴2h,第1天,羟基喜树碱6mg/m2,静脉点滴,第1~5天;甲酰四氢叶酸钙200mg/m2,静脉点滴2h,第1~3天;5-氟脲嘧啶400mg/m2,快速静脉推注,追加600mg/m2,持续静脉点滴22h,第1~3天。每21天为1个周期。对照组31例,采用FOLFOX4方案化疗草酸铂85mg/m2,静脉点滴2h(先入),第1天;甲酰四氢叶酸钙和5-氟脲嘧啶剂量与用法同治疗组,于1~2天内给予。每2周为1个周期。对两组的总反应率、毒副反应、生活质量改善率、中位进展时间(MTTP)和中位生存期(MST)作回顾性分析。结果治疗组与对照组的总反应率分别为58.8%(20/34)和48.4%(15/31),无显著性差异(χ2=0.71,P>0.05);完全缓解率分别为20.6%(7/34)和3.2%(1/31),有显著性差异(χ2=4.53P<0.05);两组主要毒副反应为血液和神经毒性。生活质量改善率分别为82.6%和60.0%,有显著性差异(χ2=4.78,P<0.05)。MTTP及MST差异亦具有显著性。结论OHLF3和FOLFOX4方案治疗晚期胃癌的疗效均较好,毒副反应能耐受,在完全缓解率生活质量改善率及MTPP和MST方面OHLF3方案优于FOLFOX4方案。     

三种肺癌化疗方案的药物经济学分析

目的探讨肺癌不同治疗方案治疗效果的药物经济学分析。方法93例肺癌患者,根据不同治疗方案随机分为第一、第二和第三组。运用药物经济学成本-效果分析方法对3组治疗方案进行回顾性分析、评价。结果第一组(NP 250方案)显效率53.13%,一个疗程费用13683元;第二组(NP 500方案)和第三组(NP方案)显效率分别为64.52%和46.67%,一个疗程费用分别为13922元和13443元。第二组方案优于第一组和第三组。结论药物经济学在优化治疗方案,指导合理用药,提高经济效益,节约卫生资源方面具有重要意义。     

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。     

CAF方案及综合治疗方案治疗激素受体阴性乳腺癌多发性骨转移的疗效比较

目的　评价单用CAF方案及综合治疗方案 (CAF方案 +甲孕酮 +氯甲双磷酸盐 )治疗激素受体阴性乳腺癌多发性骨转移的疗效和毒副作用。方法　CAF方案 2 8例 ;综合治疗方案 3 0例。结果　综合治疗方案骨痛缓解率及骨转移灶疗效分别为 2 8/ 3 0、17/ 3 0 ,均高于单用CAF方案 15 / 2 8、9/ 2 8,其差异有显著性 ;综合治疗方案的中位生存期为 6 8月 ,稍优于CAF方案 5 7月 ,但其差异无显著性。此外 ,综合治疗方案的骨髓毒性低于CAF方案 ,其差异有显著性。结论　CAF方案 +甲孕酮 +氯甲双磷酸盐这一综合治疗方案是治疗激素受体阴性乳腺癌多发性骨转移的较有效方案     

Addition of either irinotecan or methotrexate to bolus 5-fluorouracil and high-dose folinic acid every 2 weeks in advanced colorectal carcinoma: a randomised study by the Southern Italy Cooperative Oncology Group.

PURPOSE: The purpose of this study was to compare the activity and toxicity of the combination of irinotecan (IRI) plus folinic acid (FA)-modulated 5-fluorouracil (5-FU) i.v. bolus with a regimen of double modulation of 5-FU with methotrexate (MTX) and FA in patients with advanced colorectal carcinoma. PATIENTS AND METHODS: Two-hundred and thirty-four patients were enrolled: 118 patients received IRI 200 mg/m2 (90-min i.v. infusion) on day 1, followed by levo-FA 250 mg/m2 (2-h i.v. infusion) and 5-FU 850 mg/m2 (i.v. bolus) on day 2 (IRIFAFU), and 116 patients received MTX 750 mg/m2 (2-h i.v. infusion) on day 1, followed by levo-FA 250 mg/m2 (2-h i.v. infusion) and FU 800 mg/m2 (i.v. bolus) on day 2 (MTXFAFU). Both cycles were repeated every 2 weeks until progression or to a maximum of 16 cycles. Response rate (RR) was the main end point of the study; responses were assessed every four cycles and confirmed after 2 additional months of treatment. RESULTS: RR was significantly greater with IRIFAFU (36%) than with MTXFAFU (20%) (P <0.001). Multivariate analysis showed that IRIFAFU was significantly associated with a greater activity (P = 0.028). Median progression-free survival was longer with IRIFAFU than with MTXFAFU (7.2 months compared with 4.8 months; P = 0.048). Median survival time (MST) did not differ between the two arms (14.7 months compared with 14.8 months, respectively). Patients not receiving second-line chemotherapy, however, lived longer when treated in the first-line with IRIFAFU (MST 11.9 months compared with 6.4 months; P = 0.038). IRIFAFU caused a significantly greater occurrence of grade 3 or 4 neutropenia (40% compared with 9%; P = 0.001) and diarrhoea (13% compared with 4%; P = 0.024), but a significantly lower incidence of stomatitis (3% compared with 12%; P = 0.007), than the comparative regimen. CONCLUSIONS: IRIFAFU appeared comparable in terms of activity and toxicity with other weekly or biweekly bolus or infusional combination regimens. IRIFAFU, however, seems easier to administer, because it does not require infusional catheter or pump devices, and it is less expensive. It may represent a new option for treating advanced colorectal carcinoma.     

Intensified CHOP regimen in aggressive lymphomas: maximal dose intensity and dose density of doxorubicin and cyclophosphamide.

BACKGROUND: Following our previous study of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) intensification in non-Hodgkin's lymphoma (NHL), in the present report we attempted to further increase dose intensity by shortening the between-course intervals with the support of growth factors. PATIENTS AND METHODS: A total of 67 patients were enrolled. With a fixed dose of doxorubicin 75 mg/m(2), cyclophosphamide (CTX) was started at a dose of 1750 mg/m(2) and increased by 250 mg/m(2) in consecutive cohorts of patients provided that no dose-limiting toxicity occurred. After the maximal tolerated dose (MTD) had been identified, this was used to treat more patients in order to confirm the feasibility of the regimen on a large scale, with the number of cycles being varied on the basis of disease extension. RESULTS: Twenty-three cases were enrolled in the CTX dose finding phase. Dose-limiting non-hematological toxicity occurred at 2250 mg/m(2). As the intermediate level of 2000 mg/m(2) had a borderline toxicity profile, a CTX dose of 1750 mg/m(2) was defined as the MTD. A total of 53 patients then received the MTD during the course of the study as a whole. At the MTD, toxicity was acceptable. Only 10 of 189 cycles (4%) required hospitalization due to infection or febrile neutropenia. Seventy-four percent of the patients achieved complete remission. Freedom from progression and overall survival at 12 months were 71% and 86% in the whole series, and 58% and 71% for high-risk cases, respectively. CONCLUSIONS: This intensified CHOP regimen is feasible on an outpatient basis. It can be safely considered a definitive treatment in patients at low and intermediate risk, and as induction before high-dose consolidation in high-risk cases.     

Randomized phase II study of biweekly CHOP and dose-escalated CHOP with prophylactic use of lenograstim (glycosylated G-CSF) in aggressive non-Hodgkin's lymphoma: Japan Clinical Oncology Group Study 9505.

BACKGROUND: CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) is accepted as the best available standard treatment for first-line chemotherapy in aggressive non-Hodgkin's lymphoma (NHL). However, the therapeutic efficacy of CHOP remains unsatisfactory, particularly in high-intermediate risk and high risk patients, and a new strategy is warranted in this patient population. The aim of the present study was to explore a suitable therapeutic-intensified regimen for the treatment of aggressive NHL. PATIENTS AND METHODS: Between May 1995 and July 1998, a total of 70 patients with high-intermediate risk or high risk aggressive NHL, according to the International Prognostic Index, were enrolled and randomly assigned to receive either eight cycles of standard CHOP (cyclophosphamide 750 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.4 mg/m(2) and prednisolone 100 mg for 5 days) every 2 weeks, or six cycles of dose-escalated CHOP (cyclophosphamide 1500 mg/m(2), doxorubicin 70 mg/m(2), vincristine 1.4 mg/m(2) and prednisolone 100 mg for 5 days) every 3 weeks. Lenograstim (glycosylated rHuG-CSF), at a dose of 2 micro g/kg/day s.c., was administered daily from day 3 until day 13 with biweekly CHOP and until day 20 with the dose-escalated CHOP. The primary endpoint was complete response rate. RESULTS: The complete response rate was 60% [21 of 35; 95% confidence interval (CI) 42% to 76%] with biweekly CHOP and 51% (18 of 35; 95% CI 34% to 69%) with dose-escalated CHOP. The major toxicity was grade 4 neutropenia and was more frequent in the dose-escalated CHOP arm (86%) than in the biweekly CHOP arm (50%). Grade 4 thrombocytopenia was also more frequent in the dose-escalated CHOP arm (20%) than the biweekly CHOP arm (3%). Non-hematological toxicities were acceptable in both arms. One treatment-related death (due to cardiac arrhythmia) was observed in a dose-escalated CHOP patient. Progression-free survival at 3 years was 43% (95% CI 27% to 59%) in the biweekly CHOP arm and 31% (95% CI 16% to 47%) in the dose-escalated CHOP arm. Although seven patients were deemed ineligible by central review of the pathological diagnosis, the results for both eligible and all enrolled patients were similar. CONCLUSIONS: Similar complete response rates and progression-free survival rates, but lower toxicity, indicated that biweekly CHOP was superior to dose-escalated CHOP in the treatment of aggressive NHL. Based on these results, the Lymphoma Study Group of the Japan Clinical Oncology Group is conducting a randomized phase III study comparing biweekly CHOP with standard CHOP in newly diagnosed patients with advanced-stage aggressive NHL.