伊立替康（艾力）联合氟尿嘧啶与四氢叶酸钙治疗晚期耐药胃癌的临床探讨

目的观察伊立替康（irinotecan,CPT-11）联合氟尿嘧啶（5-fluorouracil,5-Fu）与四氢叶酸钙（Leucovorin,CF）组成IFL方案治疗晚期耐药胃癌的近期疗效及其安全性。方法回顾性分析我科2003年3月至2009年3月收治的33例具有完整临床资料的晚期耐药胃癌患者接受伊立替康（艾力）联合5-氟尿嘧啶与四氢叶酸钙治疗的情况,艾力100 mg/m2,静滴,第1天;四氢叶酸钙100mg/m2,静滴,第1~5天;氟尿嘧啶300 mg/m2,静滴,第1~5天,21 d为1周期,至少2个周期后按照WHO标准评估疗效及不良反应。结果完全缓解（CR）0例,部分缓解（PR）8例,稳定（SD）12例,进展（PD）13例,客观有效率（ORR）为24.2%（8/33）,临床肿瘤控制率（tumor control rate,TCR）为60.6%（20/33）。主要不良反应是恶心、呕吐、腹泻及骨髓抑制等,而肝功能异常、口腔黏膜炎、发热等较轻,无明显肾毒性和心脏毒性,未发生因化疗产生严重不良反应而终止治疗者,无化疗相关性死亡病例。结论伊立替康（艾力）联合氟尿嘧啶与四氢叶酸钙治疗晚期耐药胃癌安全有效,且适合我国社会与经济情况。

Clinical study of irinotecan combined with 5-fluorouracil and leucovorin in treatment of refractory advanced gastric cancer

Objective To evaluate the clinical efficacy and safety of the improved IFL regimen consisting of irinotecan combined with 5-fluorouracil（5-Fu） and leucovorin（CF） in the treatment of refractory advanced gastric cancer.Methods Records of 33 patients with refractory advanced gastric cancer,who had integral clinical data and treated with irinotecan/5-Fu/CF regimen from March.2003 to March.2009,were reviewed.All patients received chemotherapy of the regimen： irinotecan 100 mg/m2 iv gtt d1,CF 100 mg/m2 iv gtt d1-5,5-Fu 300 mg/m2 iv gtt d1-5,one cycle was 21 days.A1l patients received at least two cycles of treatment.Results There was no complete response（CR） patient.The partial remission（PR）,stable disease（SD） and progression disease（PR） rates were 24.4%（8/33）,36.4%（12/33） and 39.4%（13/33） respectively.Objective response rate（CR＋PR） was 24.4%（8/33）,clinical tumor control rate was 60.6%（20/33）.The therapy was generally well tolerated,the main toxic reactions were nausea,vomiting,diarrhea and myelosuppression.There was no chemotherapy-related death.Conclusion Irinotecan /5-Fu/CF regimen is effective and well tolerated in the patients with refractory advanced gastric cancer.Furthermore,it also meets the social and economoic requirements in our country.