吉西他滨联合奈达铂三线治疗晚期鼻咽癌的临床观察

目的观察吉西他滨（gemcitabine,GEM）联合奈达铂（nedaplatin,NDP）的方案治疗晚期鼻咽癌的近期疗效及毒性反应。方法 21例均为一线含铂方案及二线紫杉类方案化疗失败的晚期鼻咽癌患者。GEM1000mg/m2静脉滴注,第1、8d;NDP80mg/m2静脉滴注,第1d,3-4周为1个周期,完成2周期化疗后评价疗效及毒性反应。结果 21例患者无CR病例,5例PR（23.8%）,9例SD（42.9%）,7例PD（33.3%）,有效率（CR＋PR）23.8%,疾病控制率（CR＋PR＋SD）66.7%。中位缓解时间4.2个月。主要毒副反应为骨髓抑制：Ⅲ-Ⅳ度的WBC及N下降11例,占52.4%,粒细胞减少性发热有3例;Ⅲ-Ⅳ度的血小板下降12例,占57.1%。非血液学毒性轻微。结论吉西他滨联合奈达铂方案三线用药对鼻咽癌仍有较好疗效,除骨髓毒性外其他毒副反应轻微,经过严格的病例选择及采取有效及时的防治措施,可作为鼻咽癌化疗的三线方案临床应用推广。

Gemcitabine plus Nedaplatin as third-line chemotherapy in patients with metastatic Nasopharyngeal Carcinoma

Objective To evaluate the short term efficacy and toxicity of gemcitabine in combination with nedaplatin as third-line treatment in the patients with metastatic nasopharyngeal carcinoma（NPC）. Methods All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with paclitaxel or docetaxel. Gemcitabine was given on day 1, 8 at a dose of 1000mg/m2 and nedaplatin on days 1 at a dose of 80mg/m2. The chemotherapy was repeated every 3 or 4 weeks. Efficacy and toxicity would be evaluated after the completion of two cycles of chemotherapy. Results No complete response occurred in the patients. Partial remission was observed in 5 patients（23.8%）, 9 patients achieved a stable status（42.9%）, 7 patients suffered from progressive disease（33.3%）. The total response rate（CR＋PR） was 23.8% and the disease control rate（CR＋PR＋SD） was 56.7%. Median time to progression（TTP） was 4.2 months. Hematological toxicities were the predominant side effects with grade 3/4 leukopenia, thrombocytopenia were observed in 52.4%, 57.1% of patients ,respectively, 3 febrile neutropenia occurred. Non-hematological toxicity was mild. Conclusion The combination of gemcitabine and nedaplatin showed a promising results as third-line chemotherapy in patients with metastatic NPC, which merits the further study in a prospective clinical trial.