晚期胃癌一线化疗失败后不同解救化疗方案的疗效比较

目的　回顾性分析不同化疗方案对一线化疗失败的晚期胃癌患者进行解救治疗的疗效和安全性,探讨晚期胃癌二线治疗适宜的化疗方案。方法　８８例一线化疗失败的晚期胃癌患者,分为紫杉类组（３２例）：多西紫杉醇６０～７５ｍｇ／ｍ^２或紫杉醇１３５～１７５ｍｇ／ｍ^２,分ｄ_１、ｄ_８;５-ＦＵ５００ｍｇ／ｍ^２ｄ_１～ｄ_５或顺铂２０ｍｇｄ_１～ｄ_５,２１天为１周期。奥沙利铂组（３１例）：奥沙利铂８５ｍｇ／ｍ^２ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。伊立替康组（２５例）：伊立替康１５０～１８０ｍｇ／ｍ^２,ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。结果　８８例均可评价不良反应,８２例可评价客观疗效。紫杉类组、奥沙利铂组以及伊立替康组总有效率分别为３.２％、１４.３％和１７.４％,疾病控制率分别为４８.４％、６０.７％和６５.２％;中位ＰＦＳ分别为２个月（１.３９～２.６１个月）、３个月（２.１６～３.８４个月）和３个月（２.４６～３.５４个月）,差异无统计学意义（Ｐ＝０.１９５）;中位ＯＳ为６个月（４.２１～７.７９个月）、７个月（６.１２～７.８８个月）和７个月（５.０８～８.９２个月）,差异无统计学意义（Ｐ＝０.３９３）。３组不良反应易耐受,主要为１～２级血液学毒性。伊立替康组腹泻发生率较高,为４８％,但３级以上发生率较低,仅为８％。奥沙利铂组外周神经毒性为４８％。结论　晚期胃癌一线治疗失败后采用目前常用的化疗方案解救治疗有一定的客观缓解率和临床受益率,但疗效有限,需要进一步积极探索有效的治疗方案。     

洛铂联合５-ＦＵ／ＣＦ治疗晚期胃、结直肠癌的剂量爬坡试验

目的　观察国人对不同剂量洛铂联合５-ＦＵ／ＣＦ治疗晚期胃、结直肠癌的耐受性、毒性反应以及与剂量的关系,探讨洛铂在联合化疗中的人体安全耐受剂量。方法　选取洛铂从低剂量逐渐至高剂量,５-ＦＵ和ＣＦ剂量不变,每剂量组至少３例受试者。初始剂量为洛铂２５ｍｇ／ｍ^２ｄ_１,５-ＦＵ４００ｍｇ／ｍ^２ｄ_１～ｄ_５,ＣＦ２００ｍｇ／ｍ^２ｄ_１～ｄ_５,２１ｄ为１周期;如无明显毒性反应则进入下一剂量组,直至最大耐受量（ＭＴＤ）或５０ｍｇ／ｍ^２。结果　１８例晚期胃、结直肠癌患者进入试验,分别进行了６个剂量组的研究,最高剂量组为５０ｍｇ／ｍ２,未观察到ＭＴＤ。主要毒性反应为血红蛋白减少、白细胞减少,其次为恶心、呕吐和腹泻,所有患者未出现３～４级不良反应。结论　洛铂联合５-ＦＵ／ＣＦ毒性反应较轻,患者耐受性较好。推荐使用洛铂４５ｍｇ／ｍ^２联合５-ＦＵ４００ｍｇ／ｍ^２和ＣＦ２００ｍｇ／ｍ^２用于进一步临床研究。     

羟基喜树碱联合奥沙利铂、氟尿嘧啶和亚叶酸钙治疗晚期胃癌的临床研究

目的　观察羟基喜树碱（ＨＣＰＴ）联合奥沙利铂（ＯＸＡ）、氟尿嘧啶（５ ＦＵ）及亚叶酸钙（ＣＦ）联合治疗晚期胃癌的近期疗效及毒副反应。方法　ＨＣＰＴ１０ｍｇ／ｍ^２静脉滴注,ｄ_１～ｄ_５;ＯＸＡ１００ｍｇ／ｍ^２静脉滴注,ｄ_１;５-ＦＵ７５０ｍｇ／ｍ^２静脉滴注,ｄ_６～ｄ_１０;ＣＦ１００ｍｇ／ｍ^２静脉滴注,ｄ_６～ｄ_１０。每２８天为１个周期,连续２个周期后评价疗效。结果　５４例均可评价疗效,ＣＲ４例,ＰＲ２７例,有效率为５７.４％,中位疾病进展时间（ＴＴＰ）为４.５个月,中位总生存时间（ＯＳ）８个月。主要毒副反应为白细胞减少、血红蛋白减少、胃肠道反应和脱发。结论　ＨＣＰＴ联合ＯＸＡ、５-ＦＵ、ＣＦ治疗晚期胃癌有较好的疗效,且毒性可以耐受,值得进一步研究。     

洛铂联合氟尿嘧啶治疗晚期食管癌的临床观察

目的　观察洛铂联合氟尿嘧啶（５-ＦＵ）治疗晚期食管癌的疗效和毒副作用。方法　２００９年８月至２０１０年３月,将４８例晚期食管癌患者分为观察组（ｎ＝２６）和对照组（ｎ＝２２）。观察组：洛铂３０ｍｇ／ｍ^２ 静滴,ｄ_１;亚叶酸钙２００ｍｇ／ｍ^２ 静滴,ｄ_１～ｄ_５;５-ＦＵ５００ｍｇ／ｍ^２静滴,ｄ_１～ｄ_５。对照组：顺铂２０ｍｇ／ｍ^２静滴,ｄ_１～ｄ_４;亚叶酸钙２００ｍｇ／ｍ^２静滴,ｄ_１～ｄ_５;５-ＦＵ５００ｍｇ／ｍ^２静滴,ｄ_１～ｄ_５。两组化疗均２１天为１周期。比较两组的疗效、不良反应以及生存随访情况。结果　４８例患者均可评价疗效,其中观察组的有效率为５３.８％,对照组为５０.０％,两组差异无统计学意义（Ｐ＞０.０５）。两组主要不良反应为消化道反应和骨髓抑制,其中观察组的恶心呕吐发生率低于对照组（Ｐ＜０.０５）,血小板减少发生率高于对照组（Ｐ＜０.０５）。观察组和对照组的中位疾病进展时间分别为３.７个月和３.４个月,中位生存期分别为８.７个月和８.２个月。结论　洛铂联合氟尿嘧啶治疗晚期食管癌的疗效较好,毒副反应可以耐受,值得临床进一步研究应用。     

培美曲塞联合低剂量ＦＰ方案治疗难治性晚期胃癌的临床观察

目的　观察培美曲塞联合低剂量ＦＰ方案在晚期难治性胃癌的疗效和不良反应。方法　全组２５例患者应用培美曲塞联合低剂量ＦＰ方案化疗,具体方法：培美曲塞５００ｍｇ／ｍ^２ｄ_１;低剂量ＦＰ方案：氟尿嘧啶（５-ＦＵ）２５０ｍｇ／ｍ^２化疗泵静脉持续静滴,ｄ_１～ｄ_１４;顺铂（ＤＤＰ）６ｍｇ／ｍ^２,ｄ_１～ｄ_５、ｄ_８～ｄ_１２。每３周为１周期,平均用药３.个周期。结果　２５例患者均可评价疗效,其中ＰＲ８例,ＳＤ１３例,ＰＤ４例,总有效率３２％（８／２５）。中位随访８.个月（２.～２４个月）,中位无肿瘤进展时间为４.个月（９５％ＣＩ：３.～７.个月）,中位总生存时间７.个月（９５％ＣＩ：６.～１３.个月）。主要不良反应为骨髓抑制和黏膜炎。结论　培美曲塞联合低剂量ＦＰ方案对难治性晚期胃癌患者疗效较好,不良反应可以耐受,值得深入研究。     

吉西他滨联合氟尿嘧啶类药物治疗耐药性晚期结直肠癌的临床观察

目的　观察吉西他滨（ＧＥＭ）联合氟尿嘧啶类药物治疗耐药性晚期结直肠癌（ｍＣＲＣ）的有效性和安全性。方法　３２例二线及二线以上方案化疗失败的ｍＣＲＣ患者,使用ＧＥＭ（１０００ｍｇ／ｍ^２,ｄ_１、ｄ_８）联合氟尿嘧啶（５-ＦＵ５００ｍｇ／ｍ^２,ｄ_１～ｄ_５）１３例,联合卡培他滨（１２５０ｍｇ／ｍ^２,ｄ_１～ｄ_１４）１９例,直至疾病进展或出现不可耐受的不良反应,每２个周期按照ＲＥＣＩＳＴ标准（１.０版）进行疗效评价,按ＮＣＩ-ＣＴＣ（３.０版）评价毒性并随访生存情况。结果　３２例均可评价疗效和毒性,其中获ＰＲ４例,ＳＤ１４例,ＰＤ１４例,疾病控制率（ＤＣＲ）为５６.３％,中位肿瘤进展时间（ｍＴＴＰ）为３.８个月,中位总生存时间（ｍＯＳ）为８.１个月。主要毒副反应为骨髓抑制、皮疹及发热,多为１～２级,支持对症处理可以恢复。结论　ＧＥＭ联合氟尿嘧啶类药物治疗国人耐药性ｍＣＲＣ具有一定疗效,不良反应可以耐受,值得进一步研究。     

ＦＯＬＦＯＸ６方案治疗晚期原发性肝癌的临床观察

目的　探讨奥沙利铂联合亚叶酸钙、氟尿嘧啶（ＦＯＬＦＯＸ６）方案治疗３１例晚期原发性肝癌患者的疗效及毒性反应。方法　入组３１例晚期原发性肝癌患者,接受奥沙利铂１００ｍｇ／ｍ^２静脉滴注１８０ｍｉｎ,第１天,亚叶酸钙２００ｍｇ／ｍ^２静脉滴注１２０ｍｉｎ,第１天,氟尿嘧啶４００ｍｇ／ｍ^２静脉推注＋２４００ｍｇ／ｍ^２４６ｈ静脉泵注,每２周重复,４周为１周期。治疗至疾病进展或出现不能耐受的毒性,持续至多６周期,每２周期评价疗效,随访２４个月。客观疗效按照ＲＥＣＩＳＴ标准评价,毒性反应按照美国ＮＣＩＣＴＣ标准评价。结果　３１例患者均可评价疗效及毒性,其中ＣＲ１例,ＰＲ４例,有效率１６.１３％,ＳＤ８例,有１６例患者（５１.６１％）的主要临床症状得以明显改善或消失,Ｋａｒｎｏｆｓｋｙ评分稳定或增高,生存质量明显提高。中位肿瘤进展时间（ＴＴＰ）为５.５个月,中位总生存时间（ＯＳ）为９.７个月。毒副反应主要为粒细胞减少３８.７１％（１２／３１）,血红蛋白减少２９.０３％（９／３１）,血小板减少３２.２６％（１０／３１）和较轻的神经毒性３８.７１％（１２／３１）。结论　ＦＯＬＦＯＸ６方案治疗晚期原发性肝癌有效,毒性反应可以接受,值得进一步研究。     

同期放化疗治疗局部晚期不可手术的直肠癌近期疗效观察

目的：观察同期放化疗治疗局部晚期不可手术的直肠癌患者的近期疗效及耐受性。方法：３８例经病理证实的局部晚期或局部 区域复发的直肠癌患者接受全盆腔三维适形放疗ＤＴ４６～５０Ｇｙ／２３～２５ｆ,后缩野至肿瘤区继续推量至ＤＴ６４～６６Ｇｙ／３２～３３ｆ,同期接受奥沙利铂１３０ｍｇ／ｍ^２ｄ_１,氟尿嘧啶３５０ｍｇ／ｍ^２ｄ_１～ｄ_５,甲酰四氢叶酸２００ｍｇ／ｍ^２ｄ_１～ｄ_５,４周为１周期,共２个周期。结果：获ＣＲ７例（１９.４％）,ＰＲ１６例（４４.４％）,ＳＤ６例（１６.７％）,ＰＤ７例（１９.４％）,总有效率（ＣＲ＋ＰＲ）为６３.９％;疼痛症状缓解率为１００％;全身状况好转率７２.２％;中位生存时间为２２个月,１年和２年总生存率分别为６７.７％和２１.３％。治疗相关的毒副反应以中性粒细胞减少、腹泻、恶心呕吐以及周围神经毒性反应为主,其３级毒副反应的发生率分别为１９.４％、１６.７％、１３.９％和１１.１％,均无３级以上毒副反应发生。结论：以奥沙利铂为基础的化疗同期联合放疗对局部晚期不可手术直肠癌患者具有较好的姑息治疗作用,其治疗依从性高,治疗相关毒性可以接受,值得临床进一步推广。     

紫杉醇脂质体联合顺铂、氟尿嘧啶一线治疗晚期胃癌的临床观察

目的：评价紫杉醇脂质体联合顺铂、氟尿嘧啶（ＰＣＦ方案）一线治疗晚期胃癌的临床疗效和毒副反应。方法：ＰＣＦ方案一线治疗４２例晚期胃癌的具体用法：紫杉醇脂质体１７５ｍｇ／ｍ^２,第１天静滴９０ｍｉｎ;顺铂７５ｍｇ／ｍ^２,第１天静滴;亚叶酸钙４００ｍｇ／ｍ^２,第１天滴注２ｈ;氟尿嘧啶２６ｇ／ｍ^２,亚叶酸钙滴注结束后立即持续泵入４６ｈ。２１天为１周期,每２周期按ＲＥ ＳＩＳＴ标准评价疗效,所有患者至少接受２周期化疗。结果：４２例患者共接受１９２个周期的化疗,所有患者均可评价疗效。完全缓解３例（７.１％）,部分缓解２０例（４７.６％）,稳定１２例（２８.６％）,进展７例,总有效率为５４.８％,中位进展时间（ＴＴＰ）６.５个月,中位生存时间（ＭＳＴ）１３.９个月。常见的不良反应为血液学毒性,胃肠反应、肌肉酸痛、外周神经毒性较轻,以Ⅰ、Ⅱ级为主。１０例（２３.８％）发生Ⅲ ～Ⅳ级粒细胞减少,伴发热１例（２.４％）;Ⅲ级恶心呕吐反应４例（９.５％）,Ⅲ级肌肉酸痛３例（７.１％）,Ⅲ级外周神经毒性２例（４.７％）,无化疗相关性死亡病例。结论：紫杉醇脂质体联合顺铂、氟尿嘧啶（ＰＣＦ方案）一线治疗晚期胃癌疗效确切,不良反应轻,值得临床推广应用。     

雷替曲塞或氟尿嘧啶／亚叶酸钙联合奥沙利铂治疗局部晚期或复发转移性结直肠癌的随机对照多中心Ⅲ期临床试验

目的　前瞻性比较雷替曲塞或氟尿嘧啶／亚叶酸钙联合奥沙利铂治疗局部晚期或复发转移性结直肠癌的有效性和安全性。方法　经病理组织学或细胞学确诊的局部晚期或复发转移性的结直肠癌患者２１４例,随机入试验组和对照组。试验组：雷替曲塞３ｍｇ／ｍ^２静滴,第１天;奥沙利铂１３０ｍｇ／ｍ^２静滴,第１天。对照组：亚叶酸钙２００ｍｇ／ｍ^２静滴,第１～５天;氟尿嘧啶３７５ｍｇ／ｍ^２静滴,第１～５天;奥沙利铂１３０ｍｇ／ｍ^２静滴,第１天。两方案均３周为１周期。每３个周期评价疗效,直至疾病进展或毒性不能耐受,最多治疗６周期。结果　全组２０３例可评价疗效,２１４例可评价毒副反应。试验组和对照组的有效率分别为２９.１％（３０／１０３）和１７.０％ （１７／１００）,差异有统计学意义（Ｐ＝０.０４１０）;疾病控制率分别为７７.７％和６３.０％,差异有统计学意义（Ｐ＝０.０２３７）。试验组中位无疾病进展时间８.７个月,明显优于对照组的７.２个月,差异有统计学意义（ＨＲ＝１.５３６,Ｐ＝０.０４５）。试验组１～２级中性粒细胞减少（４８.２％ ｖｓ．２９.４％,Ｐ＝０.００５）和转氨酶升高（４９.１％ ｖｓ．３５.３％,Ｐ＝０.０４１）的发生率明显高于对照组。对照组呕吐的发生率明显高于试验组（６１.８％ ｖｓ．４０.２％,Ｐ＝０.０００２）。结论　雷替曲塞联合奥沙利铂方案是晚期复发转移性结直肠癌有效的姑息治疗方案,有效率明显高于传统的氟尿嘧啶／亚叶酸钙联合奥沙利铂方案,毒副反应可耐受且用药方便,不用亚叶酸钙增效,值得在临床上推广应用。     

ＦＯＬＦＯＸ６方案联合腹部内生场热疗治疗晚期大肠癌的临床研究

目的　评价ＦＯＬＦＯＸ６方案联合腹部内生场热疗治疗晚期大肠癌的疗效和不良反应。方法　对照组３９例采用ＦＯＬＦＯＸ６方案：奥沙利铂１００ｍｇ／ｍ２静滴２小时,第１天;亚叶酸钙（ＣＦ）２００ｍｇ／ｍ２静滴２小时,第１天;氟尿嘧啶（５-ＦＵ）４００ｍｇ／ｍ２静推,第１天,然后总量２４００ｍｇ／ｍ２持续静滴４６小时;每２周重复１次。试验组３９例采用ＦＯＬＦＯＸ６方案化疗的同时（剂量和方法同对照组）,每周期第１天（５-ＦＵ静滴后１小时）、第８天分别进行腹部内生场热疗１小时。４周期治疗结束后评价疗效和毒副反应。结果　试验组有效率（ＣＲ＋ＰＲ）为５６４１％,中位肿瘤进展时间（ＴＴＰ）为９.５个月;对照组有效率为４１.０３％,中位ＴＴＰ为８.６个月,试验组略优于对照组,但两组差异无统计学意义（Ｐ值分别为０.１７４和０.８１２）。试验组神经系统毒性较对照组明显减轻,尤其是肢端感觉异常及面部感觉异常,两组差异有统计学意义（Ｐ值分别为０.０２３和０.０３９）。结论　ＦＯＬＦＯＸ６方案联合腹部内生场热疗治疗晚期大肠癌的疗效好,毒副作用少。     

FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study.

PURPOSE: In metastatic colorectal cancer, phase III studies have demonstrated the superiority of fluorouracil (FU) with leucovorin (LV) in combination with irinotecan or oxaliplatin over FU + LV alone. This phase III study investigated two sequences: folinic acid, FU, and irinotecan (FOLFIRI) followed by folinic acid, FU, and oxaliplatin (FOLFOX6; arm A), and FOLFOX6 followed by FOLFIRI (arm B). PATIENTS AND METHODS: Previously untreated patients with assessable disease were randomly assigned to receive a 2-hour infusion of l-LV 200 mg/m(2) or dl-LV 400 mg/m(2) followed by a FU bolus 400 mg/m(2) and 46-hour infusion 2,400 to 3,000 mg/m(2) every 46 hours every 2 weeks, either with irinotecan 180 mg/m(2) or with oxaliplatin 100 mg/m(2) as a 2-hour infusion on day 1. At progression, irinotecan was replaced by oxaliplatin (arm A), or oxaliplatin by irinotecan (arm B). RESULT: Median survival was 21.5 months in 109 patients allocated to FOLFIRI then FOLFOX6 versus 20.6 months in 111 patients allocated to FOLFOX6 then FOLFIRI (P =.99). Median second progression-free survival (PFS) was 14.2 months in arm A versus 10.9 in arm B (P =.64). In first-line therapy, FOLFIRI achieved 56% response rate (RR) and 8.5 months median PFS, versus FOLFOX6 which achieved 54% RR and 8.0 months median PFS (P =.26). Second-line FOLFIRI achieved 4% RR and 2.5 months median PFS, versus FOLFOX6 which achieved 15% RR and 4.2 months PFS. In first-line therapy, National Cancer Institute Common Toxicity Criteria grade 3/4 mucositis, nausea/vomiting, and grade 2 alopecia were more frequent with FOLFIRI, and grade 3/4 neutropenia and neurosensory toxicity were more frequent with FOLFOX6. CONCLUSION: Both sequences achieved a prolonged survival and similar efficacy. The toxicity profiles were different.     

榄香烯乳注射液联合FOLFOX4方案治疗晚期胃癌的临床观察

目的 评价榄香烯乳注射液联合FOLFOX 4方案治疗晚期胃癌的临床疗效和不良反应.方法 49例晚期胃癌随机分为榄香烯乳注射液联合化疗(治疗组)25例和单纯化疗(对照组)24例,两组均应用FOLFOX 4方案(奥沙利铂85mg/m2静滴,第1天;亚叶酸钙50mg静滴,第1、2天;氟尿嘧啶400mg/m2静推,600mg/...     

Oxaliplatin, Fluorouracil and Leucovorin （FOLFOX） as First-line Chemotherapy for Metastatic or Recurrent Colorectal Cancer Patients

OBJECTIVE To investigate the efficiency and safety of the oxaliplatin, fluorouracil(5-FU)and leucovorin regimen(FOLFOX)in previously untreated patients with metastatic or recurrent colorectal cancer. METHODS Previously untreated patients with metastatic or recurrent colorectal cancer received 100 mg/m2 of oxaliplatin intravenously(IV)over 2 h on day 1,and IV 400 mg/m2 of leucovorin over 2 h followed by a bolus of 400 mg/m2 of 5-FU.Then 2,600~3,000 mg/m2 of 5-FU was administered by continuous infusion over 46 h. RESULTS An evaluated response rate was determined for 97 of 105 treated patients.The overal response rate was 35.1%,9 patients(9.3%) had a complete response and 25 patients(25.8%)a partial response.Thirty-two patients(33.0%)developed stable disease and 32.0%of the patients progressed.The median time to progression(TTP)was 7.7 months and the median overal survival 20.5 months.One and 2-year survival rates were 68%and 32%.Toxic effects based on the National Cancer Institute-Common Toxicity Criteria(NCI-CTC),reaching grade 3/4 were:neutropenia 12.3%, anemia 11.3%,vomiting 4.1%and diarrhea 7.2%.Grade 3 neuropathy was 5.1%.The overall survival rate of patients who had received a radical resection was superior to the patients who had not received a operation,or had received a pal iative resection(P=0.0658).The serum levels of CEA,ALP and LDH had no relationship with survival(P>0.05). CONCLUSION The FOLFOX regimen containing oxaliplatin,5-FU plus leucovorin was an efficacious regimen with good tolerability in previously untreated metastatic or recurrent colorectal cancer patients.     

Multicenter phase II study of bimonthly high-dose leucovorin, fluorouracil infusion, and oxaliplatin for metastatic colorectal cancer resistant to the same leucovorin and fluorouracil regimen.

PURPOSE: To evaluate the objective tumor response rates and toxicities of leucovorin (LV) plus fluorouracil (5-FU) cancer regimen combined with oxaliplatin (85 mg/m(2)) every 2 weeks on metastatic colorectal cancer patients with documented proof of progression while on bimonthly LV and 5-FU alone. PATIENTS AND METHODS: One hundred patients were enrolled onto this study and 97 received the study drugs between October 1995 and December 1996. Eighty-nine patients were eligible for per-protocol efficacy analysis with documented proof of progression on one of the following two treatments: LV 500 mg/m(2) and continuous 5-FU infusion 1.5 to 2 g/m(2)/22 hours, days 1 through 2 every 2 weeks (FOLFUHD); or LV 200 mg/m(2), bolus 5-FU 400 mg/m(2), and continuous 5-FU infusion 600 mg/m(2)/22 hours, days 1 through 2 every 2 weeks (LV5FU2). In our study, 40 patients received FOLFUHD + 85 mg/m(2) of oxaliplatin day 1 (FOLFOX3) and 57 patients received LV5FU2 + 85 mg/m(2) of oxaliplatin day 1 (FOLFOX4). RESULTS: Of the 97 patients treated, 20 partial responses were observed (FOLFOX3/4: response rate, 20.6%; 95% confidence interval, 13% to 31.1%; FOLFOX3: response rate,18.4%; FOLFOX4: response rate, 23.5%). For patients treated with FOLFOX3/4, the median response duration for was 7.5 months, and the major toxicities were peripheral neuropathy and neutropenia. The incidence of grade 3 (National Cancer Institute common toxicity criteria) peripheral neuropathy was 20.6%; whereas the overall incidence of grade 3 to 4 neutropenia was 27.8%, 15%, and 36.9% for FOLFOX3/4, FOLFOX3, and FOLFOX4, respectively (P =.02). From the start of treatment, median progression-free survival was 4. 7, 4.6, and 5.1 months for FOLFOX3/4, FOLFOX3, FOLFOX4, respectively, and median overall survival was 10.8, 10.6, and 11.1 months, respectively. CONCLUSION: This phase II study of oxaliplatin at 85 mg/m(2) in combination with bimonthly LV plus 5-FU in patients with colorectal cancer resistant to LV plus 5-FU alone confirms the enhanced antitumor activity of oxaliplatin in combination with 5-FU.     

Oxaliplatin, 5Fluorouracil and Leucovorin (FOLFOX4) as First Line Chemotherapy in Elderly Patients with Advanced Gastric Cancer

Background: Gastric cancer is considered the fourth most common cancer and second most common cause of cancerrelated mortalities worldwide. Gastric cancer develops more frequently among elderly. The oxaliplatin/5FU/leucovorin (FOLFOX) regimen has shown a notable activity against gastric cancer. Aim: To evaluate the responses and complications of FOLFOX4 regimen as first line chemotherapy in elderly patients with advanced gastric cancer. Materials and Methods: From October 2014 to November 2015, a total of 21 patients with metastatic or local AGC (advanced gastric cancer) were analyzed. All patients were administered a FOLFOX4 regimen consisting of a 2h infusion of oxaliplatin 85 mg/m2 (day 1), continuous infusion of 1000mg/ m2 5Fu in 24h., and leucovorin 200 mg/m2 in 2h infusion as a firstline chemotherapy. Results: A total of 18 patients were assessable for efficacy and toxicity. One of 18 patients achieved a complete response, and 12 had partial responses, giving an overall response rate of 72.6%. Three (16%) patients demonstrated stable disease and 2 (12%) progression. The median progression free survival was 7.3 months, and the median overall survival was 11.9 months. One patient had grade 3 neuropathy. No other grade 3 or 4 NCICTC were seen. Conclusions: The FOLFOX4 regimen used in our study was both active and acceptable for AGC in elderly patients as neoadjuvant and main therapy.     

雷替曲塞联合奥沙利铂治疗晚期贲门癌的疗效

目的:观察雷替曲塞联合奥沙利铂与氟尿嘧啶/左亚叶酸钙联合奥沙利铂治疗晚期贲门癌的疗效和毒副反应。方法:将92例研究病例分为试验组与对照组,每组46例,试验组给予雷替曲塞2.5mg/m2,15min内静脉滴注,第1天;联合奥沙利铂130mg/m2,静脉滴注>3小时,第1天。对照组给予奥沙利铂130mg/m2,第1天;左亚叶酸钙200mg/m2,静脉滴注2小时,5-氟尿嘧啶500mg/m2,第1~5天静脉滴注,每3周为1个周期,每2个周期后评价疗效及毒副反应,最多化疗6个周期。结果:全组92例均可评价疗效及不良反应,其中试验组有效率56.5%,临床获益率78.3%,中位生存期10.9个月;对照组有效率60.9%,临床获益率82.6%,中位生存期11.5个月。两组有效率、临床获益率和中位生存期均无统计学差异。在不良反应方面,两组均有不同程度的骨髓抑制反应,其中Ⅰ-Ⅳ级发生率相比差异无统计学意义(P＞0．05),Ⅲ-Ⅳ级发生率相比差异有统计学意义(P＜0．05);实验组较对照组在胃肠道反应及静脉炎等不良反应方面的发生率均低,有显著性差异(P＜0．05);两组在神经毒性、转氨酶异常及其他化疗反应的发生率上无显著性差异(P＞0．05);所有病例均无化疗相关性死亡。结论:雷替曲塞联合奥沙利铂方案治疗晚期贲门癌的有效率和中位生存时间与氟尿嘧啶/亚叶酸钙联合奥沙利铂方案相当,部分毒副反应轻,发生率低且可耐受,不用亚叶酸钙增效,值得在临床上推广应用。     

草酸铂治疗晚期胃癌疗效观察

目的 :观察草酸铂 (L OHP)联合5 -氟尿嘧啶 ( 5 FU )和甲酰四氢叶酸钙(CF)在治疗晚期胃癌中的作用。方法 :L OHP 13 0mg/m2 静脉滴入 ,持续 2h ,d1;CF 10 0mg/m2 静脉滴入 ,d1～d5,5 FU 3 75mg/m2 静脉滴入 ,d1～d5。 2 1d重复。结果 :2 2例患者中 ,完全缓解 (CR) 1例 ,部分缓解 (PR) 12例 ,稳定 (NC) 5例 ,进展 (PD)4例 ,有效率 (CR PR) 5 9 0 9%。毒副反应均比较轻 ,毒性特点是外周神经感觉异常 ,症状可逆。结论 :L OHP联合 5 FU(CF)方案应用于治疗晚期胃癌可以获得比较高的疗效 ,显著提高患者生活质量     

XELOX与FOLFOX4方案治疗进展期胃癌的随机对照临床研究

目的：评价卡培他滨联合奥沙利铂方案（XELOX）与氟尿嘧啶／亚叶酸钙联合奥沙利铂方案（FOL-FOX4）治疗进展期胃癌的临床疗效及不良反应。方法：54例进展期胃癌患者随机分成两组,XELOX组28例,卡培他滨1000mg／m2,口服,2次／日,第1—14天;奥沙利铂135mg／m2,静脉点滴,第1天,21天为1个周期。FOLFOX4组26例,奥沙利铂85mg／m2,静脉点滴,第1天;亚叶酸钙200mg／m。,静滴2h后予氟尿嘧啶400mg/m2,推注,后续600mg／m。持续静滴2h,第1、2天,每2周重复,4周为1周期。两组均治疗4周期以上。结果：XELOX组有效率53．57％,中位TTP5．8个月,MsT10个月,FOLFOX4组有效率46．15％,中位TTP5 ．7个月,MST9．8个月。两组近期有效率差异无显著性。不良反应比较,手足综合征以XELOX组显著（P〈0．05）,Ⅲ／Ⅳ级恶心呕吐发生率以FOLFOX4组显著（P〈0．05）,其余不良反应除腹泻外发生率以FOLFOX4组稍高,但差异无显著性。结论：XELOX方案与FOLFOX4方案治疗进展期胃癌疗效确切,不良反应能耐受,两组近期疗效相似,不良反应以XELOX组更易耐受,尤其对一般情况欠佳及老年的患者耐受性好。     

FOLFOX-4 regimen with concomitant highly active antiretroviral therapy in metastatic colorectal cancer HIV-infected patients: a report of five cases and review of the literature

Colorectal cancers are rare in developing countries, but are the second most frequent malignancy in the affluent world. Data on colorectal cancer in HIV-positive patients are limited. Up to now, there are no published data on treatment patterns, response to therapy, or survival in this setting. Oxaliplatin is an antineoplastic agent currently indicated, concomitantly to fluorouracil and leucovorin, for the treatment of advanced colorectal cancer. The FOLFOX-4 regimen (oxaliplatin 85 mg/m(2) as a two-hour infusion on day 1; leucovorin 200 mg/m(2) as a two-hour infusion on days 1 and 2, fluorouracil as a bolus infusion on days 1 and 2, followed by a fluorouracil 22-hour infusion 600 mg/m(2) for two consecutive days every two weeks), with concomitant highly active antiretroviral therapy (HAART) is feasible and active, while the HIV infection is not a limiting factor for its use. Moreover, the concomitant use of HAART does not seem to increase the toxicity of the FOLFOX-4 regimen.