吉西他滨联合顺铂二线治疗晚期乳腺癌的临床观察

目的：探讨吉西他滨联合顺铂二线治疗晚期乳腺癌的疗效和不良反应。方法：选择蒽环类和（或）紫杉类化疗后的转移性乳腺癌患者30例,采用吉西他滨1000mg／m^ 2,静脉滴注,第1、8天;顺铂25mg／m^2,静脉滴注,第1—3天,21d为1周期,至少2周期后评价疗效。结果：CR2例（6．7％）,PRl2例（40．0％）,总有效率为46．7％。中位生存期12．8个月,中位TTP5．6个月。主要不良反应为骨髓抑制及胃肠道反应。结论：吉西他滨联合顺铂二线治疗晚期乳腺癌的近期疗效较好,患者耐受性好,值得临床推广。     

吉西他滨联合顺铂治疗晚期非小细胞肺癌

目的观察吉西他滨联合顺铂治疗晚期非小细胞肺癌的疗效和安全性．方法吉西他滨联合顺铂治疗37例初治的晚期非小细胞肺癌病人。吉西他滨1000mg／m^2，静脉滴注，d1，d8;顺铂30mg／m^2，静脉滴注，d1～3，21d为一周期．每例病人治疗24周期。结果全组37例均可评价疗效，完全缓解者占2．7％（1／37），部分缓解者占45．9％（17／37），稳定者占40．6％（15／37），进展者占10．8％（4／37），有效率（RR）为48．6％。中位进展时间（TTP）为6．5mo，中位生存期为10．7mo，1年生存率为43．2％（16137）。主要不良反应为血液学毒性，Ⅲ～Ⅳ度白细胞下降者占24.3％（9／37），Ⅲ度血小板下降者占10．8％（4／37），无Ⅳ度下降者。恶心呕吐发生率为78.4％，仅2例为毒性反应Ⅲ度。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌有较好的疗效，病人不良反应可以耐受。     

泰索帝联合顺铂治疗31例蒽环类耐药性晚期乳腺癌疗效分析

目的 观察泰索帝联合顺铂方案治疗蒽环类耐药性晚期乳腺癌的疗效与安全性。方法 2000年4月至2005年3月,以泰索帝联合顺铂方案治疗蒽环类耐药性晚期乳腺癌31例。泰索帝75mg／m^2,静滴,第1天;顺铂75mg／m^2,静滴,第1天加水化、利尿、止吐等治疗;21d为1周期。本组中位化疗周期数为4（2～8）周期。结果 31例均可评价疗效。完全缓解（CR）2例（6．5％）,部分缓解（PR）15例（48．4％）,稳定（SD）7例（22．6％）,进展（PD）7例（22．6％）,总有效率（CR＋PR）54．9％,中位肿瘤进展时间（TTP）5个月。1年生存率66．7％。主要毒性为恶心、呕吐和骨髓抑制。结论 泰索帝和顺铂联合方案治疗蒽环类耐药性晚期乳腺癌疗效较好,使用方便,毒性反应较轻,是蒽环类耐药性乳腺癌的有效解救治疗方案。     

吉西他滨联合卡铂用于晚期鼻咽癌二线治疗的临床观察

 目的 观察吉西他滨（泽菲国产吉西他滨）联合卡铂的联合方案治疗晚期复治鼻咽癌的近期疗效及毒性反应。方法 32例均为一线含顺铂方案化疗失败的晚期鼻咽癌病人。吉西他滨1000mg／m²，d1.8；卡铂400mg／m²，d1；21天为1周期。完成2周期后评价疗效及毒性。结果 32例中CR4例，占12．5％；PR16例，占50．0％；总缓解率（CR＋PR）62．5％。SD8例（25％），PD4例（12．5％）。中位缓解时间4．5个月。骨髓抑制为主要毒性：Ⅲ／Ⅳ度白细胞下降为43．6％，4例合并感染发热；Ⅲ／Ⅳ度血小板下降为21．8％。胃肠道反应轻微。结论 吉西他滨与卡铂的联合方案对一线含顺铂方案化疗失败的晚期鼻咽癌有较高的缓解率，毒性反应轻，值得作为二线方案推广使用。     

奈达铂联合多西他赛治疗晚期复治非小细胞肺癌的临床观察

目的：观察奈达铂联合多西他赛治疗晚期复治非小细胞肺癌的疗效和毒副反应。方法：46例晚期复治非小细胞肺癌患者,采用奈达铂联合多西他赛化疗,其中奈达铂100mg／m^2,静脉滴注,第1天;多西他赛75mg／m^2,静脉滴注,第1天;每3周重复。完成2周期治疗后评价疗效。结果：46例患者共化疗128个周期,全组45例可评价疗效,无CR患者,PR 11例,NC 19例,PD 15例。总有效率为24．44％（11／45）,疾病控制率66．67（30／45）。中位TTP为5．5个月,中位生存期（MST）为9个月,1年生存率为41％。主要毒副反应为骨髓抑制。结论：奈达铂联合多西他赛治疗晚期复治非小细胞肺癌有一定的疗效,消化道反应及肾毒性较轻,可选为顺铂或卡铂耐药患者的二线治疗。     

紫杉醇脂质体联合顺铂、替加氟二线治疗转移性食管癌26例

[目的]探讨紫杉醇脂质体联合顺铂、替加氟作为二线方案治疗转移性食管癌的疗效和安全性。[方法]26例转移性食管癌患者使用紫杉醇脂质体80mg／m^2静脉滴注3h，d1.8；顺铂20mg／m^2，静脉滴注，d1-3；甲酰四氢叶酸200mg／m^2，静脉滴注2h，d1-3替加氟600mg／m^2，静脉滴注，d1-3；28d为1个周期。[结果]26例患者共完成99周期化疗，平均3．81个周期。8周后复查CT结果显示：完全缓解（CR）2例（7．7％），部分缓解（PR）9例（34．6％），稳定（SD）8例（30．8％），进展（PD）7例（26．9％），有效率（RR）为42．3％（11／26），疾病控制率73．1％（19／26）。中位疾病进展时间（TTP）为4．8个月（95％可信区间，2．8～8．2月），中位生存期（MST）为8．4个月（95％可信区间，4．1～13．2月），1年生存率为11．5％（3／26）。毒性反应较小，主要是中性粒细胞减少。[结论]紫杉醇脂质体联合顺铂、替加氟作为二线方案治疗转移性食管癌具有较好的疗效和安全性。     

吉西他滨联合顺铂对蒽环类及紫杉类耐药的晚期乳腺癌的治疗

[目的]观察吉西他滨联合顺铂治疗耐蒽环类及紫杉类晚期乳腺癌的疗效及毒性反应。[方法]34例对蒽环类及紫杉类耐药的晚期乳腺癌患者，接受吉西他滨1000mg／m^2，静脉滴注，第1、8天；顺铂30mg／m^2，静脉滴注，第1～3天；21天为1个周期。[结果]全组病例共完成116个周期，巾位周期数为4个；1例（2．94％）完全缓解，15例（44．12％）部分缓解，12例（35．92％）病灶稳定，6例（17．85％）病灶进展，总有效率为47．10％。中位疾病进展时间为6个月．中位生存期为12．5个月；主要毒副反应为骨髓抑制及胃肠道反应。[结论]吉两他滨联合顺铂治疗耐蒽环类及紫杉类的晚期乳腺癌疗效较好，毒副反应较轻，可作为蒽环类及紫杉类治疗失败的晚期乳腺癌的解救方案。     

吉西他滨联合顺铂治疗耐药晚期乳腺癌疗效观察

目的观察吉西他滨联合顺铂治疗蒽环类和紫杉类耐药的晚期乳腺癌的疗效与安全性。方法蒽环类和紫杉类耐药的晚期乳腺癌患者36例,采用吉西他滨（泽菲）1000mg／m2,第1、8天,静脉滴注;顺铂25mg／m2,第1～3天。静脉滴注,21天为1个周期。中位周期数为3（2～4）个周期。结果完全缓解（CR）4例（11．1％）,部分缓解（PR）13例（36．1％）,稳定（sD）15例（41．7％）,进展（PD）4例（11．1％）,总有效率（CR＋PR）为47．2％。中位疾病进展时间（TTP）为6．1个月,中位生存期为12．8个月。主要毒性为骨髓抑制和胃肠道反应。结论吉西他滨联合顺铂是治疗蒽环类和紫杉类耐药的复发或晚期乳腺癌的有效方案,毒性可耐受。     

吉西他滨联合顺铂方案二线治疗晚期非小细胞肺癌的临床观察

目的：观察吉西他滨联合顺铂二线治疗晚期非小细胞肺癌的疗效及毒性反应。方法：从2000年3月～2004年10月对38例晚期非小细胞肺癌患者采用二线化疗,入组患者均经病理组织学证实,有可测量病灶,具体为吉西他滨1000mg／m。第1、8天,顺铂80mg/m^2,分3天应用,21天为1个周期。化疗2个周期后评价疗效及毒副反应。结果：所有患者均可评价,总共进行108周期的化疗。完全缓解（CR）0例,部分缓解（PR）11例,稳定（SD）12例,进展（PD）15例,总有效率28．9％。中位缓解时间4．5月,中位生存时间7．8月。主要不良反应为血液学毒性,其中Ⅲ／Ⅳ度的中性粒细胞下降、血小板下降和血红蛋白下降分别为18．5％（20／108）、11．1％（12／108）和8．3％（9／108）。其次为消化道毒性,Ⅲ／Ⅳ度的食欲下降和恶心呕吐分别为13．9％（15／108）和12．0％（13／108）。结论：吉西他滨联合顺铂对复治晚期非小细胞肺癌有较好疗效,毒副反应可以耐受。     

FOLFIRI方案对晚期胃癌二线治疗的临床观察

目的观察和评价伊立替康（开普拓,CPT-11）联合氟尿嘧啶（5-Fu）与亚叶酸钙（CF）用于晚期胃癌患者的二线治疗的疗效及毒副反应。方法回顾性分析2004年5月至2008年12月38例晚期胃癌患者接受FOLFIRI方案作为二线治疗的资料。CPT-11给药剂量按180mg／m^2,第1天静滴30min：CF200mg／m^2,第1～2天静滴2h;5一Fu400mgm^2,第1～2天静脉推注;5-Fu600mg／m^2,第1～2天持续静滴22h。每2周为1个周期,每例至少接受3周期化疗后评价疗效。结果全组38例均可评价,有效率[完全缓解（CR）＋部分缓解（PR）]为18．4％（7／38）,稳定（SD）26．3％（10／38）,进展（PD）55．3％（21／38）。中位疾病进展时间（TTP）3．4个月,中位生存时间（MOS）9．1个月。治疗相关毒副反应主要为中性粒细胞减少及迟发性腹泻。结论FOLFIRI方案二线治疗晚期胃癌疗效肯定,可使部分患者临床获益,其毒副反应可以耐受。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.