吉西他滨联合顺铂治疗Ⅲ～Ⅳ期非小细胞肺癌的临床观察

目的：观察国产盐酸吉西他滨(泽菲)联合顺铂治疗Ⅲ～Ⅳ期非小细胞肺癌(NSCLC)的近期疗效及毒副反应。方法：初治的Ⅲ～Ⅳ期NSCLC病例30例,以21天为1周期,泽菲1．0g／m^2,静脉滴注,d1、d8,顺铂30mg／m^2,静脉滴注,d1～d3,连用2个周期后评价疗效。结果：全组30例均可评价,有效率为40％(12／30),主要毒副反应为胃肠反应(20％)和血液学毒性,Ⅲ～Ⅳ级白细胞下降和血小板下降分别为20％和13％。结论：泽菲联合顺铂治疗NSCLC有较好疗效,毒性较小可以耐受。     

国产吉西他滨联合顺铂治疗晚期非小细胞肺癌临床分析

目的:观察国产吉西他滨(泽菲)联合顺铂治疗晚期非小细胞肺癌(NSCLC)的近期疗效及毒副反应。方法:有明确病理和/或细胞学诊断的晚期NSCLC病例30例,泽菲1.0g/m2,静脉滴注,d1、d8,顺铂80mg/m2,静脉滴注,d1,以21天为1周期,连用2个周期后评价疗效。结果:全组30例均可评价,CR 0,PR 13例,NC 9例,PD 7例。有效率为43.33%(13/30),主要毒副反应为胃肠反应和血液毒性,III~IV级白细胞和血小板下降分别为21.74%和16.67%。结论:泽菲联合顺铂治疗NSCLC有较好疗效,毒性较小可以耐受。     

吉西他滨联合顺铂治疗47例老年晚期非小细胞肺癌

[目的]观察吉西他滨（商品名健择）联合顺铂治疗老年晚期非小细胞肺癌（NSCLC）的近期疗效、毒副反应。[方法]健择（GEM）1000mg/m2静滴30min,d1,8;顺铂30mg/m2,静滴d1～3;21d为一个周期。完成2个周期以上评价疗效。[结果]47例老年晚期NSCLC患者共行化疗189个周期,全组总有效率38.3%。（全组42例均可评价,有效率为38.3%）。主要毒副反应为胃肠反应（Ⅲ～Ⅳ度为23.4%）和血液学毒性（Ⅲ～Ⅳ度白细胞下降率为27.7%,Ⅲ～Ⅳ度血小板下降率为14.9%）。[结论]健择联合顺铂治疗老年人非小细胞肺癌,有效率高,毒副反应轻,可以耐受。     

泽菲联合顺铂治疗73例Ⅲ／Ⅳ期非小细胞肺癌临床观察

目的 研究泽菲与顺铂联合化疗方案治疗非小细胞肺癌(NSCLC)的临床疗效、生存期及毒副反应.方法 入选患者均为Ⅲ、Ⅳ期非小细胞肺癌,初治33例,复治40例.泽菲1000 mg,/m2,dl、d8;顺铂25 mg/m2,dl,d2,d3,21d为1个周期,2个周期后评价疗效及不良反应.结果 73例可评价患者,完全缓解4例,部分缓解33例,总有效率50.7%;中位生存期9.2个月,1年生存率39.0%.Ⅲ～Ⅳ度白细胞减少症和血小板减少症发生率分别为15.1%和19.2%.结论 泽菲与顺铂联合化疗方案治疗NSCLC有较好疗效,耐受性好.     

多西他赛联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌的临床观察

目的:观察国产多西他赛(艾素)联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)的疗效及毒副反应.方法:Ⅲ、Ⅳ期非小细胞肺癌30例,多西他赛80mg/m2～100mg/m2,静脉滴注第1天,90分钟内滴完,顺铂30mg/m2静滴第1天～3天,21天为一周期,2周期结束后评价疗效.结果:全组总有效率为40%(12/30),主要毒副反应骨髓和胃肠道毒性.Ⅲ°、Ⅳ°白细胞减少和血小板减少分别为20%、30%.结论:多西他赛(艾素)联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌疗效好,毒副反应轻,患者耐受性好.     

吉西他滨联合草酸铂治疗Ⅲ～Ⅳ期非小细胞肺癌的临床观察

目的观察盐酸吉两他滨联合草酸铂治疗Ⅲ～Ⅳ期非小细胞肺癌（NSCLC）的近期疗效及毒副反应。方法初治的Ⅲ～Ⅳ期NSCLC病例32例,以2l天为l周期。吉西他滨1．0g／m^2静脉滴注d1.8;草酸铂100g／m^2静脉滴注d1.8;连用2周期后评价疗效。结果全组32例均可评价疗效,总有效率37,5％（12／32）。主要毒副反应为血液学毒性,Ⅲ～Ⅳ度的白细胞下降和血小板下降分别为12．5％和15．6％。结论吉西他滨联合草酸铂治疗晚期NSCLC有较好的疗效,其毒副反应可以耐受,为晚期NSCLC提供了一种切实可行的治疗方案。     

多西他赛联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌的临床观察

目的:观察国产多西他赛(艾素)联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)的疗效及毒副反应。方法:Ⅲ、Ⅳ期非小细胞肺癌30例,多西他赛80mg/m2~100mg/m2,静脉滴注第1天,90分钟内滴完,顺铂30mg/m2静滴第1天~3天,21天为一周期,2周期结束后评价疗效。结果:全组总有效率为40%(12/30),主要毒副反应为骨髓和胃肠道毒性。Ⅲ°、Ⅳ°白细胞减少和血小板减少分别为20%、30%。结论:多西他赛(艾素)联合顺铂治疗Ⅲ、Ⅳ期非小细胞肺癌疗效好,毒副反应轻,患者耐受性好。     

多西紫杉醇联合顺铂治疗Ⅲ～Ⅳ期NSCLC临床研究

目的:观察多西紫杉醇联合顺铂化疗方案治疗Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)的临床疗效、生存期及毒副反应。方法:Ⅲ~Ⅳ期NSCLC患者62例,多西紫杉醇75mg/m2,静脉点滴,d1;顺铂75mg/m2,静脉点滴,d1~3。21天为1疗程,至少治疗3周期。结果:总有效率为43.5%(27/62,均为部分缓解),Karnofsky计分增加或不变者占67.4%,中位缓解期为7个月。主要毒副反应为骨髓抑制,Ⅲ~Ⅳ度白细胞下降占16.1%,无Ⅲ~Ⅳ度血红蛋白和血小板下降。非血液学毒性轻微。结论:多西紫杉醇与顺铂联合给药方案治疗NSCLC有较好疗效,耐受性好。     

泽菲联合盖诺治疗不能耐受顺铂晚期非小细胞肺癌临床观察

[目的]评价泽菲联合盖诺治疗不能耐受顺铂的晚期非小细胞肺癌的疗效和毒性。[方法]108例Ⅲ和Ⅳ期非小细胞肺癌既往均未曾放疗或化疗,ECOG评分≤2,生存期超过3个月,WBC计数>4.0×109/L,肝、肾功能生化指标正常,未有活动性感染征象。36例以泽菲联合盖诺(GN)为一线方案,另外36例以吉西他滨加顺铂(GP),还有36例以长春瑞滨加顺铂(NP)为一线方案作对照组。[结果]GP组、NP组和GN组RR分别为44.44%、43.24%和33.33%,三组疗效无统计学差异(P>0.05)。GN组与另两组在Ⅲ～Ⅳ度血液学毒性方面比较无统计学差异(P>0.05);GN组非血液学毒性比较少(P<0.01)。[结论]GN方案疗效较好,毒性较低,尤其适合于不能耐受顺铂的晚期NSCLC患者。     

紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效观察

目的:观察紫杉醇联合顺铂的方案治疗晚期非小细胞肺癌(NSCLC)的疗效和毒性反应。方法:本组42例应用紫杉醇135mg/m2静脉滴注,第1天、第15天,顺铂(诺欣)20mg/m2静脉滴注,第1～4天,28d为1周期,连用2周期后评价疗效。结果:全组42例均可评价疗效,CR4例(9.5%),PR22例(52.4%),总有效率(CR PR)为61.9%(26/42)。主要毒性反应为白细胞计数下降占100.0%,其中Ⅱ度为5例(11.9%),Ⅲ度24例(57.1%),Ⅳ度13例(31.0%),Ⅲ～Ⅳ度占88.1%;Ⅱ度血小板计数下降14例(33.3%),Ⅲ～Ⅳ度2例(4.8%);Ⅲ度血红蛋白下降4例(9.5%)。Ⅰ～Ⅱ度恶心呕吐23例(52.8%),Ⅲ度未出现。结论:紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效较高,骨髓毒副反应较明显,消化道反应较轻。     

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.