NP方案在局部晚期乳腺癌新辅助化疗中的应用

[目的]了解诺维本加顺铂(navelbine/(NVB) cisplatin/(CDDP),NP)的新辅助化疗方案在局部晚期乳腺癌综合治疗中的作用.[方法]23例Ⅱb～Ⅲb期的乳腺癌患者,术前化疗用药为NVB 25mg/m2d1.8 CDDP 25mg/m2d1～3,每3周为一周期,术前用药3周期后评价疗效.[结果]肿瘤原发灶化疗有效率为86.9%,完全缓解(CR)1例,部分缓解(PR)19例,无变化(SD)3例;腋淋巴结临床有效率82.6%,CR 4例,PR 15例,SD 4例.78.3%(18/23)患者可以在3个周期的新辅助治疗后行手术治疗.毒副反应主要为骨髓抑制和消化道反应.[结论]NP方案作为局部晚期乳腺癌新辅助化疗方案有效率高,毒副反应可以耐受.     

TE方案与TEC方案在乳腺癌新辅助化疗中的疗效比较

[目的]对比分析多西他赛联合表柔比星加/不加环磷酰胺（TEC/TE）两种新辅助化疗方案治疗乳腺癌的近期疗效。[方法]回顾性分析2006~2009年收治的Ⅱ~Ⅲ期乳腺癌新辅助化疗患者108例的临床病理资料,分别术前接受新辅助化疗的TE方案（n=62）及TEC方案（n=46）,两组患者均在术前接受2~4个周期化疗。TE方案：多西他赛75mg/m2,第1天静脉滴注;表柔比星（EPI）60mg/m2,第1天静脉滴注。[结果]全组108例患者均可评价疗效,CR 10例（9.25%）,PR 75例（69.44%）。TE组有效率为75.81%,而TEC组有效率为82.61%,两组有效率无统计学差异（χ2=0.729,P=0.392）。Ⅱ期患者28例均生存。Ⅲ期患者80例3年生存率为82.4%,其中TE组44例3年生存率为74.6%;而TEC组36例3年生存率为91.8%,差异有统计学意义（χ2=4.149,P=0.042）。[结论]在Ⅱ~Ⅲ期乳腺癌患者新辅助化疗中,TE与TEC方案近期疗效相似,TEC组3年生存率较佳,有待于进一步加大样本量进行研究。     

新辅助化疗NP方案与FEC方案治疗乳腺癌122例比较

[目的]对比观察NP方案与FEC方案新辅助化疗治疗乳腺癌的疗效和毒副反应。[方法]122例Ⅱ、Ⅲ期乳腺癌病人随机分组。NP方案组：NVB25mg／m^2第1，8天,DDP 30mg／m^2第1～3天，FEC方案组：5-Fu 500mg／m^2第1，8天，EPI 25mg／m^2第1，2天，CTX 500mg／m^2第1，8天。每3周为1个疗程．完成2个疗程后，分别观察两组病人原发肿瘤病灶和区域淋巴结的缓解情况．并观察毒副反应。[结果]NP组总有效率70．3％，其中CR6例，PR39例，NC19例。FEC组总有效率51．7％，CR2例,PR28例,NC28例，两组均无进展者。Ⅱ期疗效高于Ⅲ期。NP组白细胞下降和胃肠道反应高于FEC组，两组脱发程度相似。[结论]NP和FEC方案的新辅助化疗方案治疗Ⅱ、Ⅲ期乳腺癌均有效，毒副反应两组均可耐受，NP组疗效及毒性反应均高于FEC组。     

紫杉醇脂质体联合表阿霉素方案在乳腺癌新辅助化疗中的近期疗效

[目的]观察紫杉醇脂质体在乳腺癌新辅助化疗中的疗效、毒副反应。[方法]回顾性分析20例局部晚期乳腺癌患者含紫杉醇脂质体方案新辅助化疗的疗效、毒副作用。化疗方案为紫杉醇脂质体加表阿霉素，21d为一周期，术前化疗2～6个周期，评估肿瘤缓解情况及毒副反应。[结果]化疗有效率为90％，其中CR3例，PR15例，SD1例，PD1例，达pCR1例。[结论]紫杉醇脂质体联合表阿霉素方案在乳腺癌的新辅助化疗中疗效肯定．毒副反应低．值得进一步研究。     

乳腺癌新辅助化疗28例临床观察

目的探讨CF化疗方案在乳腺癌新辅助化疗中近期疗效及毒副反应。方法用CF方案对Ⅱ～Ⅲ期乳腺癌患者进行新辅助化疗2个周期。结果总有效率为67．9％，其中临床完全缓解（cCR）2例，部分缓解（PR）17例，稳定（SD）6例，进展（PD）3例。主要毒副反应为胃肠道反应、骨髓抑制、腹泻、乏力及脱发，但均可耐受。结论CF方案在乳腺癌新辅助化疗中安全、有效，临床应用毒副反应可耐受。     

可手术乳腺癌NEF方案新辅助化疗的临床观察

目的评价NEF方案用于可手术乳腺癌新辅助化疗的近期疗效及其不良反应.方法 2000至2004年应用NEF方案治疗Ⅱb～Ⅲ期可手术乳腺癌患者52例.NEF 方案长春瑞滨(NVB) 30 mg/ m2,d1,5;EPI 50 mg/ m2 ,d1;5-Fu 500 mg/ m2 ,d1～5.28 d为1 个周期,所有患者完成2 个周期新辅助化疗后评价疗效,化疗结束后2～3周手术.结果 34例(65.4%)降低了临床分期;其中完全缓解(CR)3例(5.8%),病理完全缓解(pCR) 2例(3.8%),部分缓解(PR)35例(67.3%),病变稳定(SD)14例(26.9%),全组无疾病进展(PD)者,总有效率(CR+PR)为73.1%.Ⅱb期、Ⅲa期、Ⅲb期有效率分别为83.3% (15/18)、69.6%(16/23)和63.6%(7/11),Ⅱb期有效率高于Ⅲa期和Ⅲb期.新辅助化疗2个周期后有42.0%(21/50) 未触及肿大淋巴结;46.0%(23/50)肿大淋巴结明显缩小,腋窝淋巴结总有效率为88.0%(44/50).毒副反应为白细胞下降、恶心呕吐、脱发、神经毒性和周围静脉炎等,患者均可耐受.结论 NEF方案用于可手术乳腺癌新辅助化疗,对原发灶和腋窝淋巴结均有较高的有效率,而且可以降低临床分期,不良反应可耐受,值得推广.     

多西他赛表柔比星联合环磷酰胺方案在乳腺癌新辅助化疗中的应用

目的探讨TEC(多西他赛、表柔比星、环磷酰胺)方案在乳腺癌新辅助化疗中的应用。方法选取2005年9月至2010年10月间进行新辅助化疗的乳腺癌患者187例,患者均采用TEC方案,分析该方案的疗效及不良反应。结果根据实体瘤疗效评价标准1.1(RECIST 1.1)进行评估,完全缓解(CR)23例,部分缓解(PR)113例,疾病稳定(SD)46例,疾病进展(PD)5例。新辅助化疗过程中,Ⅳ度骨髓抑制患者31例,且2例患者经过化疗药物剂量减量后持续出现Ⅳ度骨髓抑制,甚至并发严重感染,放弃新辅助化疗,进行手术治疗。结论 TEC方案对局部晚期乳腺癌行新辅助化疗,疗效确切,不良反应可以耐受。     

TCH方案术前新辅助化疗对HER-2阳性乳腺癌的疗效观察

目的 观察TCH方案术前新辅助化疗对HER-2阳性乳腺癌的近期疗效及毒副反应.方法 37例女性HER-2阳性乳腺癌患者给予TCH方案术前新辅助化疗,治疗3～4周期后进行疗效和毒副反应评价.结果 37例患者中CR 5例,PR 28例,NC 4例,PD 0例,有效率为89.2％.主要毒副反应:中性粒细胞减少22例(59.5％),恶心呕吐15例(40.5％),肝功能异常8例(21.6％).结论 TCH方案用于HER-2阳性乳腺癌患者术前辅助化疗疗效较好,毒副反应可耐受.     

长春瑞滨联合表阿霉素新辅助化疗治疗乳腺癌的临床研究

目的:评价长春瑞滨联合表阿霉素新辅助化疗治疗乳腺癌的近期疗效.方法:2005年1月～2008年6月,采用长春瑞滨联合表阿霉素方案,对64例乳腺癌Ⅱ、Ⅲ期患者进行新辅助化疗,3周期～4周期;表阿霉素60mg/m2 dl、长春瑞滨30mg/m2dl、8,4周为1个周期.结果:所有患者完成3个～4个周期化疗,临床有效率(CR+PR)为84.4%,病理完全缓解率(pCR)12.5%.化疗主要毒副反应为白细胞减少、恶心、呕吐、脱发、静脉炎、头痛等,患者均可耐受.结论:长春瑞滨联合表阿霉素新辅助化疗治疗乳腺癌是安全、有效的化疗方案.     

TEC及TE方案在乳腺癌新辅助化疗中的近期疗效及不良反应的对比分析

目的对比分析以紫杉醇类及蒽环类为基础加/不加环磷酰胺（TEC/TE）两种化疗方案在乳腺癌新辅助化疗中的疗效及不良反应。方法回顾性分析2012年1月至2014年4月本院收治的共139例Ⅱ~Ⅲ期浸润性导管癌患者的临床病理资料。所有患者均接受4个周期的新辅助化疗,其中TEC方案（多西他赛75 mg/m2＋表柔比星60 mg/m2＋环磷酰胺500 mg/m2）共68例,TE方案（多西他赛75 mg/m2＋表柔比星60 mg/m2）共71例。以RECIST标准判断临床疗效,完全缓解（complete response,CR）＋部分缓解（partial response,PR）为临床有效,以Miller Payne标准判断病理疗效,Ⅲ级＋Ⅴ级＋Ⅳ级为病理学有效,同时观察恶心、呕吐等不良反应。等级资料的比较采用非参数检验,计数资料采用χ2检验。结果 TEC组的p CR率、CR率分别为13.85%（9/68）和10.29%（7/68）,TE组为11.27%（8/71）和5.63%（4/71）,但差异无统计学意义（Z=-1.804、-1.336;P=0.071、0.181）。TEC组的病理有效率为78.46%（51/65,3例缺失病理数据）,显著高于TE组的61.97%（44/71）（χ2=4.382,P=0.036）,但两组的临床有效率差异无统计学意义[72.06%（49/68）比61.97%（44/71）,χ2=1.596,P=0.206]。TEC组及TE组的保留乳房率分别为5.88%（4/68）、8.45%（6/71）,差异均无统计学意义（χ2=0.066,P=0.797）。两组的常见不良反应为恶心呕吐、粒细胞减少症及心脏毒性,差异均无统计学意义（Z=-1.670、-0.667、-1.326;P=0.095、0.505、0.185）。结论与TE方案比较,患者接受TEC方案新辅助化疗更易获得病理学缓解,且不增加不良反应。TEC方案在新辅助化疗中有一定的应用前景。     

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.