羟基喜树碱联合FOLFOX4方案二线治疗晚期胃癌的临床分析

Objective: To evaluate the therapeutic as well as side effects of hydroxycamptothecin (HCPT) plus FOLFOX4 regimen as salvage therapy for patients with advanced gastric cancer. Methods: A total of 19 patients with advanced gastric cancer received HCPT plus FOLFOX4 as salvage therapy, in detail, Oxaliplatin 85 mg/m2 was given intravenously on day 1, CF 200 mg/m2, 5-Fu 400 mg/m2 given in bolus immediately after CF, days 1-2; 5-Fu 600 mg/m2 given continuously after bolus for 22 h on day 1, day 2, HCPT given intravenously at dosage of 10 mg/m2 on days 1-2. Therapeutic effects were evaluated at least after two cycles of treatment. Results: 17 cases among the 19 patients were valid for response evaluation, with CR 1 , PR 6, SD 4, PD 6. The response rate was 41.2%. For the 12 patients with liver metastasis, response rate of the liver foci was 50%. The main toxicities were bone marrow suppression, nausea and vomiting, and peripheral neuropathy; there were no chemotherapy-related deaths. Conclusion: The combination regimen with HCPT plus FOFLOX4 regimen was effective as salvage therapy for patients with advanced gastric cancer, with particularly high response rate for liver metastasis, and the side effects were tolerable and manageable.     

Clinical study of combining chemotherapy of oxaliplatin or 5-fluorouracil/leucovorin with hydroxycamptothecine for advanced colorectal cancer

OBJECTIVE To estimate effects, survival rate after the short-time efficacy, side the treatment of combining chemotherapy of oxaliplatin or 5-fluorouracil/leucovorin with hydroxycamptothecine （HCPT） for the patients with advanced colorectal cancer.
METHODS From January 2002 to November 2005, 59 patients with advanced colorectal cancer confirmed by pathology were enrolled into this study in the department of medical oncology, in the Sixth People＇s Hospital of Shanghai Jiaotong University, Shanghai. Patients＇ characteristics in two groups were similarly confirmed by statistic. All 37 patients in OH group received oxalip21atin （130 mg/m^2 d1） plus hydroxycamptothecine （6 mg/m d1-4）, and all 22 patients in the HLF group received hydroxycamptothecine （6 mg/m^2 d1-4） plus leucovorin （300 mg d1-5） and 5-fluorouracil （0.375 g/m^2 d1-5）. The regimens in both groups were 21-day cycle that was repeated three weeks. The side effects were evaluated. The efficacy was estimated after two cycles of chemotherapy for each patient.
RESULTS The efficacy of the treatment in the OH group with 37 patients and in the HLF group with 22 patients was estimated. The overall response rate （CR ＋ PR） was 32.4% in the OH group and 22.7% in the HLF group. There was no complete response （CR） and there was no statistical significantly difference （%2= 0.876, P = 0.704） in two groups. The 1-year survival rate was 30.98% in the OH group and 15.02% in the HLF group, and it had no significant difference between the two groups. The median PSF and OS were 5.83 months and 11.17 months in the OH group vs. 7.40 months and 10.48 months in the HLF group, and it had no significant differences between the two groups （P 〉 0.05）. The major side effects of grade III and IV in the two groups were myelosuppression and gastrointestinal reactions. The statistically significant difference in side effects appeared in leukopenia （χ^2= 17.173, P = 0.001）, nausea/vomiting （χ^2= 6.426, P = 0.039）, diarrhea （χ^2= 16.245, P = 0.000） and peripheral neuropathy. CONCLUSION The efficacy was almost equal between the OH and the HLF groups, and the two regimens can be used as the second-line treatments for the patients with colorectal cancer. Leucopenia, nausea, diarrhea and peripheral neuropathy appeared more in OH group, and anemia and thrombocytopenia were almost equal between the OH and the HLF groups.     

Clinical observation of raltitrexed/bevacizumab combined with irinotecan or oxaliplation for advanced colorectal cancer简

Objective： The aim of the study was to investigate the efficacy and safety of raltitrexed/bevacizumab in combination with irinotecan or oxaliplation for advanced colorectal cancer as the second-line and second-line above treatments. Metho ods： Fifteen cases of advanced colorectal cancer were enrolled to receive regimens including raltitrexed/bevacizumab combined with irinotecan or oxaliplation. Two cases were treated with raltitrexed ＋ bavacizumab regimen, 9 cases with raltitrexed ＋ bavacizumab ＋ irinotecan regimen, and 4 cases with raltitrexed ＋ bevacizumab ＋ oxaliplation regimen. The doses of the drugs were as follows： bevacizumab 5 mg/kg ivgtt, d 1; raltitrexed 2.0 mg/m2 ivgtt 15 min, d2; irinotecan 180 mg/m2 ivgtt 1 h, d2; and oxaliplatin 85 mg/m2 ivgtt 2 h, d2. Two weeks was a cycle for each regimen. Results： The efficacy of the 15 patients could be evaluated. Two cases were in PR ,10 cases in SD, 3 cases in PD, the response rate was 13.3%, and the disease control rate was 80.0%. The median progress-free survival was 5.1 months （95% CI： 3.404-6.813 months）, and the median overall survival was 11.5 months （95% CI： 8.985-13.930 months）. The adverse effects included anorexia, nausea/vomiting, fatigue, leucopenia, thrombocytopenia, etc, and the main 3-4 grades adverse effects were anorexia, nausea/vomiting, fatigue, and thrombocytopenia. Conclusion： Raltitrexed/bevacizumab combined with irinotecan or oxaliplatin as the secondline and second-line above treatments for advanced colorectal cancer has high disease control rates, and the adverse effect is well tolerated. The combined regimen can be recommended as a phase III clinical research and second-line and secondlines above treatments for advanced colorectal cancer.     

Clinical Research on Use of Oxaliplcrtin in Combination with HCPT, LV and 5FU in a Regimen for Advanced Gastric Cancer

OBJECTIVE To observe the effects and adverse reactions of a OXA-HCPT LV/5FU 3 regimen for patients with advanced gastric cancer.METHODS OHLF3 regimen: OXA 130 mg/m^2iv d 1, HCPT6 mg/m^2, iv d 1-5, LV 200 mg/m2iv 2 h followed by a 5FU 400 mg/m2 iv bolus and 5FU 600mg/m2 iv d 1-3, were given, every 21 days as 1 cycle. Assessment of the tumor was conducted after 3 cycles and the effective cases were confirmed after 4 weeks.RESULTS Among 39 patients, 36 were actually evaluable. Overall response rates (CR PR} were 50%‘ the major adverse reactions were mild hematological toxicity, nausea and vomiting and peripheral nerve abnormalities.CONCLUSION The OHLF 3 regimen using OXA and HCPT is effective and results in mild toxicity when used in combined chemotherapy for advanced gastric cancer.     

Oxaliplatin combined with 5-fluorouracil, leucovorin regimen for patients with advanced colorectal cancer

Objective： To observe the efficacy and tolerability of continuously infusing 5-fluorouracil （5-FU） / folic acid combined with oxaliplatin （L-OHP/5-FU/LV regimen） as first line treatment in advanced colorectal cancer. Methods： 23 patients of advanced colorectal cancer were treated with 5-FU 500 mg/d, civ, d 1-d5, d8-d12, leucovorin 100 mg/d, iv gtt, d1, d8, folic acid tablet 60 mg/d, po, d2-d5, d9-d12, and oxaliplatin 65 mg/（m^2·d）, iv gtt, dl, d8, repeated every 21 days （one cycle）. The effect was evaluated after two cycles. Results： Complete response in 2 cases and partial response in 10 cases were observed with an overall response rate of 47.18%. Adverse effects were mainly grade 1-2, including nausea, vomiting, diarrhea, dental ulcer, peripheral neuritis and myelosuppression. Conclusion： L-OHP/5-FU/LV regimen is an effective and better tolerated alternative treatment in advanced colorectal cancer and yields promising clinical application.     

吉西他滨联合奥沙利铂治疗晚期胰腺癌30例

Objective: To evaluate the activity and safety of combination chemotherapy with gemcitabine plus oxaliplatin (GEMOX regimen) in patients of advanced pancreatic carcinoma. Methods: 30 patients with advanced pancreatic cancer were enrolled into this study. All patients received gemcitabine 1000 mg/m2, given by 30-minute intravenous infusion, on days 1 and 8 of each 21-day cycle. Oxaliplatin 100 mg/m2 was administered as a 2 h infusion on day 1 of each 21 day. Clinical outcomes for patients treated with two cycles of chemotherapy were evaluated according to WHO criteria. Results: All 30 patients were eligible for effectiveness and safety analysis. Objective response rate was approximately 20.0%. Clinical benefit response (CBR) was a composite of assessment of pain, performance status and body weight. The pain relief rate, improve-ment rate of performance status and body weight were 53.3%, 46.7% and 36.7%, respectively. The main adverse effects were bone marrow depression, peripheral nerve toxicity and gastrointestinal reaction. There was no treatment-related death during the chemotherapy. Conclusion: The high response rate with low toxicity observed in this study suggests that GEMOX regimen may be an effective alternative curative treatment for patients with advanced pancreatic carcinoma and can be used more extensively in clinical practice.     

奥沙利铂联合卡培他滨治疗晚期及复发转移性胃癌的临床观察

Objective To investigate the therapeutic effect and side effect of combined capecitabine with oxaliplatin on advanced and recurrent gastric cancer.Methods 56 patients with advanced and recurrent gastric cancer were treated with combined oxaliplatin and capecitabine chemotherapy,and the therapeutic effect and side effect were analyzed retrospectively.Results Among all 56 patients treated with combined oxaliplatin and capecitabine chemotherapy,4 patients (7.1%) were complete remission,26 patients (46.4 %)were partial remission,20 patients (35.7 %) were stabilization,6 patients (10.7 %) were progression,and the response rate was 53.6 %.The median remission time was 7.8 months,and the median survival time was 11.3 months.The main side effects were nausea and vomiting,diarrhea,hand-foot syndrome,peripheral nerve toxicity,transaminase increasing and leuco cytopenia,however,the side effects were mainly grade Ⅰ and Ⅱwhich could be tolerated by patients.Conclusion The combined oxaliplatin and capecitabine chemotherapy is an effective method and has better tolerance in treatment of advanced gastric cancer and is well worth clinical application.     

奥沙利铂联合卡培他滨治疗晚期及复发转移性胃癌的临床观察

Objective To investigate the therapeutic effect and side effect of combined capecitabine with oxaliplatin on advanced and recurrent gastric cancer.Methods 56 patients with advanced and recurrent gastric cancer were treated with combined oxaliplatin and capecitabine chemotherapy,and the therapeutic effect and side effect were analyzed retrospectively.Results Among all 56 patients treated with combined oxaliplatin and capecitabine chemotherapy,4 patients (7.1%) were complete remission,26 patients (46.4 %)were partial remission,20 patients (35.7 %) were stabilization,6 patients (10.7 %) were progression,and the response rate was 53.6 %.The median remission time was 7.8 months,and the median survival time was 11.3 months.The main side effects were nausea and vomiting,diarrhea,hand-foot syndrome,peripheral nerve toxicity,transaminase increasing and leuco cytopenia,however,the side effects were mainly grade Ⅰ and Ⅱwhich could be tolerated by patients.Conclusion The combined oxaliplatin and capecitabine chemotherapy is an effective method and has better tolerance in treatment of advanced gastric cancer and is well worth clinical application.     

参麦注射液防治晚期非小细胞肺癌化疗不良反应的临床观察

Objective： To observe the efficacy of Shenmai injection in the treatment for adverse reactions of chemotherapy on advanced non-small cell lung cancer （NSCLC）. Methods： 45 NSCLC patients with stages IIIb-IV were randomly divided into two groups： the treatment group （treated by chemotherapy combined with Shenmai injection） and the control group （treated by chemotherapy only）. The efficacy of the two groups was evaluated after 3 cycles of treatment. Results： There was no significant difference between the two groups in the recent curative effects （P 〉 0.05）, while there were significant differences between them in Karnofsky score and weight （P 〈 0.05）. The treatment group was better than the control group in preventing leucopenia and decreased hemoglobin, and significant differences were found between them （P 〈 0.05）. The incidence of thrombocytopenia, nausea and vomiting, hepatic and renal dysfunction in the treatment group was lower than that in the control group, but no significant differences were found between them （P 〉 0.05）. Conclusion： Shenmai injection would not influence the efficacy of chemotherapy on advanced NSCLC patients, while it could improve the quality of life, increase the body weight of patients, alleviate adverse reactions of chemotherapy as myelosuppression so as to improve the tolerance of organism to chemotherapy.     

CLINICAL EFFICACY OF VINORELBINE PLUS CISPLATIN IN ADVANCED NON-SMALL CELL LUNG CANCER

A clinical study of the efficacy of vinorelbine plus cisplatin regimen in the management of advanced NSCLC was performed in 35 patients. Five of the 35 patients failed to finish one cycle of chemotherapy with this regimen because of severe and intractable leukopenia or rapid progress of the disease. Tumor response and toxicity were evaluated in the remaining 30 cases. Results showed that, with this regimen, the objective response rate (CR PR) was 46.7%. The most common toxicity was leukopenia; other side effects included alopecia, gastrointestinal reactions, slight and transient renal and hepatic impairment and peripheral neuropathy. It suggested that vinorelbine plus cisplatin is a safe and effective regimen in the management of advanced NSCLC.     

HCPT联合L-OHP方案治疗复发转移结直肠癌的近期临床疗效

背景与目的:虽然含氟尿嘧啶(5-fluarouracil,5-FU)联合方案是目前治疗结直肠癌的标准方案,但是作为二线治疗的疗效不高,探索新的替代方案显得十分必要。本研究拟应用羟基喜树碱(hydroxycampothecin,HCPT)联合草酸铂(oxaliplatin,L-OHP)方案治疗复发转移结直肠癌,并观察其近期疗效、不良反应及1年生存率。方法:47例经病理学检查证实的复发转移结直肠癌,采用HCPT L-OHP方案治疗86个周期,HCPT6mg/m2 NS500ml,静脉滴注d1～4;L-OHP130mg/m2 5%GS500ml,静脉滴注d1。每例治疗2个周期后进行近期临床疗效和不良反应评定,两次化疗间隔为3周。结果:38例可进行疗效评价,总有效率(CR PR)为36.8%(14/38)。化疗后KPS改善和显著改善者20例,占52.6%。白细胞下降59周期,占68.6%,其中Ⅲ～Ⅳ度白细胞下降18周期,占30.5%;腹泻48周期,占55.8%,其中Ⅲ～Ⅳ度腹泻18周期,占37.5%。1年生存率为40.0%,中位总生存期(medianoverallsurvival,mOS)和中位无进展生存期(medianprogressionfreesurvival,mPFS)分别为11.7和7.8个月。结论:HCPT L-OHP方案治疗一线化疗后复发的结直肠癌病例有较好的近期临床疗效,主要不良反应是白细胞下降和腹泻。     

HCPT联合FOLFOX4方案治疗晚期胃癌、大肠癌疗效观察

目的评价羟基喜树碱(HCPT)联合FOLFOX4方案治疗晚期胃癌、大肠癌的近期疗效和毒副反应。方法28例晚期消化道癌患者,先给予草酸铂(L-OHP)85mg/m2静脉点滴2h d1,亚叶酸钙(CF)200mg/m2静脉点滴2h d1~d2,随后5-氟尿嘧啶(5-FU)400mg/m2静脉推注,5-FU600mg/m2静脉点滴22h d1~d2,同时给予HCPT6 mg/m2静脉点滴3h d1~d3。2周重复,4周期后评价疗效。结果全组28例,其中完全缓解(CR)2例(7.1%),部分缓解(PR)16例(57.1%),稳定(SD)4例(14.3%),进展(PD)6例(21.4%)。总有效率(CR PR)64.3%。胃癌16例,11例有效,有效率68.8%。大肠癌12例,7例有效,有效率58.3%。毒副反应主要是恶心呕吐,白细胞减少,神经感觉毒性,无化疗相关死亡。结论HCPT联合FOLFOX4方案治疗晚期消化道癌疗效肯定,毒副反应能耐受。     

含羟基喜树碱方案联合化疗晚期大肠癌的临床观察

目的　观察 10 -羟基喜树碱 (HCPT)、甲酰四氢叶酸钙 (CF)、5 -氟脲嘧啶 (5 -Fu)联合治疗晚期大肠癌的临床疗效。方法　将5 7例晚期大肠癌随机分为两组 ,分别采用HCPT + 5 -Fu +CF方案及 5 -Fu +CF方案化疗两个周期以上 ,评定其疗效及毒性。结果　HCPT + 5 -Fu +CF组有效率 5 3 6 % ,明显高于 5 -Fu +CF组的 2 7 6 % (P <0 0 5 ) ,毒副反应较轻。结论　HCPT + 5 -Fu +CF具有协同作用 ,可以作为晚期大肠癌的首选方案。     

奥沙利铂联合方案区域动脉灌注治疗晚期大肠癌的临床观察

目的观察奥沙利铂(L-OHP)联合甲酰四氢叶酸(CF)和5-氟尿嘧啶(5-Fu)腹腔区域动脉灌注治疗晚期大肠癌的临床效果和毒副反应.方法采用Seldinger方法,23例晚期大肠癌患者根据肿瘤部位不同将导管插入相应主要供血动脉,治疗组11例,动脉灌注L-OHP、CF、5-Fu;对照组12例,动脉灌注顺铂(PDD)、CF、5-Fu.每三周重复一次,治疗二次后评价疗效.结果临床症状缓解率、肿瘤有效率:治疗组为72.7%、63.6%;对照组为41.7%、33.3%;两组有显著性差异(P＜0.05).两组毒副反应主要有恶心、呕吐、腹泻、粘液血便、白细胞下降,大多为Ⅰ～Ⅱ度;对照组发生率较治疗组高,治疗组感觉神经毒性明显升高,但停药后可缓解.结论L-OHP联合CF、5-Fu腹腔区域动脉灌注治疗晚期大肠癌具有疗效好,毒副反应轻、能耐受的特点.     

奥沙利铂联合5-氟尿嘧啶/亚叶酸钙3周重复方案用于结直肠癌术后辅助化疗的临床观察

目的:探讨奥沙利铂(oxaliplatin,OXA)联合5-氟尿嘧啶(5-fluorouracil,5-FU)和亚叶酸钙(leucovorin,CF)3周重复方案用于结直肠癌术后辅助化疗的临床价值.方法:98例Ⅱ～Ⅲ期结直肠癌患者根治术后接受OXA联合5-FU/CF 3周重复方案辅助化疗,共化疗6个周期.患者化疗结束后每3个月进行1次全面复查,观察无病生存期及1和2年的无病生存率.结果:本组患者总的2年无病生存率为74.5%,其中Ⅱ和Ⅲ期患者的2年无病生存率分别为87.0%和63.5%.化疗期间的主要不良反应为Ⅰ～Ⅱ度外周神经毒性、中性粒细胞减少及腹泻,Ⅲ～Ⅳ度不良反应少见.结论:OXA联合5-FU/CF 3周重复方案用于结直肠癌术后辅助化疗疗效明确,患者耐受性好,是结直肠癌术后辅助化疗的理想选择.     

L-OHP和HCPT分别联合5-Fu/CF治疗晚期大肠癌对照研究

目的对照研究奥沙利铂(L-OHP)和羟基喜树碱(HCPT)分别联合5-Fu/CF治疗晚期大肠癌的临床效果。方法将符合入选条件的79例晚期大肠癌患者,随机分为观察组40例(含L-OHP方案)及对照组39例(含HCPT方案),2组均完成3个疗程化疗,每3周重复。对照观察2组的近期疗效及毒副反应。结果观察组CR 1例,PR 18例,总有效率(CR PR)为47.5%;对照组CR 0例,PR 10例,总有效率(CR PR)为25.6%,P<0.05。观察组神经毒性及腹泻发生率较高(45%及35%),对照组粒细胞减少发生率较高(61.5%),P<0.05,但2组恶心呕吐、脱发等毒性反应无明显差异。结论奥沙利铂联合5-Fu/CF是治疗大肠癌的有效化疗方案,特别适宜晚期大肠癌以及对5-Fu耐药的病例。     

L-OHP、DOC和HCPT联合5-Fu序贯化疗治疗晚期胃癌的临床研究

目的 探讨奥沙利铂(oxaliplatin,L-OHP)、多西紫杉醇(docetaxel,DOC)和羟基喜树碱(hydroxy camptothecine,HCPT)联合5-氟尿嘧啶(5 Fluorouracil,5-Fu)/亚叶酸钙(calcium folinate,CF)组成的序贯化疗方案治疗晚期胃癌(advanced gastric cancer,AGC)的疗效和不良反应.方法 入组35例AGC患者,以序贯方式依次接受L-OHP+ 5-Fu/CF、DOC+5 Fu/CF和HCPT+ 5-Fu/CF方案化疗,每个方案连用2周期,均每3周重复,共6周期化疗;观察疗效和不良反应,并随访疾病进展情况.结果 35例均能评价疗效,总缓解率(RR)为60％(21/35),中位肿瘤进展时间(TTP)为7.6月,95％置信区间(CI)(7.0～8.2),中位生存期(OS)15.1月,95％ CI (14.2～16.0);不良反应程度较轻,主要为骨髓抑制、胃肠道反应、脱发及过敏反应,但均可逆,未出现因化疗毒性而死亡病例.结论 LOHP、DOC和HCPT联合5-Fu/CF的序贯化疗是AGC有效治疗方案,化疗耐受性好,新颖的序贯化疗模式在AGC中应用值得进一步研究.     

恩度联合XELOX方案一线治疗老年晚期结直肠癌的临床观察

目的:观察恩度联合卡培他滨和奥沙利铂(XELOX)一线治疗老年晚期结直肠癌的疗效、疾病进展时间(TTP)、总生存期(OS)及不良反应。方法:回顾性分析了66例经组织病理学确诊的转移性结直肠癌患者的临床资料。XELOX方案化疗(XELOX)30例,恩度联合XELOX方案化疗(XELOXE)36例。2个周期后进行疗效评价。结果:XELOXE组总有效率(RR)44.4%,XELOX组RR30.0%,差异有统计学意义,P=0.04;两组的mT-TP(7个月vs6个月,P=0.014)和mOS(18个月vs16个月,P=0.041)比较,差异均有统计学意义。Ⅲ度以上不良反应主要有末梢神经感觉异常(6.1%)、手足综合征(7.6%)及血小板减少(7.6%)。高血压(8.3%)与心律失常(5.6%)主要为Ⅰ~Ⅱ度。结论:恩度联合XELOX一线治疗老年转移性结直肠癌有较好疗效,且毒性反应轻,耐受性好。     

含雷替曲塞方案治疗进展期结直肠癌的临床观察

目的 观察含有雷替曲塞的方案二线及多线治疗进展期结直肠癌的临床疗效和不良反应.方法 42例进展期结直肠癌患者接受含有雷替曲塞的方案化疗.评价患者的客观缓解率(ORR)、疾病控制率(DCR)、中位无进展生存时间(mPFS)和不良反应.结果 42例患者的ORR为16.67％,DCR为80.96％,mPFS为4.90个月(95％ CI为2.99 ～6.81个月).大部分患者不良反应为Ⅰ～Ⅱ度,包括白细胞减少(30.95％)、血小板减少(2.38％)、血红蛋白减少(40.48％)、恶心呕吐(2.38％)、食欲减退(4.76％)、腹泻(2.38％)、转氨酶升高(47.62％)、乏力(11.90％).只有4.76％的患者出现Ⅲ～Ⅳ度转氨酶升高.结论 含有雷替曲塞的方案二线及多线治疗进展期结直肠癌临床疗效肯定,患者耐受性好,值得临床上推荐使用.     

FOLFIRI方案治疗常规化疗失败晚期大肠癌的疗效分析

目的：探讨FOLFIRI方案治疗常规化疗失败晚期大肠癌患者的临床疗效和不良反应。方法：常规化疗失败的晚期大肠癌患者25例,开普拓（Irinotecan,CPT-11）180mg／m^2,静脉滴注,d1;FA200mg／m^2,静脉滴注,d1-2;5-FU400mg／m^2静脉推注,然后5-FU 600mg／m^2持续静脉滴注22h,d1-2,每2周重复,2次为1个周期,共行1—6个周期,中位周期1．5个。结果：25例患者,PR9例,SD10例,PD6例,总缓解率36．0％,中位缓解时间3．0—13．5个月。主要不良反应为迟发性腹泻和中性粒细胞减少,Ⅲ-Ⅳ度发生率分别为25．6％（11／43）和41．9％（18／43）。结论：FOLFIRI方案是治疗常规化疗失败晚期大肠癌的有效化疗方案,缓解率较高,迟发性腹泻和中性粒细胞减少为其主要不良反应。