吉西他滨联合希罗达方案治疗耐药晚期乳腺癌

目的:评价对蒽环类和紫杉类耐药的晚期乳腺癌患者,使用吉西他滨联合希罗达方案化疗的疗效及毒性。方法:耐药的晚期乳腺癌患者,接受吉西他滨1000mg/m2,静脉滴注,第1,8天;希罗达950mg/m2,每日分两次口服,第1~14天,每3周重复,至少2个周期。然后评价临床疗效和毒性。结果:30例患者进入研究,均可评价疗效和毒副作用。总有效率(CR PR)为36.7%,临床获益率为(CR PR SD>6个月)50%,疾病控制率(CR PR SD)为80%。中位随访12.5(2~24)月,中位无进展生存期为10个月,中位生存期14个月。化疗最常见的毒性为手足综合征和骨髓抑制。结论:吉西他滨联合希罗达是治疗蒽环类和紫杉类耐药的晚期乳腺癌的有效方法,毒性可被耐受。     

Gemcitabine and s-1 combination chemotherapy in patients with advanced biliary tract cancer: a retrospective study

Background

The aim of this study was to investigate the efficacy and safety of gemcitabine and S-1 combination chemotherapy in patients with advanced biliary tract cancer.

Patients and Methods

A retrospective study was performed on 15 consecutive patients. Gemcitabine was administered intravenously at 1,000 mg/m² on days 8 and 15. Oral S-1 (60 mg/m² in 2 divided doses) was given daily for the first 2 weeks, followed by 1 week of rest. This 3-week course of treatment was repeated. The primary endpoint was response rate, and the secondary endpoints were overall survival, progression-free survival, and safety.

Results

The overall response rate was 26.7%, and the disease control rate was 73.4%. The overall survival was 12.0 months (95% CI, 9.5–14.5 months), and the progression-free survival was 8.0 months (95% CI, 4.3–11.7 months). Adverse events of grade 3 or 4 occurred in 33.3%, and the major grade 3/4 toxicities were anemia (20.0%), leukopenia (13.3%), and anorexia (13.3%).

Conclusion

Gemcitabine and S-1 combination chemotherapy is effective and safe in patients with advanced biliary tract cancer.Key Words: Biliary tract cancer, Chemotherapy, Gemcitabine, S-1     

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.     

Cisplatin combination chemotherapy in advanced seminoma

Thirty-one patients were treated with cisplatin combination chemotherapy for advanced seminoma (26 Stage III or bulky Stage II testicular, and five disseminated extragonadal). Seventeen (89%) of 19 patients not previously pretreated and four (80%) of five who had received only abdominal irradiation entered continuous complete remission (CR), versus only two (28%) of seven patients who had received extensive infra- and supradiaphragmatic radiotherapy. Results were not significantly influenced by stage, human chorionic gonadotropin (HCG) titers and histologic subgroups, whereas patients with lactic dehydrogenase (LDH) values exceeding 500 mIU/ml did worse (50% continuous CR rate in 12 cases) than those with normal or less elevated titers (89% continuous CR rate in 19 cases). After a median follow-up period of 34 months (range, 12+ to 77+ months), 23 patients (74.5%) remain alive in continuous CR, two (6%) died in CR and another one (3%) entered CR after deferred treatment of residual disease. Five patients (16%) died of cancer. Toxicity was severe in extensively irradiated patients, but it was acceptable in those not pretreated and in those who had received only subdiaphragmatic radiotherapy. Cisplatin combination chemotherapy can be successfully and safely used as the primary treatment of choice in patients with advanced seminoma. It is also an excellent salvage therapy for patients who had received subdiaphragmatic irradiation only. On the contrary, it is very difficult to treat with chemotherapy extensively irradiated patients.     

Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients

Background: Antioxidants protect the body against cellular oxidative damage and thus some of the adverse effects induced by cisplatin and other cytostatic drugs.Patients and methods: The effect of cisplatin-combination chemotherapy on concentrations of plasma antioxidants was studied in 36 cancer patients, including osteosarcoma and testicular carcinoma patients.Results: Eight to 15 days after the start of each cytostatic drug infusion concentrations of various plasma antioxidants were measured and compared to pretreatment values: vitamin C and E, uric acid and ceruloplasmin levels fell significantly (P < 0.01–0.005) and returned to baseline levels before the start of the next chemotherapy cycle. Levels of the antioxidants bilirubin, albumin and the ratio vitamin E/cholesterol + triglycerides measured three weeks after the start of chemotherapy significantly decreased compared to pretreatment levels and remained low thereafter (P < 0.001–0.002). Dietary intake of antioxidants and anthropometric measurements, evaluated in 14 patients did not change during the whole treatment period.Conclusions: Cisplatin-combination chemotherapy induces a fall in plasma antioxidant levels, that may reflect a failure of the antioxidant defense mechanism against oxidative damage induced by commonly used anticancer drugs. This probably results from consumption of antioxidants caused by chemotherapy induced-oxidative stress as well as renal loss of water-soluble, small molecular weight antioxidants such as uric acid.     

吉西他滨在晚期膀胱癌化疗中的应用

吉西他滨是一种新型抗嘧啶核苷酸代谢化疗药物,近年来已在晚期膀胱癌的化疗中被大量应用,吉西他滨联合顺铂(GC)化疗方案已经取代传统的标准化疗(MVAC)方案,成为晚期膀胱癌新的标准化疗方案.现综述近年来吉西他滨在晚期膀胱癌化疗中的应用.     

吉西他滨加卡铂治疗晚期非小细胞肺癌

目的：观察吉西他滨(GEM)加卡铂(CBP)联合化疗治疗晚期非小细胞肺癌(NSCLC)的近期疗效及毒副作用。方法：27例Ⅲ～Ⅳ期NSCLC(初治10例，复治17例)，采用联合化疗：GEM1250mg／m^2，静脉滴注，第1、8天，CBP300mg／m^2，静脉滴注，第1天，21天为1个周期。结果：初治10例中CR PR 6例，有效率60％，复治17例中CR PR7例，有效率41．2％，总有效率44．4％，主要副作用为骨髓抑制。结论：GEM CBP联合化疗治疗晚期非小细胞肺癌疗效较好，毒副反应可耐受。     

Cisplatin plus VP-16 combination chemotherapy in advanced refractory breast cancer.

Twenty-nine patients with advanced refractory breast cancer were treated with cisplatin 20 mg/m2/d and VP-16 100 mg/d for 5 days every 3-4 weeks. Ten patients received mitomycin C 10 mg/m2 every 6 weeks additionally. Partial response was obtained in 10 of 26 evaluable patients (38%). The response rates for the group treated with and without mitomycin C were 40% and 37.5%, respectively. Median response duration was 5.5 months in partial responders. Median survival was 9.5 months for partial responders and 2 months for the rest of the patients. Cisplatin and VP-16 combination can be considered as a salvage treatment in heavily pretreated patients with advanced breast cancer.     

Gemcitabine based combination chemotherapy in advanced pancreatic cancer-indirect comparison

Background

Few empirical data show the pattern of functional decline at the end of life for cancer patients, especially among older patients.

Methods

In a mortality follow-back survey (the Italian Survey of the Dying of Cancer – ISDOC) a random sample of 1,271 lay caregivers were interviewed, at a mean of 234 days after bereavement. The main outcome was number of days before death when the patient experienced a permanent functional decline.

Results

1,249 (98%) caregivers answered the question about patient's function. The probability to be free from a functional disability was high (94%) 52 weeks before death, but was lower for older age groups (15% for those aged 85 or more) and women (8%). It remained stable until 18 weeks before death, then fell to 63% at 12 weeks and 49% at 6 weeks before death (among those aged 85 or more the figures were 50% and 41%). The pattern was consistent across sub-groups, except for patients affected by Central Nervous System tumors who experienced a longer, slower functional decline.

Conclusion

This study provides empirical support for the declining trajectory in cancer, and suggests that the decline commences at around 12 weeks in all age groups, even among patients over 85 years.     

吉西他滨联合顺铂二线治疗晚期乳腺癌

目的观察国产吉西他滨(泽菲)联合顺铂组成的GP方案二线治疗蒽环类或紫杉类耐药性晚期乳腺癌的疗效与安全性。方法2003~2005年以GP方案治疗蒽环类或紫杉类耐药性晚期乳腺癌29例,泽菲1250mg/m2静滴,第1、8天,顺铂80mg/m2静滴,第1天,每21天为1周期。以WHO标准评价疗效和毒性。结果29例患者,中位化疗周期数为3周期(2~4周期),其中CR1例(3·4%),PR14例(48·3%),SD8例(27·6%),PD6例(20·7%),有效率为51·7%。随访2年,中位TTP35周(12~44周),中位生存期为62周(45~81周)。主要毒性反应为恶心、呕吐与骨髓抑制。结论国产吉西他滨和顺铂联合方案治疗蒽环类或紫杉类耐药性晚期乳腺癌疗效较好,使用方便,毒性反应较轻,是二线治疗蒽环类或紫杉类耐药性晚期乳腺癌的有效解救方案。     

Gemcitabine plus paclitaxel as first-line chemotherapy for patients with advanced breast cancer

OBJECTIVES: To assess the efficacy and tolerability of gemcitabine and paclitaxel as first-line treatment in advanced breast cancer. METHODS: Patients with histologically confirmed metastatic or metastatic plus locally advanced breast cancer received gemcitabine 1,200 mg/m(2) on days 1 and 8 and paclitaxel 175 mg/m(2) on day 1 every 21 days for 8 cycles. RESULTS: From December 1999 to August 2001, 45 patients, with a median age of 53.5 years (range, 22-77), received a total of 260 cycles. All were assessable for response and toxicity. Twenty-seven patients had prior adjuvant therapy. Hormonal receptor status was positive in 31.1% and negative in 40.0% of patients. Main metastatic sites included soft tissue (62.2%) and lung (53.3%). The objective response rate was 66.7%; complete response, 22.2%; partial response, 44.4%; stable disease, 15.6%; progressive disease, 17.8%. Median duration of response was 18 months and median time to tumor progression was 11 months. Grade 3/4 leukopenia, neutropenia, and thrombocytopenia developed in 13.3% of patients, and 15.5% developed grade 3/4 mucositis. No treatment-related deaths occurred. Median overall survival was 19 months. CONCLUSIONS: Gemcitabine plus paclitaxel is an active combination with a favorable toxicity profile as first-line treatment for patients with advanced breast cancer.     

吉西他滨联合顺铂治疗晚期原发性肝癌的临床观察

目的观察吉西他滨（商品名健择）联合顺铂化疗治疗晚期原发性肝癌的疗效及毒副反应。方法34例失去手术机会的晚期肝癌患者,给予GP方案化疗四个周期,观察其疗效及毒副反应。结果CR 1例、PR 9例,MR10例,SD8例,PD6例,RR 29．4%（10/34）。45．8%（11/24）的病人AFP较治疗前基线下降超过50%。21例疗前有肝区疼痛的患者,疼痛全部于化疗两个周期后消失。不良反应主要为骨髓抑制,Ⅲ-Ⅳ度白细胞减少为17．6%（6/34）,Ⅲ-Ⅳ度血小板减少为14．7%（5/34）;非血液学毒性方面,除少数病人有轻度恶心外,胆红素、转氨酶升高均不超过正常值上限1．5倍,尿素氮、肌酐未发现有明显升高。临床获益患者中位TTP4．5个月,MST12．8个月,一年生存率60．7%。结论GP方案化疗治疗晚期肝癌具有较好的客观疗效,副反应轻,能明显减轻病人的痛苦,延长病人的生命,值得进—步探讨、研究。     

吉西他滨联合奥沙利铂治疗晚期非小细胞肺癌的临床研究

目的:观察吉西他滨联合奥沙利铂治疗晚期非小细胞肺癌(NSCLC)的疗效、毒副作用、中位疾病无进展生存、中位生存期、生存率、生活质量.方法:58例经病理组织学证实的晚期非小细胞肺癌患者给予奥沙利铂130mg/m2第8天静脉输注;吉西他滨800-1200 mg/m2第1,8天静脉输注.21天为1个周期,完成2-4周期治疗后评价疗效.结果:全组患者可评价56例,无完全缓解,部分缓解(PR)12例(21.4%),稳定(SD)30例(53.6%),进展(PD)14例(25%),总有效率21.4%,疾病控制率(PR SD)75%,中位疾病无进展生存7个月,中位生存期15.1个月,1年生存率59.17%,2年生存率32.16%.主要毒副反应为骨髓抑制和神经毒性.结论:吉西他滨联合奥沙利铂方案治疗晚期非小细胞肺癌有一定疗效,可延长生存期,毒副反应可耐受,生存质量下降不明显.     

顺铂时辰与常规给药合并羟基喜树碱治疗晚期非小细胞肺癌的临床观察

目的探索顺铂(DDP)时辰给药与常规给药合并羟基喜树碱(HCPT)治疗晚期非小细胞肺癌的疗效和毒副作用。方法59例ⅢB-Ⅳ期非小细胞肺癌患者随机分为2组,顺铂时辰给药合并羟基喜树碱组(时辰化疗组)和顺铂、羟基喜树碱常规给药组(常规化疗组),两组顺铂和羟基喜树碱的剂量相同,顺铂(DDP)14mg/(m~2·d),羟基喜树碱(HCPT)6mg/(m~2·d),2药连用5天,21天为1周期,时辰化疗组顺铂18:00用药,其他用药时间相同。每例连用2周期以上评价疗效。结果时辰化疗组PR 13例,SD 13例,PD 4例,有效率(CR PR)43.3%(与常规组比较P=0.051),中位生存期6.62个月,12个月生存率30.4%(9/30例),18个月生存率13.3%(4/30)。常规化疗组PR 9例,SD 17例,PD 3例,有效率31.0%,中位生存期5.06个月,12个月生存率24.1%(7/29),18个月生存率3.4%(1/29)。毒副作用两组相仿,但时辰化疗组的有效率和生存期较常规组有优势。结论顺铂时辰给药合并羟基喜树碱治疗晚期非小细胞肺癌有一定的临床应用价值。     

Induction chemotherapy with docetaxel and cisplatin is highly effective for locally advanced nasopharyngeal carcinoma

Radiotherapy (RT) with concomitant chemotherapy (CT) has improved the therapeutic outcome of patients with locally advanced nasopharyngeal carcinoma (LANC). However, the importance of induction CT before definitive therapy is still undefined. Patients (n=59) who had LANC were included in this retrospective study. They received induction CT consisting of cisplatin and docetaxel followed by definitive RT with cisplatin. The median age was 49 years (18-68). All patients were of stages II (15%), III (63%) and IV (22%). Fifty eight patients could receive 3 cycles of CT. Except one patient, there was no grade 3 or 4 toxicity during induction CT. Chemoradiotherapy could be given to 49 patients (83%). Twelve percent of patients had complete response after induction CT and this number had increased to 95% after the completion of the therapy. Objective responses (complete and partial) were 100% after the completion of the therapy. Median follow up time was 29 months. Nine patients had relapse (2 had local only, 4 distant, 3 local and distant). Three patients who had both local and distant relapse died during follow-up. Three year overall and progression free survival rates were 94.9% and 84.7%, respectively. Induction CT with docetaxel and cisplatin is a feasible and tolerable treatment for patients with LANC.     

吉西他滨联合顺铂治疗耐药三阴性晚期乳腺癌的临床观察

目的　观察吉西他滨联合顺铂方案治疗ＥＲ、ＰＲ、ＨＥＲ-２均阴性对蒽环类耐药的晚期转移性乳腺癌的疗效和安全性。方法　３４例对蒽环或紫杉类耐药晚期转移性乳腺癌患者,经免疫组化证实ＥＲ、ＰＲ、ＨＥＲ-２均阴性,给予吉西他滨联合顺铂方案治疗,具体用药为：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。２１天为１周期,至少２个周期,２周期后评价疗效和毒副反应。结果　３４例患者均可评价疗效,获完全缓解（ＣＲ）２例（５.９％）,部分缓解（ＰＲ）１２例（３５.３％）,稳定（ＳＤ）１４例（４１.２％）,进展（ＰＤ）６例（１７.６％）,总有效率（ＣＲ＋ＰＲ）为４１.２％;中位疾病进展时间为５.２个月。主要不良反应包括骨髓抑制和胃肠道反应,无化疗相关死亡。结论　吉西他滨联合顺铂方案对蒽环类或紫杉类耐药的转移性三阴性乳腺癌有较好的近期疗效,不良反应可耐受,是有效的解救方案之一。     

Gemcitabine in combination with vinorelbine for treatment of advanced breast cancer

Several cytotoxic drugs have substantial antitumor activity against breast cancer. Combination cytotoxic regimens are associated with higher response rates and longer durations of response and survival than single-agent regimens. However, combination regimens of conventional agents have not changed the course of advanced disease. Since 1990, several newer cytotoxic agents have been developed and integrated into management strategies for advanced breast cancer. Gemcitabine and vinorelbine are 2 such newer cytotoxic agents that have demonstrated promising antitumor activity and favorable toxicity profiles as single-agent therapy for metastatic breast cancer. Gemcitabine and vinorelbine have different mechanisms of antitumor activity, good therapeutic indices, and nonoverlapping toxicities. The combination of these 2 drugs has been evaluated for the treatment of advanced breast cancer. Preliminary results from phase II clinical trials suggest that gemcitabine/vinorelbine with or without granulocyte colony-stimulating factor is effective first- or second-line therapy for advanced breast cancer and has a favorable safety profile. Further studies of the gemcitabine/ vinorelbine combination regimen are warranted