紫杉醇脂质体与紫杉醇治疗老年小细胞肺癌的疗效对比分析

目的比较紫杉醇脂质体与普通紫杉醇治疗老年小细胞肺癌的疗效及不良反应。方法将70例老年小细胞肺癌患者随机分为试验组和对照组。试验组34例给予紫杉醇脂质体135mg/m2,对照组36例给予紫杉醇135mg/m2,1个周期/21d,共2周期。观察两组的疗效及不良反应情况。结果两组在疗效及血液学毒性、消化道反应的差异无统计学意义,但因溶媒产生的过敏反应方面,试验组明显低于对照组,有统计学意义。结论紫杉醇脂质体治疗老年小细胞肺癌效果良好,两种紫杉醇疗效相当,但紫杉醇脂质体的过敏反应明显低于紫杉醇。     

紫杉醇脂质体与普通紫杉醇治疗胃癌疗效比较

目的比较周疗法紫杉醇脂质体联合方案和普通紫杉醇联合方案治疗晚期胃癌的疗效和毒副作用。方法 31例晚期胃癌患者分别接受紫杉醇脂质体（实验组）或紫杉醇（对照组）75 mg/m2,第1、8天;草酸铂130 mg/m2,第1天;亚叶酸钙200 mg于5-氟尿嘧啶前静脉滴注,第1～5天,5-氟尿嘧啶500 mg/m2,第1～5天。21 d为1个周期。结果实验组有效率61.54%（8/13）,对照组有效率55.56%（10/18）,P〉0.05;2组不良反应在血液学和消化道毒性以及乏力、脱发、手脚麻木、皮疹、呼吸困难等方面无差异,但对照组关节痛、肌肉痛、面色潮红发生率高于实验组（P均〈0.05）。结论周疗法紫杉醇脂质体联合方案与紫杉醇普通剂型的联合方案相比疗效相似,毒副作用减少。     

紫杉醇联合奈达铂治疗晚期食管癌疗效观察

目的观察紫杉醇（PTX）联合奈达铂（NDP）治疗晚期食管癌的临床疗效。方法39例晚期食管鳞癌患者给予PTX与NDP联合治疗,PTX 135-175 mg/m2,静滴3 h,第1天,用药前常规抗过敏反应;NDP 30 mg/m2,静滴2 h,第2-4天;加入500 ml生理盐水中,滴完后继续输液1000 ml以上,21 d为一周期。至少进行2个周期后评价。结果39例患者中CR 3例,PR 16例,SD 12例,PD 8例。主要不良反应为骨髓抑制所致的血小板及白细胞减少,消化道反应、ALT升高、BUN升高发生率相对较轻。结论PTX联合NDP治疗晚期食管癌疗效较好,不良反应可以耐受。     

低剂量地塞米松预处理方案防治老年人多西紫杉醇过敏反应的临床研究

目的 探讨在多西紫杉醇周疗法的老年患者中用低剂量地塞米松防治其过敏反应的疗效和安全性. 方法 对用多西紫杉醇(25 mg/m2,第1、8、15天静脉滴注,28 d重复)或多西紫杉醇+顺铂(多西紫杉醇25 mg/m2,第1、8、15天静脉滴注+顺铂20 mg/m2,第1～5天静脉滴注.28 d重复)治疗的老年患者,采用非等量随机对照方法 ,按入院顺序以3:2比例分为试验组和对照组,共91例,年龄65～82岁,中位年龄68岁.其中试验组54例,预处理方案为地塞米松4.5 mg,每日1次;对照组37例,预处理方案为地塞米松8 mg 2次/d,均为多西紫杉醇用药前1 d、用药当天和用药后连续3 d口服.所有患者均按照改良疾病累积评分表(MCIRS)进行评分.不良反应评价参照美国国立癌症研究所的常规毒性判定标准NCI-CTCAE3.0版. 结果 91例患者中发生过敏反应7例(7.7%).其中试验组发牛过敏反应4例(7.4%),对照组发生过敏反应3例(8.1%),差异无统计学意义(P=1.000),主要症状为皮疹或瘙痒3.3%(3/91)、血管性水肿2.2%(2/91)、发热或寒战1.1%(1/91)和胸部不适1.1%(1/91).不良反应主要为中性粒细胞减少、血红蛋白减少、恶心呕吐、疲劳、肌痛、兴奋或失眠和胃部烧灼感.. 结论 低剂量地塞米松预处理方案安全有效,与常规剂量比较,过敏反应的发生率无明显增高.     

周低剂量紫杉醇同步放疗治疗局部晚期食管癌的疗效

目的 探讨周低剂量紫杉醇同步放疗与周期性化疗同步放疗治疗局部中晚期食管癌的临床疗效及毒副反应.方法 将70例局部晚期食管癌患者随机分成两组,周低剂量紫杉醇同步放疗组(观察组,35例)采用紫杉醇(30 mg·m-2·w-1)静脉滴注,放疗第1天给药,持续6w;周期性化疗同步放疗组(对照组,35例)采用紫杉醇联合顺铂(紫杉醇135 mg/m2,第1天,顺铂20 mg/m2,第1～5天,21 d为1个周期,共2个周期),两组均采用23EX直线加速器三维适形同步放疗.比较治疗后两组近期疗效、毒副反应及2年生存率.结果 观察组与对照组总有效率有统计学差异(P＜0.05);两组的远处转移率和2年生存率之间无统计学差异(P＞0.05).观察组Ⅲ、Ⅳ度骨髓抑制和放射性食管炎的发生率优于对照组(P＜0.05),Ⅰ、Ⅱ度骨髓抑制无统计学差异(P＞0.05).结论 周低剂量紫杉醇同步放疗对比周期性化疗同步放疗治疗局部晚期食管癌能明显提高疗效,且能降低毒副反应.     

多西紫杉醇或紫杉醇联合顺铂治疗老年晚期非小细胞肺癌的疗效比较

目的探讨多西紫杉醇或紫杉醇联合顺铂治疗老年晚期非小细胞肺癌(NSCLC)的临床疗效及安全性。方法将86例晚期NSCLC患者按照化疗方法随机分为对照组(n=44)与实验组(n=42)。对照组采用紫杉醇联合顺铂进行治疗(紫杉醇150 mg/m~2,静脉滴注3 h,第1天,顺铂75 mg/m~2,静脉滴注第2,3天),实验组采用多西紫杉醇联合顺铂进行治疗(多西紫杉醇75 mg/m~2,静脉滴注1 h,第1天,顺铂75 mg/m~2,静脉滴注第2,3天),两组患者化疗2~4个周期。比较两组临床总有效率、中位生存时间及不良反应发生率。结果实验组和对照组客观有效27.27%和30.95%,两组无统计学差异(P>0.05);实验组中位生存时间(11.8个月)明显高于对照组(8.9个月,P<0.05);两组不良反应(中性粒细胞、血小板减少、血红蛋白减少、过敏、发热、感染、脱发、肝功能受损、肾功能受损、恶心呕吐、腹泻及感觉神经毒性)发生率均无统计学差异(P>0.05)。结论多西紫杉醇联合顺铂组患者远期疗效优于紫杉醇组。     

多西紫杉醇奥沙利铂联合卡培他滨治疗晚期胃癌66例疗效观察

目的观察TXELOX（多西紫杉醇奥沙利铂联合卡培他滨）方案治疗晚期胃癌的近期疗效及毒副反应。方法 66例晚期胃癌（Ⅲ~Ⅳ期）使用TXELOX方案：多西紫杉醇（TAT 75 mg/m2）静脉滴注1 h,第1天,使用TAT前用地塞米松预防过敏反应及体液潴留;奥沙利铂（OXA）135 mg/m2,静脉滴注2 h,第2天,用OXA前及当日忌食生冷及接触冷物体;卡培他滨（CAP）800 mg/m2,第1~14日口服,2次/d,该方案每3周为一周期,至少完成3个周期以上,最多6个周期。结果总有效率（CR＋PR）为66.7%,中位疾病进展时间（TTP）为9.7个月,中位总生存期（OS）为13.4个月;主要的毒副反应为手足综合征及神经感觉异常,其次为骨髓抑制及消化道反应。结论 TXELOX方案在晚期胃癌近期疗效较好,不良反应轻微,耐受性较好,该方案值得临床进一步推广和使用。     

紫杉醇联合顺铂治疗晚期胃癌临床观察

目的观察紫杉醇与顺铂合用治疗晚期胃癌的近期疗效。方法紫杉醇175mg/m2每天1次静脉滴注,顺铂60~80mg/m2每天1次静脉滴注;21d为1周期。结果可评价者19例,PR9例,总有效率47.4%。毒副反应主要是骨髓抑制和消化道反应。结论紫杉醇与顺铂联合治疗晚期胃癌可获得较高疗效,毒副反应可耐受,是一种较好的联合化疗方案。     

周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌23例

目的:观察周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌的疗效和不良反应.方法:收集 2006-07-01/2008-01-31我科以周剂量紫杉醇联合奥沙利铂治疗一线化疗失败的晚期胃癌患者23例,给予紫杉醇70 mg/m2,静脉滴注1 h,第1、8、15天;奥沙利铂100 mg/m2,静脉滴注2 h,第2天,每28天为1个周期.每例患者治疗至少2个周期,2个周期化疗完成后4 wk评价疗效.结果:在可评价疗效的23例患者中,完全缓解(CR)0例,部分缓解(PR)8例(34.8%),疾病稳定(SD)8例(34.8%),疾病进展(PD)7例(30.4%);总有效率(CR+PR)34.8%,95%CI为16%-57%;临床获益者(CR+PR+SD)共16例(69.6%),95%CI为47%-87%.平均肿瘤进展时间(TTP)为3.93±1.47 mo.不良反应主要为脱发、骨髓抑制和外周神经毒性.结论:周剂量紫杉醇联合奥沙利铂二线治疗晚期胃癌疗效好,不良反应可耐受.     

替吉奥联合紫杉醇周疗对晚期老年胃癌患者的临床疗效评价

目的评价替吉奥(S-1)联合紫杉醇周疗治疗晚期老年胃癌患者的近期疗效及毒副反应物。方法将广西横县人民医院确诊的38例晚期老年胃癌患者随机分为2组,治疗组20例,采用紫杉醇联合替吉奥化疗:紫杉醇60 mg/m2,第1、8、15 d用药,替吉奥胶囊80 mg/m2,2次/d,连续口服14 d,28 d为1个周期;对照组18例,采用FP方案:顺铂15 mg/m2,第1~5天静点,5-Fu 750mg/m2,第1~5天静点,28 d为1个周期。两组患者至少治疗2个周期后评价其疗效及毒副反应。结果治疗组与对照组的有效率(RR)、疾病控制率(DCR)、1年生存率分别为40.0%、75.0%、55.0%和22.2%、50.0%、38.9%,差异无统计学意义(P0.05);治疗组患者KPS改善情况优于对照组(P0.05);治疗组的胃肠道反应及Ⅲ~Ⅳ度骨髓抑制明显低于对照组(P0.05)。结论替吉奥口服联合紫杉醇周疗方案化疗有效率高,老年患者耐受性好,是老年晚期胃癌患者值得选择的化疗方案。     

Paclitaxel hypersensitivity reactions related to bee-sting allergy

Patients with a history of beesting allergy may have a higher risk of a hypersensitivity reaction with paclitaxel treatment. We suggest careful screening of patients for allergies.     

Gemcitabine Plus Paclitaxel Versus Carboplatin Plus Either Gemcitabine or Paclitaxel in Advanced Non-small-cell Lung Cancer: A Literature-based Meta-analysis

The combination of gemcitabine plus paclitaxel has been proposed as an alternative to the platinum-based combinations for treatment of advanced non-small-cell lung cancer (NSCLC). However, conflicting results have been reported. This meta-analysis was performed to compare the activity, efficacy, and toxicity of gemcitabine plus paclitaxel versus carboplatin plus either gemcitabine or paclitaxel in patients with untreated advanced NSCLC. Randomized phase II and phase III clinical trials comparing gemcitabine plus paclitaxel with carboplatin plus gemcitabine or paclitaxel were collected from electronic databases (Medline, EMBASE, and the Cochrane Central Register of Controlled Trials), relevant reference lists, and abstract books. The published languages and years were not limited. Pooled odds ratios (ORs) were calculated for the 1-year survival rate (1-year SR), the overall response rate (ORR), and grade 3 and grade 4 toxicities. Four randomized controlled trials (2186 patients) were identified from 2051 reports. They were all published as full-text articles. No significant heterogeneity was detected in these studies. A significant difference in ORR favoring gemcitabine plus paclitaxel over carboplatin-based doublets was observed [OR = 1.20; 95% confidence interval (95% CI) = 1.02–1.42; P = 0.03], whereas the trend toward an improved 1-year SR was not significant (OR = 1.07; 95% CI = 0.91–1.26; P = 0.41). An increased risk of grade 3–4 toxicities for patients receiving carboplatin-based chemotherapy was statistically demonstrated. The gemcitabine plus paclitaxel combination showed an improved ORR and a better toxicity profile but a similar 1-year SR compared to carboplatin-based doublets. For nonplatinum-based chemotherapy, gemcitabine plus paclitaxel is a useful alternative.     

Paclitaxel coated-stent for early-onset thrombosis after liver transplantation

Hepatic artery thrombosis (HAT) is the most common vascular complication of orthotopic liver transplantation (OLT) and constitutes a potential emergency during the postoperative period. Surgical revascularization and retransplantation are the treatments of choice for this condition. The aim of this report is to present long-term follow-up on survival and graft function of three patients with paclitaxel-coated hepatic artery stents placed percutaneously after earlyonset HAT. Three patients developed early onset HAT after cadaveric-donor OLT in a tertiary care center in Mexico. These patients were treated percutaneously with balloon angioplasty and paclitaxel-coated stents. After 24 months or more of follow-up, 2 patients present total occlusion of the stent and one patient, intra-stent stenosis; interestingly, all patients have normal graft function and excellent quality of life. In conclusion, although balloon angioplasty and stent placement may be a therapeutic option for suitable patients with early-onset HAT after OLT, longterm patency is unlikely even with the use of paclitaxel- coated materials.     

Paclitaxel induces apoptosis in human gastric carcinoma cells

AIM: To investigate the apoptosis in gastric cancer cells induced by paclitaxel, and the relation between this apoptosis and expression of Bcl-2 and Bax. METHODS: In in vitro experiments, MTT assay was used to determine the cell growth inhibitory rate. Transmission electron microscope and TUNEL staining method were used to quantitatively and qualitively detect the apoptosis status of gastric cancer cell line SGC-7901 before and after the paclitaxel treatment. Immunohistochemical staining was used to detect the expression of apoptosis-regulated gene Bcl-2 and Bax. RESULTS: Paclitaxel inhibited the growth of gastric cancer cell line SGC-7901 in a dose-and time-dependent manner. Paclitaxel induced SGC-7901 cells to undergo apoptosis with typically apoptotic characteristics, including morphological changes of chromatin condensation, chromatin crescent formation, nucleus fragmentation and apoptotic body formation. Paclitaxel could reduce the expression of apoptosis-regulated gene Bcl-2, and improve the expression of apoptosis-regulated gene Bax. CONCLUSION: Paclitaxel is able to induce the apoptosis in gastric cancer. This apoptosis may be mediated by down-expression of apoptosis-regulated gene Bcl-2 and up-expression of apoptosis-regulated gene Bax.     

Paclitaxel induces thrombomodulin downregulation in human aortic endothelial cells

Patients with paclitaxel-eluting stents are at risk of developing stent thrombosis upon premature discontinuation of dual antiplatelet therapy. In this study, we set out to clarify whether paclitaxel can modulate thrombomodulin expression in human aortic endothelial cells. Human aortic endothelial cells were stimulated with paclitaxel. Methoxyphenyl tetrazolium inner salt cell viability assay, Western blot analysis, real-time polymerase chain reaction, and immunohistochemical assay were performed. In human aortic endothelial cells, paclitaxel (10(-5) to 10(-9) mol/L) treatment for 13 hours caused significant cytotoxicity at drug concentrations greater than 10(-7) mol/L. Paclitaxel (10(-5) to 10(-9) mol/L) treatment for 5 hours downregulated thrombomodulin expression dose-dependently, persisting even at 13 hours. Cotreatment with thrombin and paclitaxel did not alter the effect of paclitaxel on thrombomodulin downregulation. Paclitaxel caused a 0.63-fold decrease in thrombomodulin messenger RNA expression, and thrombin cotreatment did not alter this decrease. In vivo studies confirmed that paclitaxel (10 mg/kg) caused endothelial thrombomodulin downregulation in mice. In summary, paclitaxel downregulates thrombomodulin expression regardless of thrombin stimulation, which is an important factor for patients receiving paclitaxel-eluting stents. Therefore, further designs of drug-eluting stents should consider the influence of the eluted drugs on endothelial thrombogenicity.     

Coronary artery aneurysms associated with a Paclitaxel coated stent

Coronary artery aneurysm associated with the Paclitaxel drug eluting stent (Taxus) is a rare complication. We describe the case of a 71-year-old female, who developed two coronary artery aneurysms in her right coronary artery associated with the insertion of a Taxus stent. Although no adverse clinical outcome resulted, this case highlights a potential problem going forward.     

紫杉醇局部治疗抑制猪静脉桥新生内膜形成和增厚的实验研究

目的 :局部药物治疗是一个很好的防治静脉桥病变的策略。本研究用抗细胞增殖药物紫杉醇处理大隐静脉桥后植入猪的颈动脉 ,以观察紫杉醇的抗细胞增殖作用在抑制静脉桥内膜平滑肌细胞增殖、迁移导致内膜形成和增厚的效果。方法 :将 10头猪的 2 0只大隐静脉桥分为两组。治疗组 :将大隐静脉桥 10只置于含有 10 μmol/L浓度的紫杉醇溶液中 (先用该溶液灌洗 )浸泡 1h后植入猪的颈动脉 ,紫杉醇是溶解在 2 5 μl/L的无水酒精中 ,对照组 10只大隐静脉桥置于单纯的酒精中浸泡。 4周后取开放的静脉桥进行组织学分析。结果 :①治疗组静脉桥新生内膜面积 (1 5 9± 0 95 )mm2 ,对照组新生内膜面积高达 (2 43± 1 3 5 )mm2 ,治疗组显著低于对照组 ,两组比较有非常显著的差异 ,P <0 0 1;②治疗组内膜平滑肌细胞密度均值为 (3 681± 193 5 ) /mm2 ,对照组为 (4 60 7± 1993 ) /mm2 ,两组比较有显著性差异 ,P <0 0 5 ;中膜平滑肌细胞密度均值治疗组 (2 13 9± 73 4) /mm2 ,对照组(3 62 9± 3 2 0 7) /mm2 ,两组比较有显著性的差异 ,P <0 0 5。结论 :紫杉醇可显著抑制静脉桥内膜、中膜平滑肌细胞的增殖 ,抑制新生内膜的形成 ,证明紫杉醇可在防治静脉桥闭塞方面发挥独特作用。