伊立替康联合顺铂治疗广泛期小细胞肺癌的临床观察

为了观察伊立替康联合顺铂治疗广泛期小细胞肺癌(SCLC)的近期疗效及毒副反应,对28例患者采用伊立替康联合顺铂治疗的方法.伊立替康 60 mg/m2,静脉滴入,d1、d8、d15;顺铂 60 mg/m2 ,静脉滴入,d1.28 d 为1个周期,2个周期后评价疗效. 结果可评价疗效28例,其中CR 6例(21.4%),PR 12例(42.9%),NC 4例(14.3%),PD 6例(21.4%),总有效率为64.3%(18/28).主要毒副反应为腹泻、骨髓抑制、恶心和呕吐.初步结果提示,伊立替康联合顺铂治疗SCLC有明显的疗效,毒副反应可以耐受,可以作为SCLC临床治疗的有效方案之一.     

伊立替康联合奥沙利铂治疗 晚期复发转移卵巢癌的临床观察

目的 观察伊立替康联合奥沙利铂治疗晚期复发转移卵巢癌的疗效及毒副反应.方法 34例晚期复发转移卵巢癌患者予以伊立替康联合奥沙利铂治疗.结果 34例晚期复发转移卵巢癌患者中,CR 8例,PR 11例,SD 12例,PD4例,总有效率55.9％.中位肿瘤进展时间为6.8个月.毒副反应主要为骨髓抑 制、胃肠道反应和神经毒性,均经对症处理后缓解或自行缓解.结论 伊立替康联合奥沙利铂治疗晚期复发转移卵巢癌疗效确切,毒副反应可耐受.     

伊立替康、顺铂、卡培他滨联合化疗治疗晚期食管癌的疗效观察

目的：观察伊立替康、顺铂、卡培他滨联合化疗对晚期食管癌的近期疗效及不良反应。方法：经临床明确诊断的晚期食管癌病人21例,接受伊立替康、顺铂、卡培他滨联合化疗,伊立替康180mg/m2,d1,顺铂20mg/m2,d1-d5,卡培他滨2000mg/（m2.d）,分早、晚2次口服,d1-d14,3周为一周期,治疗两个周期评价疗效一次。结果：21例患者可评价客观疗效和不良反应。完全缓解（CR）1例,部分缓解（PR）9例,稳定（SD）4例,进展（PD）7例。客观效率（RR）47.6%,疾病控制率（DCR）66.7%,中位疾病进展时间（mTTP）5.8个月。主要不良反应为腹泻、中性粒细胞减少及恶心和呕吐。结论：伊立替康、顺铂、卡培他滨联合化疗对晚期食管癌的疗效较好,不良反应可以控制。     

伊立替康、顺铂、卡培他滨联合化疗治疗晚期食管癌的疗效观察

目的 观察伊立替康、顺铂、卡培他滨联合化疗对晚期食管癌的近期疗效及不良反应.方法 经临床明确诊断的晚期食管癌病人21例,接受伊立替康、顺铂、卡培他滨联合化疗,伊立替康180mg/m2,d1,顺铂20mg/m2,d1- d5,卡培他滨2000mg/(m2*d),分早、晚2次口服,d1- d14,3周为一周期,治疗两个周期评价疗效一次.结果 21例患者可评价客观疗效和不良反应.完全缓解(CR)1例,部分缓解(PR)9例,稳定(SD)4例,进展(PD)7例.客观效率(RR)47.6%,疾病控制率(DCR)66.7%,中位疾病进展时间(mTTP)5.8个月.主要不良反应为腹泻、中性粒细胞减少及恶心和呕吐.结论 伊立替康、顺铂、卡培他滨联合化疗对晚期食管癌的疗效较好,不良反应可以控制.     

食管癌伴锁骨上淋巴结转移放射治疗疗效及相关因素的关系探讨

目的：分析伴锁骨上淋巴结转移食管癌患者的放射治疗的疗效及其预后影响因素,进一步评价食管癌临床分期。方法：回顾性分析资料完整的68例接受三维适形放疗的初治食管癌伴锁骨上淋巴结转移的患者,对预后生存进行单因素和多因素分析,锁骨上淋巴结转移与食管癌临床分期的关系及其对预后的影响。结果：全组患者原发灶治疗后完全缓解（CR）26例,部分缓解（PR）33例,无变化（NR）9例。全组锁骨上转移淋巴结治疗后CR 49例,PR 19例,总有效率为100%。全组1、2、3年生存率分别为51.4%、31.0%和15.0%,中位生存期15.0个月。单因素分析表明病变部位、 病变长度、 原发灶放疗剂量、腹腔淋巴结转移、锁骨上转移淋巴结的大小及化疗为影响预后的因素。其中病变部位、 原发灶放疗剂量、锁骨上转移淋巴结的大小及化疗为独立预后影响因素。食管胸下段癌患者的生存率及中位生存期均最低。结论：放化疗联合者可作为中晚期食管癌的主要治疗方法,胸上段食管癌伴锁骨上淋巴结转移者应归为区域淋巴结转移。     

上腔静脉综合征24例近期疗效观察

目的 观察拓扑替康、多西紫杉醇分别联合顺铂治疗肿瘤上腔静脉综合征24例的近期疗效和患者不良反应.方法 小细胞肺癌(SCLC)组:拓扑替康1 mg/m2,静脉滴注,第1天至第5天,顺铂30 mg/m2,静脉滴注,第1天至第3天;非小细胞肺癌(NSCLC)组:多西紫杉醇75 mg/m2,静脉滴注,第1天,顺铂30 mg/m2,静脉滴注,第1天至第3天,每3周重复,连用3个周期后评价疗效.结果 SCLC组,完全缓解(CR)4例,部分缓解(PR)5例,CR率36.4%,总有效率81.9%;NSCLC组CR 5例,PR 6例,CR率38.5%,总有效率84.7%.24例治疗后CR率为37.5%,总有效率为83.3%.两种化疗方案患者的主要不良反应均为骨髓抑制和胃肠道反应.结论 SCLC组选用拓扑替康加顺铂,NSCLC选用多西紫杉醇加顺铂,治疗肺癌并上腔静脉综合征化疗方案安全有效,值得临床进一步研究.     

伊立替康联合顺铂方案治疗复治性晚期小细胞肺癌23例临床观察

目的观察伊立替康联合顺铂方案治疗复治性晚期小细胞肺癌的疗效和安全性。方法伊立替康联合顺铂治疗23例复发或进展的小细胞肺癌,伊立替康60mg／m^2静脉滴注,d1,8,15,DDP60mg／m^2静脉滴注,d1;每28d为1个周期。结果23例均可评价疗效,完全缓解率为13％（3／23）,部分缓解率为30.4％（7／23）,总有效率CR＋PR为43.5％;稳定6例（26．1％）,进展7例（30．4％）,中位疾病进展时间为4、6个月,中位生存期为8、3个月。主要毒副反应为血液学毒性和消化道症状,其中Ⅲ、Ⅳ度白细胞减少发生率为65．2％（15／23）;血小板减少发生率为34．8％（8／23）;恶心呕吐发生率为82．6％（19／23）;腹泻发生率较高,为87、0％（20／23）,其中Ⅲ、Ⅳ度腹泻为56．5％（13／23）。全组无毒性相关死亡。结论伊立替康联合顺铂作为二线方案治疗复治性晚期小细胞肺癌有较好的疗效,毒副反应可以耐受。     

拓扑替康联合顺铂治疗小细胞肺癌的近期疗效

目的　观察拓扑替康加顺铂联合方案对小细胞肺癌的疗效和毒性反应。方法　经病理组织学或细胞学证实的 2 6例小细胞肺癌应用拓扑替康 1.2 5mg/(m2 ·d) ,连用 5天 ,顺铂 2 5mg/(m2 ·d) ,连用 3天 ,2 1天为一周期 ,至少应用 2个周期。结果　全组 2 6例可评价病例中 ,CR 3例 ,PR 11例 ,SD 7例 ,PD 5例 ,总有效率为 5 3.8%。 12例初治患者中 ,CR 2例 ,PR 7例 ,SD 2例 ,PD 1例 ,有效率为 75 .0 % ;14例复治患者中 ,CR 1例 ,PR 4例 ,SD 5例 ,PD 4例 ,有效率为 35 .7%。 5例脑转移患者中 1例获PR。中位生存期 2 7周 ,1年生存率为 38.5 % ( 10 /2 6 )。主要不良反应为骨髓抑制。结论　拓扑替康联合顺铂治疗小细胞肺癌有较好的近期疗效 ,不良反应可耐受     

替吉奥联合伊立替康治疗晚期胃癌临床观察

目的 探讨替吉奥联合伊立替康治疗晚期胃癌的近期疗效和不良反应.方法 67例经病理证实的晚期胃癌患者接受替吉奥联合伊立替康方案的化疗:替吉奥100 mg·m-2,bid,d1~14;伊立替康80 mg·m-2,持续静脉滴注90 min,d1,8,21 d为1周期.结果 67例患者均可评价疗效,其中CR 4例,PR 25例,SD 28例,PD 10例,有效率为43.3%(29/67),疾病控制率为85.1%(57/67).化疗主要不良反应为骨髓抑制和胃肠道反应.结论 替吉奥联合伊立替康治疗晚期胃癌安全有效,可作为晚期胃癌治疗方案的选择之一.     

奥沙利铂或伊立替康联合希罗达治疗晚期胃癌的临床比较分析

目的 观察并比较奥沙利铂联合希罗达与伊立替康联合希罗达治疗晚期胃癌的近期疗效和毒副反应.方法 59例晚期胃癌随机分为两组,A组31例应用奥沙利铂联合希罗达,B组28例应用伊立替康联合希罗达.均化疗2个周期以上.结果 A组中CR 1例,PR 14例,有效率为48.39%,中位无进展生存期为6.3个月;B组中CR 0例,PR 13例,有效率为46.43%.中位无进展生存期为5.9个月.两组有效率及巾位无进展生存期比较差异均无统计学意义(P>0.05).两组主要毒副反应为骨髓抑制和胃肠道反应,A组神经毒性较重,B组腹泻较重;两组均无化疗相关性死亡.结论 两种方案对晚期胃癌均有较好的疗效,且疗效相当;毒副反应均可耐受.     

GP和FP治疗转移性鼻咽癌的疗效观察

目的：观察吉西他滨＋顺铂（GP）方案和氟尿嘧啶＋顺铂（FP）方案治疗晚期复发转移性鼻咽癌的疗效及不良反应。方法：选择放疗后复发转移性鼻咽癌60例,分别采用GP方案或FP方案静脉化疗,21天为1周期。结果：GP组：CR5例、PR19例,有效率（CR＋PR）80％;FP组：CR2例、PR14例,有效率（CR＋PR）53．3％两组有效率有显著差异（P=0．0283）。中位PFS（无进展生存期）GP组8个月,FP组3个月（P=0．0001）。中位OS期（总生存期）GP组11个月,FP组7个月（P=0．0002）。两组毒性均能耐受。结论：GP方案较FP可以更好改善复发转移性鼻咽癌的RR、PFS和OS。     

Phase II study of irinotecan plus cisplatin induction followed by concurrent twice-daily thoracic irradiation with etoposide plus cisplatin chemotherapy for limited-disease small-cell lung cancer.

PURPOSE: Irinotecan plus cisplatin (IP) chemotherapy demonstrated a promising outcome with a high complete response (CR) rate in chemotherapy-na?ve patients with extensive small-cell lung cancer (SCLC). We evaluated the efficacy of induction IP chemotherapy followed by concurrent etoposide plus cisplatin (EP) chemotherapy with twice-daily thoracic radiotherapy (TDTRT) in limited-disease SCLC (LD-SCLC). PATIENTS AND METHODS: Between November 2001 and May 2003, 35 chemotherapy-na?ve patients with LD-SCLC were enrolled. Thirty-three patients (94%) were male, and 29 (83%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. The median age was 63 years. Treatment consisted of two 21-day cycles of cisplatin 40 mg/m2 and irinotecan 80 mg/m2 intravenously (i.v.) on days 1 and 8 followed by two 21-day cycles of cisplatin 60 mg/m2 i.v. on days 43 and 64, and etoposide 100 mg/m2 i.v. on days 43 to 45 and 64 to 66, with concurrent TDTRT of total 45 Gy beginning on day 43. RESULTS: All 35 patients were assessable for response. The objective response rate was 97% (CR, 3; partial response [PR], 31) after induction chemotherapy and 100% (CR, 15; PR, 20) after concurrent chemoradiotherapy (CCRT). After a median follow-up of 26.5 months, the median survival was 25.0 months (95% CI, 19.0 to 30.9) with 1- and 2-year overall survival rates of 85.7% and 53.9%, respectively. Median progression-free survival (PFS) was 12.9 months with a 1- and 2-year PFS of 58.5% and 36.1%, respectively. The most common toxicities were grade 3 or 4 neutropenia in 68% of patients during induction chemotherapy and 100% during CCRT. Febrile neutropenia occurred in 20% of patients during induction chemotherapy and 60% during CCRT. CONCLUSION: IP induction chemotherapy followed by concurrent TDTRT with EP chemotherapy showed a promising activity with favorable 1- and 2-year survival rates. Based on the favorable outcome in this trial, this regimen should be evaluated in a large phase III trial.     

Phase II study of irinotecan and cisplatin with concurrent split-course radiotherapy in limited-disease small cell lung cancer

Background

Irinotecan and cisplatin are one of active regimens for patients with extensive-stage small cell lung cancer (SCLC). To determine the efficacy and toxicity of irinotecan and cisplatin with concurrent split-course thoracic radiotherapy in limited-disease (LD) SCLC, we conducted a phase II study.

Patients and methods

Thirty-four patients fulfilling the following eligibility criteria were enrolled: chemotherapy-na?ve, good performance status (PS 0–1), age ≤75, LD-SCLC, and adequate organ function. The patients received irinotecan 40?mg/m² i.v. on days 1, 8, and 15, and cisplatin 60?mg/m² i.v. on day 1. Four cycles of chemotherapy were repeated every 4?weeks. Split-course thoracic radiotherapy of once-daily 2?Gy/day commenced on day 2 of each chemotherapy cycle, with 26 and 24?Gy administered in the first and second cycles, respectively.

Results

Thirty-four patients were eligible and assessable for response, toxicity, and survival. Patients’ characteristics were as follows: male/female?=?29/5; PS 0/1?=?18/16; median age (range)?=?67 (50–73); and stage IB/IIA/IIB/IIIA/IIIB?=?2/2/3/16/11. The overall response was 100?% (CR 8, PR 26). Grade 4 leukopenia, neutropenia, grade 3–5 pneumonitis, diarrhea, and esophagitis occurred in 24, 38, 6, 3, and 0?%, respectively. There were 2 treatment-related deaths from pneumonitis. The median time to tumor progression was 14.3?months. The median overall survival time and the 2- and 5-year survival rates were 44.5?months, 66.7 and 46.1?%, respectively. No tumor progression was observed in patients with CR.

Conclusion

Irinotecan plus cisplatin with concurrent split-course thoracic radiotherapy was effective and tolerable in untreated LD-SCLC.     

Phase II study of irinotecan plus cisplatin with concurrent radiotherapy for the patients with limited-disease small-cell lung cancer

BACKGROUND: A recently conducted randomized, phase III study that compared irinotecan plus cisplatin (IP) with etoposide plus cisplatin for the patients with extensive disease SCLC revealed a superior median survival rate and a superior 2-year survival rate for the IP combination therapy. Yet there have been few such reports on the patients suffering with limited disease SCLC (LD-SCLC). We conducted a phase II trial to evaluate the efficacy and toxicity of administering IP with concurrent radiotherapy for the patients with LD-SCLC. PATIENTS AND METHODS: Twenty chemotherapy-na?ve patients with LD-SCLC were enrolled in our study. The patients were treated with 40 mg/m(2) irinotecan on days 1, 8 and 15 and with 60 mg/m(2) cisplatin on day 1 every 4 weeks until a maximum of six cycles was delivered. Once-daily radiotherapy included the administration of 50.4 Gy in 28 fractions. After completion of the radiation therapy, the dose of irinotecan was increased to 60 mg/m(2). RESULTS: The response rate was 85% (CR: 6; partial response, PR: 11). The median survival was 20.0 months (95% CI: 15.6-24.4 months) with 1-year and 2-year overall survival rates of 85 and 35%, respectively. The median progression free survival (PFS) was 12 months (95% CI: 6.2-18.1 months) with a 1-year PFS of 36%. The major hematologic toxicities of this regimen were neutropenia (60%), leukopenia (55%), anemia (20%) and thrombocytopenia (10%). The non-hematologic toxicities were nausea/vomiting (55%), diarrhea (35%) and dysphagia (15%). CONCLUSIONS: Our data show that IP with concurrent radiotherapy is an effective and tolerable regimen for the treatment of LD-SCLC and these findings warrant further investigation.     

Combined chemotherapy for recurrent and metastatic nasopharyngeal carcinoma

Thirty-two patients (24 males, 8 females; median age 54 yrs) with recurrent and/or metastatic undifferentiated carcinoma of the nasopharyngeal type were treated with chemotherapy. Remissions were observed in 17 of 32 (53.2%) with 5 complete (CR) (15.6%) and 12 partial responses (PR) (37.6%). A combination of cisplatin and 5-fluorouracil was the most effective regimen (CR + PR = 83.3%). Objective responses. (CR + PR) were 47% (CR = 11.7%) in schemes without cisplatin and 60% (CR = 20%) in cisplatin-based combinations. The median overall duration of response was 7.2 months. The median overall survival time was 10.3 months: 15.1 months for responders and 5.2 for non-responders. No important toxicity was observed.     

Clinical study of irinotecan plus infusional fluorouracil/l-leucovorin (FOLFIRI) in patients with fluoropyrimidine-resistant metastatic colorectal cancer

The clinical efficacy and safety of irinotecan plus infusional fluorouracil/l-leucovorin (FOLFIRI) in patients with fluoropyrimidine-resistant metastatic colorectal cancer were studied retrospectively. 20 patients were treated with FOLFIRI at our hospital between October 2003 and November 2005. The objective overall response rate was 28% (5/18; 95% confidence interval, 9.7-54%). The disease control rate (CR+PR+SD) was 61%. The most frequent grade 3 to 4 adverse event was neutropenia, and it was seen in 50%. Non-hematological toxicities were mild. The median survival time was 11 months. The 1-year survival rate was 34%. This study showed the activity and safety of FOLFIRI in practice.     

Bone metastasis and poor performance status are prognostic factors for survival of carcinoma of unknown primary site in patients treated with systematic chemotherapy

BackgroundCancer of unknown primary site (CUP) generally has a poor prognosis, and there is no established standard therapy. There have been no reports of a prognostic model for CUP patients treated with a single regimen of systemic chemotherapy.MethodsUnivariate and multivariate prognostic factor analysis for overall survival (OS) were conducted retrospectively in 58 consecutive CUP patients treated with carboplatin plus paclitaxel (Taxol) therapy as a first-line treatment.ResultsUnivariate prognostic factor analysis revealed baseline performance status (PS) of two or more, low serum albumin level, pleural effusion, bone metastasis, and liver metastasis as adverse prognostic factors. Cox proportional hazards analysis showed that poor PS and bone metastasis had the most powerful adverse impact on survival. We developed a prognostic model using those two variables—a good-risk group (PS 0–1 without bone metastasis) and a poor-risk group (PS ≥2 or bone metastasis). The poor-risk group showed significantly poorer OS than the good-risk group (1 year OS 36.8% versus 67.1%, P = 0.0003).ConclusionsPoor PS and bone metastasis were identified as independent adverse prognostic factors in CUP. A simple prognostic model was developed and seems useful for decision making as to whether chemotherapy is indicated for CUP patients.     

Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors.

PURPOSE: The efficacy of paclitaxel was evaluated in combination with ifosfamide and cisplatin as second-line chemotherapy for patients with relapsed testicular germ cell tumors (GCTs). PATIENTS AND METHODS: Forty-six patients with progressive metastatic GCTs were treated with paclitaxel and ifosfamide plus cisplatin (TIP) as second-line therapy. Eligibility required that patients have both a testis primary tumor site and a prior complete response (CR) to a first-line chemotherapy program, which had been identified previously as favorable prognostic factors to conventional-dose salvage chemotherapy. RESULTS: Thirty-two (70%) of 46 patients achieved a CR to treatment. Three patients (7%) who achieved a CR relapsed after TIP chemotherapy. Twenty-nine patients are continuously disease free at a median follow-up time of 69 months, resulting in a 63% durable CR rate and a 2-year progression-free survival rate of 65% (95% CI, 51% to 79%). CONCLUSION: Four cycles of TIP as second-line therapy achieved a durable CR rate in a high proportion of patients with relapsed testicular GCT. The high CR rate emphasizes the importance of patient selection according to prognostic factors to achieve a favorable outcome to conventional-dose salvage therapy.     

Improved results with the addition of interferon alfa-2b to dacarbazine in the treatment of patients with metastatic malignant melanoma

Sixty-four patients with histologically confirmed metastatic malignant melanoma were entered on a prospectively controlled randomized trial. Patients received dacarbazine (DTIC) alone or DTIC plus interferon (IFN) alfa-2b. Patients were reasonably balanced with respect to age, sex, performance status (PS), site of metastases, and number of metastatic sites. Objective response (complete plus partial remission [CR + PR]) was documented in six patients on DTIC and in 16 patients on DTIC plus IFN alfa-2b. Median time to treatment failure (TTF) and median survival are significantly better on the combination arm, with some long-term CRs observed. More toxicity was encountered in the combination arm, which was acceptable except in three patients where treatment was discontinued because of IFN toxicity.     

吉西他滨联合顺铂一线治疗晚期triple-negative乳腺癌41例临床研究

目的：观察吉西他滨联合顺铂（GP）一线治疗triple-negative（ER、PR、HER-2均阴性）晚期转移性乳腺癌的疾病进展时间、疗效和安全性。方法：2008年1月-2010年4月共41例经免疫组化检查证实为tri-ple-negative的晚期乳腺癌初治患者参与研究。患者接受吉西他滨联合顺铂方案治疗：吉西他滨1000mg/m2,静脉滴注30min,d1、d8;顺铂25mg/m2静脉滴注d1-3天,21天重复。结果：全组41例共完成160个周期的治疗,中位数4个周期,范围2-6个周期,均可评价疗效。完全缓解（CR）2例（4.88%）,部分缓解（PR）21例（51.22%）,病情稳定（SD）7例（17.07%）,病情进展（PD）11例（26.83%）。临床总缓解率（CR＋PR）56.10%;疾病控制率（CR＋PR＋SD）73.17%;中位疾病进展时间（mTTP）8.4个月,1年生存率65.85%。不良反应主要为Ⅰ-Ⅱ度骨髓抑制、末梢神经毒性、胃肠道反应、轻度肝功能损伤等。结论：吉西他滨联合顺铂一线治疗triple-negative晚期转移性乳腺癌患者,初步观察疗效较好,不良反应可耐受,值得进一步研究。