比卡鲁胺联合化疗治疗去势抵抗性前列腺癌的临床分析

目的探讨晚期去势抵抗性前列腺癌安全、有效的治疗方法。方法以比卡鲁胺作为二线抗雄激素药物,联合多西紫杉醇加泼尼松化疗治疗26例去势抵抗性前列腺癌患者,观察疗效及毒副反应。结果 26例去势抵抗性前列腺癌患者25例有效,有效率为96.15%。最常见的毒副反应是骨髓抑制,可耐受。结论比卡鲁胺作为二线抗雄激素药物联合多西紫杉醇加泼尼松化疗治疗去势抵抗性前列腺癌的临床疗效明显,毒副反应轻,可作为晚期去势抵抗性前列腺癌的治疗策略。     

多西他赛联合顺铂治疗激素非依赖性晚期前列腺癌

目的:探讨多西他赛联合顺铂治疗激素非依赖性晚期前列腺癌的临床效果及毒副反应。方法:16例激素非依赖性晚期前列腺癌患者均用多西他赛75 mg/m2 0.9%氯化钠注射液250 mL静脉滴注,第1天;顺铂75 mg/m2 0.9%氯化钠注射液500 mL静脉滴注,第1天,或者顺铂30 mg/m2 0.9%氯化钠注射液250 mL静脉滴注,第1~3天;21 d为一疗程。结果:16例患者中,10例患者的血PSA值降至正常水平(<5μg/L),4例PSA值下降超过50%,2例PSA值变化不明显。1例肝脏转移瘤由原来的7.5 cm缩小为3.2 cm、另1例由原来的6.0 cm缩小为2.8 cm。随访6~35个月,平均18.5个月,3例患者死亡,中位生存期16.5个月。疼痛缓解期平均为14.2个月。PSA值降低的稳定期平均为14.5个月。毒副反应:Ⅲ度 Ⅳ度中性粒细胞减少占62.5%;恶心、呕吐占37.5%;血小板减少占6.2%,但均在可耐受的范围。结论:多西他赛联合顺铂化学治疗激素非依赖性晚期前列腺癌的临床疗效显著,毒副反应可耐受,可作为激素非依赖性晚期前列腺癌的一种治疗方法。     

多西他赛联合雌二醇氮芥治疗激素抵抗性前列腺癌的疗效观察（附22例临床报道）

目的探讨多西他赛加雌二醇氮芥治疗去势抵抗性晚期前列腺癌的临床效果及不良反应。方法22例去势抵抗性晚期前列腺癌患者,全部经手术去势及不同程度的抗雄激素药物治疗后病情缓解,之后病情再进展,经全身骨扫描证实均有多发性骨转移灶,其中17例伴不同程度的骨转移灶疼痛。治疗方法：多西他赛75mg／m^2,第1天使用,雌二醇氮芥为420mg／d,第1～5天使用,每21天为一个疗程。结果5例患者的血PSA值降至正常水平（PsA〈4ng／L）,12例PSA值下降超过50％,5例PSA值变化不明显。17例伴有骨转移灶疼痛的患者中有10例疼痛消失,7例疼痛患者按VRS分级分为I级4例、Ⅱ级3例。随访时间为8～26个月,平均17．3个月。8例患者死亡,中位生存期为14．7个月,平均疼痛缓解期为12．5个月;PSA值降低的稳定期平均为11．8个月。本组病例最常见的不良反应是恶心呕吐、白细胞减少、血红蛋白降低及血小板减少等,但均在可耐受的范围。结论雌二醇氮芥加多西他赛全身化疗治疗去势抵抗性晚期前列腺癌的近期疗效显著,不良反应可以耐受,值得进一步观察研究。     

紫杉醇联合卡铂治疗激素抵抗性前列腺癌

目的：探讨紫杉醇联合卡铂治疗内分泌治疗失败前列腺癌的应用价值。方法：14例前列腺癌患者，全部经去势手术及不同程度的抗雄激素药物治疗，经全身骨扫描证实均有多发性骨转移灶，其中肝脏和双侧肾上腺转移各1例．血前列腺特异性抗原（PSA）呈逐渐上升趋势。给予紫杉醇135mg／m^2，第1、8天；卡铂AUC5300—400mg／m^2，第1天；21．28d为1个周期。结果：本组病例随访2—30个月，平均16个月。入组后接受治疗1-12个周期。4例患者PSA值降至正常水平〈4ng／mL，7例PSA值下降超过50％，有效率78．6％，有效患者PSA从治疗前（65．8±46．2）ng／mL下降至（13．4±9.8ng／mL），有效持续时间5—18个月，平均14．2个月。2例患者死亡，中位生存期为18．2个月。最常见的毒副反应为骨髓抑制．本组来出现最不利的不良反应——过敏反应，其余反应均可耐受。结论：紫杉醇联合卡铂治疗激素抵抗性前列腺癌有较好疗效，毒副反应可以耐受。     

多西他赛联合表柔比星在局部晚期乳腺癌新辅助化疗中的疗效

目的:观察多西他赛联合表柔比星在局部晚期乳腺癌新辅助化疗中的疗效和毒性反应.方法:85例局部晚期乳腺癌患者接受多西他赛75 mg/㎡,静脉滴入d1;表柔比星75 m异/㎡,静脉滴入,d1.每21天为1个周期,共行2～4个周期化疗后再行局部治疗.结果:总临床客观缓解率(CR+PR)89.4%.主要不良反应是白细胞下降,Ⅲ度及Ⅳ度白细胞减少达54.1%(46/85).结论:多西他赛联合表柔比星的新辅助化疗方案,有较好的客观缓解率,毒副反应可以耐受,对局部晚期乳腺癌患者而言是一个很好的新辅助化疗方案.     

周剂量多西他赛联合顺铂治疗老年非小细胞肺癌的临床研究

目的观察周剂量多西他赛联合顺铂治疗老年晚期非小细胞肺癌的近期疗效和毒副反应。方法86例经病理证实的晚期非小细胞肺癌患者,多西他赛35mg/m^2。第1、8天给药,联合顺铂25mg／m^2,第1～4天给药,21d为1个周期。结果86例患者完成2个周期化疗后评价近期疗效,完全缓解3例,部分缓解38例,稳定40例,进展5例,总有效率47．67％。主要毒副反应为骨髓抑制、脱发、消化道反应,但均较轻微。结论周剂量多西他赛联合顺铂方案治疗老年非小细胞肺癌疗效明显,毒副反应轻．耐受性好。     

阿比特龙联合强的松治疗去势抵抗性前列腺癌的临床观察

目的观察分析阿比特龙联合强的松治疗去势抵抗性转移性前列腺癌(m CRPC)的疗效和安全性。方法 2015年12月至2017年1月四川省人民医院收治的确诊m CRPC患者31例,给予阿比特龙1000 mg,每日1次,强的松5 mg,每日2次治疗。观察患者血清前列腺特异抗原(PSA)有效率以及毒副反应等。结果 31例患者随访时间5~20月,中位随访时间为10.3月,其中2例死亡。PSA缓解24例,总有效率77.4%,其中PSA≥100 ng/ml的缓解率为71.4%,PSA100 ng/ml的缓解率为82.3%;接受过化疗者PSA缓解率为60%,未接受过化疗者73.1%。主要的不良反应为转氨酶升高、水肿、低血钾、高血压,均可耐受。结论阿比特龙联合强的松治疗去势抵抗性转移性前列腺癌(m CRPC)的疗效肯定,可耐受性,安全性好。     

多西他赛注射液联合醋酸泼尼松治疗激素抵抗性前列腺癌的近期疗效观察

【目的】探讨多西他赛注射液联合醋酸泼尼松治疗激素抵抗性前列腺癌（HRPC）的疗效及安全性。【方法】选择本院2007年6月至2013年12月收治 HRPC患者36例,按照多西他赛注射液联合醋酸泼尼松化疗方案治疗。对比患者治疗前后骨痛数字疼痛评分（NRS）、生活质量卡式评分（KPS）、可测量病灶的变化、血清前列腺特异抗原（PSA）,并评价毒副反应。【结果】36例患者无化疗相关死亡病例,其中4例1个周期后因药物毒副作用退出治疗,2例失访,30例可评价疗效患者共完成化疗周期54个,PSA有效率为66．7％（20/30）,有效持续时间2～10个月。20例PSA有效患者中6例有可测量病灶,部分缓解4例,稳定2例。30例患者中18例存在不同程度的骨痛,12例PSA有效患者骨痛 NRS评分均下降。生活质量 KPS评价16例改善、10例稳定、4例降低。主要的毒副反应为胃肠道反应和脱发、骨髓抑制,未出现药物血管外渗漏、急性过敏病例。【结论】多西他赛注射液联合醋酸泼尼松3周化疗方案治疗 HRPC患者耐受性良好,有一定疗效,值得更大样本研究。     

多西他赛联合泼尼松治疗激素难治性前列腺癌14例观察与护理

目的：探讨多西他赛联合泼尼松化疗方案治疗激素难治性前列腺癌的效果及护理方法。方法：采用多西他赛（75mg/m^2）联合小剂量泼尼松（5mg,2次/d）3周方案,对14例激素难治性前列腺癌患者进行3-8周期化疗,比较化疗前后血清t-PSA、ALP、疼痛评分、骨及可测量病灶的变化等,进行近期疗效评估,并了解本化疗方案的不良反应。结果：每周期化疗总剂量100-140mg,共治疗1-8周期不等。血清t-PSA反应显效5例,有效3例,无效6例,总有效率为57.1%;6例N1患者中有2例淋巴结缩小,1例显示淋巴结增大,余无明显变化;骨扫描化疗后2例好转;化疗后疼痛评分减轻0-6分;Karnofsky评分平均增加4%。结论：多西他赛联合泼尼松化疗方案可抑制激素难治性前列腺癌的进展,使血清t-PSA降低、淋巴结缩小、疼痛减轻、生活质量改善,化疗耐受性较好,提高患者的生活质量,值得临床推广应用。     

奥沙利铂联合多西他赛治疗局部晚期胃癌的临床研究

目的 探讨奥沙利铂联合多西他赛对局部晚期胃癌的临床疗效以及毒副反应情况.方法 48例局部晚期胃癌患者采用奥沙利铂联合多西他赛化疗,21 d为l周期,化疗2～6个周期,按照WHO实体瘤近期客观疗效评价标准和WHO抗肿瘤药物的急性和亚急性毒副反应分度标准评价近期临床疗效和毒副反应情况.结果 48例局部晚期胃癌患者采用此方案化疗,未观察到完全缓解(CR)病例,部分缓解(PR) 17例,无变化(SD) 17例,进展(PD)14例,有效率为35.42％(17/48),疾病控制率为70.83％ (34/48),中位疾病进展时间(TTP)为6.5个月,中位生存期(MST)为10个月,最长生存时间为28个月,截至随访期末,该患者仍存活.1年生存率达41.67％ (20/48).观察到的主要毒副反应包括恶心呕吐、脱发、血红蛋白下降、中性粒细胞减少、血小板减少、肝肾功能损伤等,经对症处理后缓解,未出现不能耐受的病例.结论 奥沙利铂联合多西他赛治疗局部晚期胃癌近期临床疗效较好,副作用小,值得进一步研究和推广应用.     

Treatment of androgen-independent hormone refractory prostate cancer using docetaxel

Although prostate cancer patients with metastatic lesion initially respond to androgen ablation therapy, almost patients develop to hormone-refractory states. The optimal treatment for men with hormone refractory prostate cancer (HRPC) has not been established. Docetaxel is a semisynthetic taxane that inhibit tumor growth by induction of microtubule stabilization and promotion of bcl-2 inactivation, which induce apoptosis. Docetaxel as single agent has significant anti-tumor effect in HRPC patients. Docetaxel combined with estramustine or other antimicrotubular agents have shown further significant cytotoxicity in HRPC patients. In the United States, Food and Drug Administration (FDA) approved docetaxel, injection in combination with prednisone for the treatment of patients with advanced metastatic prostate cancer in 2004.     

经会阴冷冻治疗激素难治性前列腺癌的近期疗效观察

目的评价超声引导下经会阴冷冻治疗激素难治性前列腺癌的安全性和近期疗效。方法超声引导下经会阴冷冻治疗激素难治性前列腺癌12例。以PSA、前列腺MRI和全身骨扫描作为评定指标,疗效评价包括完全反应（CR）、部分反应（PR）、病情稳定（SD）和病情恶化（PD）。主观反应根据骨痛、排尿异常和血尿等症状的变化评定。分析其即刻和迟发并发症。结果平均手术时间（105±34）min。均未输血。术后平均住院（6±2）d。随访6～30个月,平均18个月。CR 3例、PR 5例、SD 2例、PD 2例。本组总有效率（CR＋PR）66.7%,PSA无进展生存率83.3%。主观反应均明显改善。拔除尿管后,控尿满意7例;5例尿失禁3～7 d后,恢复控尿。术后出现尿道坏死组织2例,尿道直肠瘘1例,会阴部不适1例。结论超声引导下经会阴冷冻治疗激素难治性前列腺癌安全有效,但远期疗效尚需进一步观察后明确。     

Antiemetic activity of megestrol acetate in patients receiving chemotherapy

Purpose

Several trials had independently noted that patients receiving megestrol acetate had less nausea and vomiting, but this antiemetic activity of megestrol acetate has not been reported separately in the literature. Our objective was to evaluate the antiemetic ability of megestrol acetate in patients receiving chemotherapy.

Patients and Methods

Patients receiving chemotherapy were randomly assigned to receive either megestrol acetate 320?mg PO or placebo before the first day of chemotherapy, followed on days 1?C4 by megestrol acetate 320?mg PO combined with granisetron 3?mg IV and metoclopramide 20?mg IM or only granisetron 3?mg IV combined with metoclopramide 20?mg IM in a crossover manner during two consecutive cycles. Rates of complete protection against both vomiting and moderate-to-severe nausea was the primary end point.

Results

One hundred patients were enrolled in the study. The antiemetic regimen containing megestrol acetate was superior in providing complete protection from nausea and vomiting (45% megestrol acetate regimen vs.17% no megestrol acetate regimen). Complete response of acute phase in both antiemetic regimens was different (85% megestrol acetate regimen vs. 72% no megestrol acetate regimen). Complete response of delayed emesis was also different (49% megestrol acetate regimen vs. 18% no megestrol acetate regimen). Adverse events were mostly mild to moderate. There were no serious drug-related adverse events between the two antiemetic regimens.

Conclusion

Megestrol acetate was shown to be an effective antiemetic agent. Megestrol acetate might be a new antiemetic option for chemotherapy.     

Combination chemotherapy with weekly paclitaxel or docetaxel, carboplatin, and estramustine for hormone-refractory prostate cancer

Paclitaxel (PTX) and docetaxel (DTX) have been reported to be effective for treating hormone-refractory prostate cancer (HRPC). The objective of this study was to examine the efficacy of weekly DTX (PTX)-based chemotherapy and compare weekly DTX-based chemotherapy with triweekly (once every 3 weeks) DTX-based chemotherapy. We performed a combination chemotherapy on a weekly cycle with an i.v. PTX 100 mg/m² or i.v. DTX 30 mg/m² (days 1, 8, 15, and 22), i.v. carboplatin (CBDCA) (day 1, area under the plasma concentration time curve = 6), and oral estramustine phosphate 10 mg/kg daily for 10 HRPC patients. In addition, we investigated the patient characteristics and treatment efficacy and toxicity. Among all cases, serum prostate-specific antigen (PSA) decreased by 50% or more in 90% of patients, by 75% or more in 70%, and 90% or more in 40% after chemotherapy. The effectiveness of weekly DTX-based chemotherapy was comparable with previous reports, and we showed no toxicity serious enough to require cancellation of chemotherapy. In conclusion, weekly DTX-based chemotherapy was no less effective and less toxic than triweekly DTX-based chemotherapy for HRPC patients and therefore can be useful as the first-line chemotherapy regimen for HRPC patients, especially the elderly or those with a poor performance status.     

Progressive prostate cancer associated with use of megestrol acetate administered for control of hot flashes

Low doses of megestrol acetate are frequently used for treatment of hot flashes in men having androgen ablation for prostate cancer. We report a case in which megestrol acetate (20 mg bid) was administered for symptomatic control of hot flashes in a medically castrated patient with prostate cancer. The patient was subsequently noted to have a rising prostate-specific antigen (PSA) level. Megestrol acetate administration was discontinued, and the PSA level declined. These data indicate that even the low doses of megestrol acetate used for control of hot flashes can be associated with PSA increases in some patients with prostate cancer.     

DG及DP方案治疗晚期非小细胞肺癌的临床研究

目的 探讨多西紫杉醇＋吉西他滨（DG方案）和多西紫杉醇＋顺铂(DP方案)治疗晚期非小细胞肺癌的临床疗效和毒性反应。方法 经病理学或细胞学确诊不可手术的Ⅲb／Ⅳ期NSCLC患者125例,DG组65例,DP组60例。DG组：多西紫杉醇100㎎/㎡,d1;吉西他滨1 100㎎/㎡,d1、8。DP组:多西紫杉醇100㎎/㎡,d1; 顺铂80㎎/㎡,d2。对临床疗效和毒副反应进行对比观察。结果 有效率DG组为46.2%,DP组为45%,两组差异无统计学意义（P﹥0.05）。DG组和DP组中位生存期分别为12.4月和11.7月,一年生存率为50.8%和46.7%,均无统计学差异（P >0.05）。毒副反应均以骨髓抑制、胃肠反应为主,可耐受。DP组Ⅲ~Ⅳ度白细胞下降、恶心/呕吐、腹泻较DG组严重（P﹤0.05）。其他毒副反应相似。结论 DG方案和DP方案治疗晚期NSCLC均具有较好的耐受性和疗效,毒副反应可以耐受。DG方案毒副反应较DP方案更少、更轻,可作为晚期NSCLC较理想的化疗方法之一。     

Megestrol-induced Cushing syndrome.

OBJECTIVE: To report a case of Cushing syndrome associated with megestrol acetate therapy in a patient with renal insufficiency. SUMMARY: A 17-year-old boy with renal insufficiency due to unilateral renal agenesis developed Cushing syndrome and worsening of his renal function after megestrol acetate therapy. The diagnosis was based on clinical and analytical evaluation. DISCUSSION: Megestrol acetate is indicated for the treatment of cachexia associated with AIDS and malignancy. Due to its glucocorticoid activity, megestrol use has resulted in the occurrence of Cushing syndrome in both patient groups. We report the case of a young patient with renal insufficiency due to unilateral renal agenesis who developed Cushing syndrome two months after administration of high-dose (900-mg/d) megestrol acetate for an eating disorder. CONCLUSiONS: The risk of megestrol-induced Cushing syndrome, especially with high doses of the medication, should be considered as a possible adverse effect in patents with renal insufficiency.     

多西他赛联合奈达铂治疗复发转移性鼻咽癌的临床研究

目的探讨多西他赛联合奈达铂治疗复发和（或）转移性鼻咽癌的临床疗效及不良反应。方法复发和（或）转移性鼻咽癌患者40例,经2个周期以上多西他赛联合奈达铂化疗后,评价临床疗效及不良反应。结果 40例患者均按化疗方案完成化疗,每例患者完成化疗2~4个周期,共完成134个周期化疗。化疗结束时有效率为85.0%,化疗后3个月RR为92.5%。中位无疾病进展时间7.9个月;1年生存率92.5%,中位生存时间18.7个月。不良反应主要以骨髓抑制为主。结论多西他赛联合奈达铂治疗复发和（或）转移性鼻咽癌有效率高,为有效治疗方案。     

多西他赛单药一线治疗晚期非小细胞肺癌临床研究

目的探讨多西他赛单药一线治疗晚期非小细胞肺癌临床疗效及不良反应。方法48例晚期非小细胞肺癌患者,多西他赛75m4g／lm2静脉滴注,第1天。21d为1个周期,治疗2～4个周期后评价临床疗效及不良反应。结果48例患者共化疗140个周期,中位化疗2．9个周期。RR为25．O％,DCR为56．3％,中位无进展生存期5．3个月,中位生存期8．6个月,1年生存率35．4％。不良反应以粒细胞减少、贫血、腹泻、脱发为主。结论多西他赛单药一线治疗晚期非小细胞肺癌临床疗效良好,患者耐受性较好。     

Chemotherapy for the treatment of hormone-refractory prostate cancer

AIMS: This review aims at analysing the published literature on chemotherapy for hormone-refractory prostate cancer (HRPC) to provide recommendations for the treatment of this important patient group. METHODS: The information for this review was compiled using the PubMed and Medline databases and the Proceedings of the American Society of Clinical Oncology annual meetings to search for articles, abstracts and presentations up to 1 March 2007. Electronic early-release publications were also included. Only articles published in English were considered. The search terms included hormone-refractory prostate cancer, docetaxel, mitoxantrone, satraplatin, ixabepilone, cyclophosphamide, vinorelbine, atrasentan, calcitriol, bevacizumab and targeted therapies. Priority was given to studies in high impact factor journals when available. RESULTS AND CONCLUSION: Two recent trials (TAX 327 and SWOG 9916) have shown that docetaxel chemotherapy can significantly improve survival for HRPC. Docetaxel has become the standard of care for first-line chemotherapy for HRPC and has been approved for use in the United States and Europe. Many patients with HRPC will require second- and even third-line treatment upon progression and more data are required in this setting. It is likely that the future management of patients with HRPC will build on the success of docetaxel using a sequence of chemotherapy and targeted therapies to reduce the risk of death, prevent or improve disease-related symptoms and improve quality of life for this important condition.