国产长春瑞滨联合顺铂治疗晚期乳腺癌39例疗效分析

目的:评价国产长春瑞滨(盖诺,NVB)联合顺铂治疗晚期乳腺癌的疗效和毒副反应.方法:39例晚期乳腺癌患者采用长春瑞滨联合顺铂化疗,NVB 25mg/m2静脉滴注第1、8天,顺铂30mg/m2静脉滴注第1～3天,21天～28天为1周期,3周期以上评价疗效.结果:CR 4例,PR 16例,NC 13例,PD 6例,有效率(CR+PR)为51.3%(20/39),主要毒副反应为骨髓抑制及消化道反应.结论:长春瑞滨联合顺铂治疗晚期乳腺癌疗效确切,可望成为晚期乳腺癌的二线解救方案.     

盖诺联合顺铂治疗初治非小细胞肺癌的疗效观察

目的 评价盖诺(国产去甲长春花碱)联合顺铂治疗初治非小细胞肺癌(NSCLC)近期疗效，毒副作用。方法 对56例初治晚期(Ⅲb-Ⅳ期)NSCLC采用盖诺联合顺铂化疗，盖诺25mg／(m^2．d)，d1.8顺铂(DDP)20mg/(m^2．d)，d1～5，每3周重复一次，完成2个周期评价疗效。结果 有效率(CR PR)32％，主要毒性作用是骨髓抑制和消化道反应。结论 盖诺联合顺铂治疗晚期非小细胞肺癌疗效确切，毒副反应可耐受，骨髓抑制为其剂量限制性毒性。     

盖诺联合顺铂治疗恶性肿瘤近期疗效观察

目的观察盖诺与顺铂治疗恶性肿瘤的疗效及毒副作用。方法采用NP(盖诺25mg／m^2d1.8加顺铂50mgd1～3)方案治疗恶性肿瘤32例，其中非小细胞肺癌16例，乳腺癌10例，食管癌5例，化疗2～4周期后评价疗效。结果CR3例，PR13例，NC11例，PD5例，总有效率为50％，其中NSCLC有效率43．8％，乳腺癌60％，食管癌50％，主要毒副作用为骨髓抑制及恶心呕吐。结论NP方案治疗恶性肿瘤疗效较好，毒副作用可耐受。     

国产长春瑞滨联合顺铂治疗晚期乳腺癌的临床观察

目的:观察国产长春瑞滨(盖诺)联合顺铂治疗晚期乳腺癌的临床疗效及不良反应.方法:盖诺25mg/m2静滴,第1、8天,顺铂DDP 40mg静滴,第1天～3天,共治疗晚期乳腺癌25例.结果:25例晚期乳腺癌患者近期疗效显示CR3例,PR13例,NC 5例,PD4例,总有效率64.0%,主要毒副反应为骨髓抑制,胃肠道反应和静脉炎.恶心、呕吐的发生率为96%,静脉炎的发生率为24.0%.结论:盖诺联合顺铂治疗晚期复治性乳腺癌有效率高,不良反应可耐受.     

长春瑞滨联合顺铂治疗晚期非小细胞肺癌47例疗效观察

目的：观察盖诺联合顺铂的NP方案治疗晚期NSCLC的疗效和毒性反应。方法：应用盖诺25mg／m^2静脉点滴，第1天、第8天，DDP60～80mg／m^2静脉点滴，第1天或分2天给药。结果：47例患中，无CR病例，PR25例，NC14例，PD7例，总有效率(CR PR)为53．19％(25／47)。结论：长春瑞滨联合顺铂的NP方案治疗晚期NSCLC有效率高，毒副反应可耐受。     

异长春花碱与顺铂联合治疗晚期非小细胞肺癌近期疗效观察

目的 观察异长春花碱(NVB)联合顺铂(DDP)治疗晚期非小细胞肺癌(NSCLC)的近期疗效与毒副反应。方法 共治疗52例晚期NSCLC患者：NVB25mg/m^2静滴，第1、8天，DDP80mg／m^2，第1天，同时水化3天。21天为一周期，化疗2周期后评价疗效，化疗期间记录毒副反应。结果 本组52例患者完全缓解(CR)2例，部分缓解(PR)26例，稳定(SD)17例，进展(PD)7例，总有效率(CR PR)为53．8％，NVB限制性毒性为自细胞下降、恶心呕吐及静脉炎。结论 以NVB和DDP联合化疗NSCLC有效率较高，毒副反应易耐受，可作为晚期非小细胞肺癌的一线方案。     

盖诺联合顺铂治疗初治非小细胞肺癌的疗效观察

目的　评价盖诺 (国产去甲长春花碱 )联合顺铂治疗初治非小细胞肺癌 (NSCLC)近期疗效 ,毒副作用。方法　对 5 6例初治晚期 (Ⅲb～Ⅳ期 )NSCLC采用盖诺联合顺铂化疗 ,盖诺 2 5mg/(m2 d) ,d1,8,顺铂 (DDP) 2 0mg/(m2 d) ,d1～ 5,每 3周重复一次 ,完成 2个周期评价疗效。结果　有效率 (CR PR) 3 2 % ,主要毒性作用是骨髓抑制和消化道反应。结论　盖诺联合顺铂治疗晚期非小细胞肺癌疗效确切 ,毒副反应可耐受 ,骨髓抑制为其剂量限制性毒性     

国产长春瑞滨联合顺铂治疗晚期乳腺癌39例疗效分析

目的:评价国产长春瑞滨(盖诺,NVB)联合顺铂治疗晚期乳腺癌的疗效和毒副反应。方法:39例晚期乳腺癌患者采用长春瑞滨联合顺铂化疗,NVB 25mg/m2静脉滴注第1、8天,顺铂30mg/m2静脉滴注第1~3天,21天~28天为1周期,3周期以上评价疗效。结果:CR 4例,PR 16例,NC 13例,PD 6例,有效率(CR PR)为51.3%(20/39),主要毒副反应为骨髓抑制及消化道反应。结论:长春瑞滨联合顺铂治疗晚期乳腺癌疗效确切,可望成为晚期乳腺癌的二线解救方案。     

单药持续静脉输注异长春花碱治疗高龄晚期非小细胞肺癌的临床观察

目的　观察异长春花碱 (盖诺 )持续静脉输注治疗高龄晚期非小细胞肺癌 (NSCLC)的疗效和毒性。方法　盖诺 10mg静脉滴注d1 和 10mg持续静脉输注 2 4小时d1～ 5,2 8天为 1个周期 ,至少治疗 2个周期。结果　全组 3 1例 ,CR 1例 ,PR 8例 ,NC 12例 ,PD 10例 ,总有效率 2 9%。毒性反应主要为白细胞减少 ,Ⅲ +Ⅳ度 19 3 5 % (6 3 1)。结论　该方案治疗高龄晚期NSCLC具有较高的疗效 ,毒性反应轻 ,耐受性好     

国产长春瑞滨联合顺铂治疗晚期乳腺癌的临床观察

目的:观察国产长春瑞滨(盖诺)联合顺铂治疗晚期乳腺癌的临床疗效及不良反应。方法:盖诺25mg/m2静滴,第l、8天,顺铂DDP 40mg静滴,第1天~3天,共治疗晚期乳腺癌25例。结果:25例晚期乳腺癌患者近期疗效显示CR 3例,PR 13例,NC 5例,PD 4例,总有效率64.0%,主要毒副反应为骨髓抑制,胃肠道反应和静脉炎。恶心、呕吐的发生率为96%,静脉炎的发生率为24.0%。结论:盖诺联合顺铂治疗晚期复治性乳腺癌有效率高,不良反应可耐受。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.