替吉奥胶囊联合奥沙利铂治疗晚期结直肠癌的临床观察

目的比较奥沙利铂联合替吉奥胶囊方案及FOLFOX4方案治疗晚期结直肠癌的临床疗效及毒副反应。方法46例晚期结直肠癌患者分为2组,观察组24例应用替吉奥胶囊联合奥沙利铂化疗,28d为1周期,至少完成2周期;对照组22例应用FOLFOX4方案化疗,28d为1周期,至少完成2周期。治疗后评价临床疗效和毒副反应。结果观察组有效率为54．17％,对照组为54．55％,差异无统计学意义（P〉0．05）。观察组毒副反应发生率稍低于对照组,但差异均无统计学意义（P均〉0．05）。结论替吉奥胶囊联合奥沙利铂疗效与传统的FOLFOX4方案相近,且安全性及患者耐受性方面具有一定优势,可作为晚期结直肠癌患者的治疗方案用于临床。     

替吉奥联合奥沙利铂治疗晚期食管癌近期疗效观察

目的 观察替吉奥联合奥沙利铂治疗晚期食管癌的近期疗效及不良反应.方法 30例晚期食管癌均接受化疗,替吉奥80mg/(m2 ·d),分2次,餐后口服,dl-14;奥沙利铂130 mg/m2,dl,静脉滴注＞3小时,21天为1周期,2周期后行胸腹部CT及消化道钡餐造影或胃镜评价疗效,并评价不良反应.结果 30例患者均可评价疗效,完全缓解(CR)0例,部分缓解(PR) 12例,病情稳定(SD)8例,病情进展(PD) 10例,有效率(CR+ PR)为40.0％,临床获益率(CR+PR+SD)为66.7％.中位疾病进展时间5月,1年生存率63.3％.主要不良反应为血液学毒性、消化道反应、肝功能损伤、皮疹、神经毒性等.结论 替吉奥联合奥沙利铂治疗晚期食管癌疗效较好,不良反应可耐受.     

替吉奥联合奥沙利铂及多西他赛治疗晚期及复发性胃癌的临床观察

目的探讨替吉奥胶囊(S-1)联合奥沙利铂及多西他赛治疗晚期及复发性胃癌的近期疗效和不良反应。方法对晚期及复发性胃癌52例采用多西他赛75 mg/m2静脉滴注1 h,第1天;奥沙利铂130 mg/m2静脉滴注3 h,第1天;替吉奥胶囊(S-1)40 mg/m2,早晚饭后各1次,口服化疗,第1～14天,服用14天后停药7天。每21天为1个周期,连用2个周期后评价疗效和不良反应。结果 52例均可评价,其中6例达到完全缓解(CR),22例达部分缓解(PR),15例达稳定(SD),9例进展(PD),总有效率(CR+PR)53.8%,临床受益率为82.7%。主要不良反应为胃肠道反应、白细胞减少和周围神经毒性,均较轻,未影响治疗。结论替吉奥胶囊联合奥沙利铂及多西他赛化疗治疗晚期及复发性胃癌的近期疗效较好,不良反应可以耐受,值得临床进一步研究应用。     

替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗晚期结直肠癌的临床观察

目的 观察替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗晚期结直肠癌的临床疗效及不良反应,评价其有效性和安全性。 方法 回顾性分析2010年6月-2012年6月收治的经病理学确诊的47例晚期结直肠癌病例,其中22例采用替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗(研究组),25例采用单纯替吉奥胶囊联合奥沙利铂方案治疗(对照组),观察其疗效和不良反应,并进行随访。结果 47例患者均可评价疗效和不良反应,研究组和对照组的客观有效率分别为63.6%和36.0%;疾病控制率分别为86.4%和68.0%; 中位无疾病进展期分别为7.3月和4.8月;中位生存期分别为15.0月和12.6月,差异均具有统计学意义(P<0.05);研究组较对照组增加的不良反应主要有高血压,出血等, 发生率分别为9.1% 、4.5%,均为Ⅰ级~Ⅱ级,经药物治疗后均可控制,不影响化疗的连续性。 结论 替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗晚期结直肠癌能够提高疗效,延长生存时间,且患者耐受性较好,具有较好的临床应用前景。     

奥沙利铂联合替吉奥胶囊治疗晚期胃癌的临床观察

目的观察奥沙利铂联合替吉奥（S1）胶囊方案治疗晚期胃癌的临床疗效及不良反应。方法 56例晚期胃癌患者,采用以下方案化疗：吉奥胶囊每天80mg/m2,分2次,餐后口服,d1～d14;奥沙利铂130mg/m2,静脉滴注3h,d1;28天为1个周期,至少完成2个周期。按RECIST1.1标准评价客观疗效和不良反应。结果 56例患者均可以评价疗效。CR4例（7.1%）,PR23例（41.1%）,SD17例（30.4%）,PD12例（21.4%）,RR48.2%,DCR78.6%。中位疾病进展时间（TTP）为9.3个月,中位生存期（MST）为11.2个月。不良反应主要是骨髓抑制,胃肠道反应及外周神经毒性。结论奥沙利铂联合替吉奥方案治疗晚期胃癌的近期疗效较好,不良反应可以耐受,值得进一步研究应用。     

替吉奥联合奥沙利铂方案治疗晚期胃癌的近期疗效观察

目的:观察替吉奥联合奥沙利铂治疗晚期胃癌的近期疗效及毒副反应.方法:32例晚期胃癌化疗采用L-OHP 80mg/m2~100mg/m2,静脉滴注,d1;替吉奥胶囊(80mg/m2)/d,口服bid,d1-d14,21天为1周期.结果:32例患者均可以评价疗效,完全缓解(CR)1例(3.13%),部分缓解(PR)14 例...     

替吉奥联合奥沙利铂治疗晚期胃癌的临床观察

目的 观察替吉奥(S-1)联合奥沙利铂治疗晚期胃癌的近期疗效和毒副反应.方法 33例晚期胃癌均接受化疗:替吉奥胶囊80 mg/(m2·d),早、晚餐后口服,d1～4;奥沙利铂130 mg/m2(2 h静脉滴注),d1;每21 d重复1次,至少2个周期.治疗结束后评价疗效和毒副反应.结果 CR 1例,PR 18例,SD ...     

替吉奥胶囊联合奥沙利铂治疗晚期胃癌的临床观察

目的观察替吉奥（S-1）胶囊联合奥沙利铂方案治疗晚期胃癌的临床疗效及不良反应。方法 35例晚期胃癌患者,采用以下方案化疗。替吉奥胶囊每天80 mg/m2,分2次,餐后口服,第1～14天;奥沙利铂130 mg/m2,静脉滴注2 h,21天为1个周期,至少完成2个周期。按RECIST 1.1标准评价客观疗效和不良反应。结果 35例患者均可以评价疗效。PR 16例（45.7%）,SD 11例（31.4%）,PD 8例（22.9%）。不良反应主要是骨髓抑制,胃肠道反应及外周神经毒性。结论奥沙利铂联合替吉奥方案治疗晚期胃癌的近期疗效较好,不良反应可以耐受,值得进一步临床研究应用。     

低剂量替吉奥口服治疗放弃静脉化疗的晚期结直肠癌

目的:观察口服低剂量替吉奥胶囊(国产)对晚期结直肠癌放弃全身静脉化疗患者的疗效、安全性及临床意义。方法:对90例晚期结直肠癌放弃全身静脉化疗患者,分为两组各45例,治疗组在接受常规支持对症治疗的同时,低剂量口服替吉奥胶囊化疗(替吉奥:40mg/m2,bid×4w,q6w为一疗程),休息2周后继续。对照组只接受常规支持对症治疗。比较分析CR、PR、SD、PD、OS,计算RR及DCR,同时观察不良反应,分析安全性及临床意义。结果:治疗组:无CR病例、PR 8例(17.8%)、SD 20例(44.4%)、PD 17例(37.8%)、RR(CR+PR/45)8例(17.8%)、DCR(CR+PR+SD/45)28例(62.2%),其中OS 10.2±2.1m,药物引起的不良反应大部分为1-2级,未因不良反应而停药;对照组:无CR病例、无PR病例、SD 12例(26.7%)、PD 33例(73.3%)、RR为0、DCR 12例(26.7%),其中OS 5.2±1.9m,两组比较除SD P>0.05,其余均P<0.05。结论:口服低剂量替吉奥胶囊对晚期结直肠癌放弃全身静脉化疗患者有一定的疗效、临床获益明显、不良反应较低、安全性好,具有一定的临床意义。     

替吉奥胶囊联合奥沙利铂治疗晚期大肠癌的疗效分析

目的：观察替吉奥（S-1）胶囊联合奥沙利铂治疗晚期大肠癌的临床疗效和安全性。方法：采用非盲法随机对照试验。试验组18例,替吉奥（S-1）胶囊联合奥沙利铂,替吉奥（S-1）胶囊每天80 mg/m2,分2次,餐后口服,d1-14,奥沙利铂85mg/m2,静脉滴注,3h,d1,28天一周期;对照组18例,奥沙利铂85mg/m2,静脉滴注,3h,d1,亚叶酸钙200mg/m2静脉滴注,2h,d1-5,氟尿嘧啶300mg/m2静脉滴注,2h,d1-5,28天一周期。结果：试验组（CR＋PR）RR 56.1%,中位生存期（MST）18.6个月,对照组（CR＋PR）RR 44.4%,中位生存期（MST）16.2个月。主要不良反应为血液学毒性和胃肠道反应,试验组白细胞下降发生率66.7%对照组77.8%,试验组恶心、呕吐发生率44.4%,对照组66.7%。结论：替吉奥（S-1）胶囊胶囊联合奥沙利铂是治疗晚期大肠癌是一种安全有效的化疗方案。     

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.