奥沙利铂联合希罗达治疗晚期胃癌临床观察

选择晚期胃癌患者32例。给予奥沙利铂130mg／m^2静滴,持续2h,第1天;同时口服希罗达2500mg／m^2,早晚各1次。连服114d。21d为1个周期,连用3个周期。率组完全缓解2例,部分缓解18例,稳定9例,进展3例,总有效率62．4％。毒副反应主要为末梢神经炎、手足综合症、恶心呕吐,患者均可耐受。     

奥沙利铂联合希罗达或替加氟方案治疗老年晚期胃癌的临床观察

目的比较老年晚期胃癌应用奥沙利铂联合希罗达或替加氟方案化疗的疗效和安全性。方法 72例老年晚期胃癌按收治的时间顺序交替分为两组,A组用奥沙利铂联合希罗达方案化疗,B组用奥沙利铂联合替加氟加亚叶酸钙方案化疗,两组均化疗3个周期,比较两组的疗效和毒副反应。结果 A组化疗有效率36.1%,B组有效率38.9%,两组间疗效差异无统计学意义;两组初治均比复治有效率略高,但差异无统计学意义。毒副反应主要为血液学毒性、胃肠道反应和外周神经毒性、手足综合征。两组的白细胞减少及外周神经毒性无统计学差异。A组共发生血小板减少共12例,发生率33.3%,其中有2例Ⅲ度血小板减少;B组发生血小板减少共6例,发生率16.7%,未发生Ⅲ、Ⅳ度血小板减少。A组血小板减少发生率明显高于B组,两组有显著统计学差异(P<0.005)。B组胃肠道反应发生率为77.8%,且有2例Ⅲ度胃肠道反应,明显高于A组的61.1%,两者差异有统计学意义(P<0.05)。A组共发生手足综合征12例,其中2例为Ⅲ度,发生率为33.3%;B组共发生手足综合征5例,均为Ⅰ度,发生率为13.9%,两组手足综合征的发生率差异有统计学意义(P<0.05)。结论老年晚期胃癌应用奥沙利铂联合希罗达或替加氟方案化疗均取得较好的疗效,耐受性可。希罗达组的血液学毒性及手足综合征发生率较高,卡莫氟组胃肠道反应高于对照组。     

奥沙利铂、氟尿嘧啶联合亚叶酸钙治疗晚期胃癌效果观察

目的观察奥沙利铂、氟尿嘧啶联合亚叶酸钙治疗晚期胃癌的疗效及安全性。方法将同期收治的64例晚期胃癌患者随机分为观察组及对照组各32例,分别采用奥沙利铂、氟尿嘧啶联合亚叶酸钙方案及顺铂、氟尿嘧啶联合亚叶酸钙方案治疗4个周期。观察其近期疗效及血清CA724、CA125、CA199、CEA水平、不良反应发生率。结果观察组总有些效率显著高于对照组,治疗后血清标志物水平及不良反应发生率均显著低于对照组（P均〈0.05）。结论奥沙利铂、氟尿嘧啶联合亚叶酸钙治疗晚期胃癌疗效较好、安全性高。     

FOLFOX4与奥沙利铂联合希罗达治疗晚期胃癌疗效比较

对失去手术机会的晚期胃癌或手术后复发的患者,临床主要采用以静脉途径化疗和放疗为主的综合治疗.2004年1月～2007年1月,我们采用两种方法治疗晚期胃癌加例,并对其临床疗效进行对比观察.现报告如下.     

奥沙利铂联合氟尿嘧啶及甲酰四氢叶酸治疗晚期胃肠道肿瘤近期疗效观察

奥沙利铂(草酸-1R、2R-环已二胺合铂)属于第三代新的铂类衍生物。体内外临床前研究试验已证实对人类多种肿瘤具有抗瘤活性，较顺铂具有更强的细胞毒性作用。目前奥铂与5-FU／FA方案已被公认为对晚期胃肠道肿瘤治疗愈后有显著改善。我院2001-06／2002-0l应用此方案治疗胃癌、大肠癌共20例，疗效较好，现报告如下。     

卡培他滨联合甲酰四氢叶酸钙和奥沙利铂治疗进展期胃癌28例

目的:观察卡培他滨(CAPE)联合甲酰四氢叶酸钙(LV)和奥沙利铂(OXA)化疗方案(CAPE-LV-OXA)治疗进展期胃癌(AGC)的临床疗效和毒副反应.方法:AGC患者28例接受CAPE-LV-OXA方案治疗,po LV 90 mg/d及CAPE 1250 mg/(m2·d),d1-14;OXA85mg/m2,静脉滴注2h,d1;每3wk为1个疗程.2-6个疗程后观察疗效及其不良反应.结果:可评价疗效25例,完全缓解0例,部分缓解13例,稳定7例,进展5例,有效率(RR)为52%(13/25),中位肿瘤进展时间(TTP)为5.4(2-13)mo,中位生存时间(MST)为10.3(3-25)mo.毒副反应主要为胃肠道反应、骨髓抑制、手足综合征和黏膜炎等,多为Ⅰ-Ⅱ度毒性反应,所有Ⅲ度毒副反应4例,对症治疗或停止治疗后可缓解.无化疗相关死亡者.结论:CAPE-LV-OXA方案在AGC的治疗中疗效较为肯定,且耐受性良好.     

奥沙利铂联合5-FU、亚叶酸钙治疗晚期胃癌疗效观察

目的观察奥沙利铂（LOHP）联合5-氟尿嘧啶（5-FU）、亚叶酸钙（CF）治疗晚期胃癌的疗效。方法晚期胃癌患者40例,采用LOHP联合5-FU、CF治疗。结果本组治疗后CR 2例、PR 16例、SD 10例、PD 12例,有效率（RR）为45.0%;主要不良反应为神经毒性,占患者总数的80.0%。结论 LOHP联合5-FU、CF治疗晚期胃癌近期疗效好,但神经毒性反应发生率较高。     

雷替曲塞联合奥沙利铂与5-氟尿嘧啶联合顺铂方案治疗晚期胃癌的临床观察

目的 观察雷替曲塞联合奥沙利铂（L-OHP）治疗晚期胃癌的近期疗效和毒性.方法 将80例晚期胃癌患者分为两组,A组40例,给予雷替曲塞3 mg/m2,静脉滴注15分钟,d1;奥沙利铂130 mg,/m2,静脉滴注2小时,d1,3周重复1次.B组患者40例,给予5-氟尿嘧啶（5-FU）750 mg/m2,静脉滴注,d1 ～5;顺铂25 mg/m2,静脉滴注,d1 ～3,28天重复1次.结果 A、B两组患者的有效率分别为47.5％和22.5％,两组比较差异有统计学意义（P＜0.05）.不良反应主要是骨髓抑制和消化道反应.结论 与5-FU联合顺铂的方案比较,雷替曲塞联合奥沙利铂治疗晚期胃癌临床疗效较好,不良反应轻.     

多西他赛联合奥沙利铂、亚叶酸钙和5-氟尿嘧啶治疗晚期胃癌疗效观察

晚期胃癌化疗的目的是改善生活质量和延长生存期,选择方案时应注重高效、安全。2006年10月-2008年10月,我们应用多西他赛联合奥沙利铂和氟尿嘧啶方案治疗晚期胃癌,取得较好的临床疗效,现报告如下。     

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.     

FOLFOX4方案治疗晚期胃癌的临床观察

目的 观察FOLFOX4方案治疗晚期胃癌的近期疗效和毒副反应.方法 30例晚期胃癌患者,先给予FOLFOX4方案,即:奥沙利铂(L-OHP)85 mg/m2静脉点滴2 h,d1;亚叶酸钙(CF)200 mg/m2静脉点滴2 h,d1、d2,随后5-氟尿嘧啶(5-FU)400 mg/m2静脉推注,d1、d2,5-FU 600 mg/m2微泵持续滴注22 h,d1、d2.2周重复.4个周期后以WHO评价标准评价疗效和毒性.结果 全组30例均可评价,其中完全缓解(CR)2例,部分缓解(PR)16例,稳定(SD)7例,进展(PD)5例,总有效率(CR+PR)60%.中位肿瘤进展时间(TTP)5.5月,中位生存时间(MST)为9个月.毒副反应主要是骨髓抑制,白细胞降低发生率达83.3%,其次为胃肠道反应,恶心呕吐发生率为80.0%,口腔粘膜炎为21.3%,腹泻36.7%,无Ⅳ度胃肠道反应,周围神经毒性发生率为50.0%.结论 FOLFOX4方案治疗晚期胃癌的近期疗效较好,毒副反应可以耐受,值得进一步研究应用.     

FOLFOX4方案治疗晚期胃癌40例临床观察

目的观察FOLFOX4方案治疗晚期胃癌的临床疗效及毒副反应。方法40例晚期胃癌患者，给予FOLFOX4方案化疗。即：奥沙利铂（L-OHP）85mg／m^2。静脉点滴，2h，dl；亚叶酸钙（LV）200mg／m^2，静脉点滴，2h，d1，d2；氟尿嘧啶（5-FU）400mg／m^2静脉推注，后600mg／m^2微泵持续静脉滴注22h，d1，d2；每2周重复，4周为1周期。均治疗2周期以上，按WHO标准评价客观疗效和毒副反应。结果全组40例均可评价疗效，其中完全缓解（CR）3例，部分缓解（PR）17例，稳定（SD）13例，进展（PD）7例，总有效率（CR＋PR）50．0％。中位肿瘤进展时间（m）5．7个月，中位生存时间（MST）为9．8个月。毒副反应主要是骨髓抑制，胃肠道反应及外周神经毒性。白细胞下降发生率为75．0％。主要为Ⅰ／Ⅱ度反应，恶心呕吐发生率62．5％，腹泻30．0％。口腔粘膜炎22．5％。L—OHP引起的可逆性周围神经毒性发生率为45．0％，表现为肢端感觉异常，遇冷加重，但患者一般都能耐受。结论FOLFOX4方案治疗国人晚期胃癌的近期疗效较好，毒副反应可以耐受，值得进一步研究应用。     

Clinical pharmacokinetics of oxaliplatin and 5-fluorouracil administered in combination with leucovorin in Korean patients with advanced colorectal cancer

Purpose: Oxaliplatin and 5-fluorouracil (5-FU) act synergistically in colorectal cancer. Here, we evaluated the pharmacokinetics of oxaliplatin and 5-FU administered in combination with leucovorin in Korean advanced colorectal cancer patients. Methods: Nine patients with advanced colorectal cancer were included in this study. The 3-week regimen consisted of oxaliplatin (2-h infusion, 130 mg/m² on day 1) followed by 5-FU and leucovorin (2-h infusion, 425 and 20 mg/m², respectively, from day 1 to day 5). Blood samples were taken and platinum concentrations in total plasma, plasma ultrafiltrate, and RBCs were determined. Plasma concentrations of 5-FU were also determined. Results: The C _max of oxaliplatin was observed at the end of infusion, with mean values of 4.66, 0.84, and 2.69 μg/ml for total plasma, plasma ultrafiltrate, and RBC samples, respectively. C _max ratios of total/free were significantly higher than those reported in other ethnic groups. An accumulation of platinum was observed in RBCs, but not in total plasma and plasma ultrafiltrate samples. A significant correlation was found between the total body clearance of ultrafiltrable platinum and creatinine clearance. The C _max of plasma 5-FU ranged from 23.9 to 533.8 ng/ml, indicating large inter-patient pharmacokinetic variations. Conclusions: This study shows that pharmacokinetics of oxaliplatin in Korean patients is comparable with that of other ethic groups, except for the higher C _max ratios of total/free. The C _max of 5-FU in plasma showed large variations among patients. Antitumor efficacy in Korean advanced colorectal cancer patients given oxaliplatin and 5-FU should be further evaluated with respect to pharmacokinetic variabilities.     

Phase III randomized trial comparing 5-fluorouracil and oxaliplatin with or without docetaxel in first-line advanced gastric cancer chemotherapy (GASTFOX study)

IntroductionIn advanced gastric cancer, doublet regimen including platinum salts and fluoropyrimidine is considered as a standard first-line treatment. The addition of docetaxel (75 mg/m² q3w) to cisplatin (75 mg/m² q3w) and 5-fluorouracil has been shown to improve efficacy. However, this regimen (DCF) was associated with frequent severe toxicities (including more complicated neutropenia), limiting its use in clinical practice. Interesting alternative docetaxel-based regimens have been developed that need to be validated.AimGASTFOX study is a randomized phase III trial comparing FOLFOX alone or with docetaxel at 50 mg/m² (TFOX regimen) in first-line treatment for advanced gastric cancer. In both arms, cycle is repeated every 2 weeks until disease progression or unacceptable toxicity.Materials and methodsMain eligibility criteria: histologically proven locally advanced or metastatic gastric or esogastric junction adenocarcinoma, HER negative status, measurable disease, ECOG performance status 0 or 1, and adequate renal, hepatic and bone marrow functions.ResultsThe primary endpoint is radiological/clinical progression-free survival (PFS). A difference of 2 months for the median PFS in favor of TFOX is expected (HR = 0.73) Based on a two-sided α risk of 5% and a power of 90%, 454 events are required to show this difference. Secondary endpoints included overall survival, overall response rate, safety, quality of life and the therapeutic index.ConclusionThis study is planned to include 506 patients to demonstrate the superiority of TFOX over FOLFOX in first-line advanced gastric cancer treatment (NCT03006432).     

Surgical resection of advanced gastric cancer following trastuzumab/oxaliplatin/capecitabine combination therapy

Late-stage gastric adenocarcinoma patients have a poor prognosis because of high recurrence rates. To improve long-term outcomes, perioperative chemotherapies are combined with surgery. Human epidermal growth factor receptor 2 (HER2) overexpression had been noted in gastric cancer; therefore, trastuzumab has been used occasionally in this setting. A 63-year-old male Chinese patient, who was diagnosed with adenocarcinoma in the gastric antrum, as well as lymph node metastases along the left gastric and hepatic artery, and left adrenal area, was admitted to our hospital. HER2 expression was positive, and cluster amplification was detected in a fluorescence in situ hybridization assay. The patient received three cycles of a neoadjuvant trastuzumab/oxaliplatin /capecitabine regimen. He subsequently underwent distal gastrectomy, D2+ lymphadenectomy, left adrenalectomy, cholecystectomy and Billroth II anastomosis. Treatment was continued with another five postoperative cycles of the same medication and trastuzumab application for 1 year. No recurrence has been observed 18 mo after the operation. Trastuzumab as perioperative and adjuvant medication, in combination with oxaliplatin and capecitabine for a HER2-overexpressing advanced gastric adenocarcinoma, led to recurrence-free survival of at least 18 mo after surgery.     

草酸铂及羟基喜树碱联合亚叶酸钙和氟尿嘧啶治疗进展期结直肠癌的比较

目的：比较草酸铂及羟基喜树碱联合亚叶酸钙、氟尿嘧啶治疗进展期结直肠癌的近期疗效、不良反应和生存期．方法：经病理证实的进展期结直肠癌病例60例,40例(OLF组)采用草酸铂联合亚叶酸钙和氟尿嘧啶方案化疗92个周期,20例(HLF组)采用羟基喜树碱联合亚叶酸钙和氟尿嘧啶方案化疗40个周期,观察化疗不良反应,2-3周期后评价疗效,随访观察无疾病进展生存期、总生存期,统计1a生存率．结果：OLF和HLF组近期有效率分别为30．0%(12/40)和25．0%(5/20),无统计学差异(χ~2 =0．531,P=0．811)；中位无疾病进展生存期分别为6．4和7．3 mo,无统计学差异(u=1．5088,P＞0．05)；中位总生存期分别为10．2和10．8 mo,无统计学差异(u=0．3487,P＞0．05)；1 a生存率分别为34．09%和38．55%,无统计学差异(u= 0．3275,P＞0．05)．两组间Ⅲ,Ⅳ度不良反应均以骨髓抑制和消化道反应为主,其中腹泻发生率HLF组高于OLF组,有统计学差异(χ~2=7．876,P=0．044)．结论：OLF和HLF两方案治疗进展期结直肠癌疗效相似,前者外周神经毒性较常见,后者腹泻更常见．