周剂量多西紫杉醇联合小剂量顺铂、5-氟脲嘧啶持续静脉滴注治疗晚期胃癌的疗效观察

目的 评价周剂量多西紫杉醇联合小剂量顺铂、5-氟脲嘧啶(5-Fu)持续静脉滴注治疗晚期胃癌的临床疗效和毒副反应.方法 48例晚期胃癌随机分为两组,试验组:多西紫杉醇35 mg/(m2·d)静滴,d1,8,15;顺铂 mg/(m2·d),d1～5,d8～12;5-Fu250mg/(m2·d)微量输液泵维持持续静滴,d1～14,3周为1周期.对照组:顺铂75mg/(m2·),d1静滴;5-Fu 1000mg/(m2@d),d1～5>3周为1周期.治疗3～4个周期后评价疗效和毒副反应.结果 试验组总有效率为45.8%;对照组总有效率为37.5%.两组有效率比较差异无统汁学意义(P>0.05).试验组较对照组白细胞下降(79.2%vs 45.8%);试验组腹泻(41.6%vs 20.8%)较对照组明显升高(P<0.05);试验组恶心、呕吐的发生率(33.3%vs 12.5%)低于埘照组,蒡异均有统计学意义(P<0.05).结论 多西紫杉醇联合小剂量顺铂、5-Fu持续静脉滴注治疗晚期胃癌具有较好的疗效,毒剐反应可耐受,是晚期胃癌化疗的有效方案.     

多西紫杉醇联合小剂量氟尿嘧啶持续静脉滴注治疗晚期胃癌

目的 评价多西紫杉醇联合小剂量5-氟尿嘧啶(5-Fu)持续静脉泵滴注治疗晚期胃癌的近期疗效和不良反应.方法 采用多西紫杉醇联合5-Fu化疗,多西紫杉醇静脉滴注每天40 mg/m2第1、8天;5-Fu每天250 mg/m2持续静脉泵滴注24 h,第1天至第14天,4周重复,为1个周期.每例治疗2周期后评价疗效和不良反应.结果 全组23例均可评价疗效,其中完全缓解1例,部分缓解12例,总有效率56.52%.不良反应主要为骨髓毒性,胃肠道反应轻,大部分患者耐受性好.结论 多西紫杉醇联合小剂量5-Fu持续静脉泵滴注对晚期胃癌的近期疗效理想,不良反应可以耐受.     

低剂量氟尿嘧啶持续输注联合奥沙利铂治疗老年晚期胃肠道恶性肿瘤

[目的]观察低剂量氟尿嘧啶(5-Fu)持续输注联合奥沙利铂(L-OHP)方案治疗老年性晚期胃肠道恶性肿瘤的近期疗效及毒副反应等。[方法]32例晚期胃肠道恶性肿瘤患者给予5-Fu225mg/(m2·d)微量泵持续静脉滴注3周,L-OHP60mg/m2d1、8、15,静脉滴注,28d为1个周期,2个周期后评定疗效。[结果]CR1例,PR14例,NC13例,PD4例,32例病例的总有效率为46.88%(15/32),其中转移性肝癌患者有效率为64.71%(11/17)。化疗后ECOG评分比化疗前有显著性改善(P<0.05)。化疗后毒副反应病人均能耐受。[结论]低剂量氟尿嘧啶持续静脉输注联合奥沙利铂方案治疗老年性晚期胃肠道恶性肿瘤是一个有效、低毒,且能显著改善生活质量的化疗方案。     

紫杉醇持续滴注联合方案二线治疗难治性晚期食管鳞癌

[目的]研究含紫杉醇（PTX）持续静脉滴注方案二线治疗晚期食管癌的疗效和毒性。[方法]26例晚期食管鳞癌患者应用含低剂量PTX持续静脉输注联合方案化疗：PTX20mg/m2,civ,16h,d1～3,d8～9;DDP3.75mg/m2,iv,d1～4,d8～11;5-Fu375mg/m2,civ,24h,d1～5,d8～12;叶酸60mg,po,d1～5,d8～12;21d为1个周期,至少应用2个周期。[结果]23例完成2个周期治疗者可评价疗效,CR1例,PR9例,SD10例,PD3例,有效率为43.5%,中位疾病进展时间（TTP）5.1个月。主要毒副反应为骨髓抑制和脱发,其他毒副反应较轻。[结论]低剂量PTX持续静脉输注联合方案治疗晚期食管鳞癌安全有效。     

多西紫杉醇联合氟脲嘧啶和顺铂方案治疗晚期胃癌临床观察

目的 观察多西紫杉醇联合氟脲嘧啶和顺铂方案(DCF方案)治疗晚期胃癌的近期疗效和毒副反应.方法 对28例晚期胃癌采用DCF方案化疗,多西紫杉醇75 mg/m2静脉滴入1 h,d1,DDP 25 mg/m2静脉滴入,d1-3,5-Fu 400 mg/m2静脉推注,d1-2,1 200mg/m2微量输液泵持续静脉滴注44 h,至少化疗2个周期评价疗效.结果 28例完全缓解(CR)2例,部分缓解(PR)14例,总有效率(RR)为57.14%,中位缓解期为6.5个月,中位生存期为11.6个月,1年生存率为46.3%;毒副反应主要为骨髓抑制、消化道反应和脱发,大部分为Ⅰ～Ⅱ度,耐受良好,骨髓抑制为剂量限制性毒性,Ⅲ度以上白细胞减少6例.结论 多西紫杉醇联合氟脲嘧啶和顺铂方案治疗晚期胃癌的近期疗效好,毒副反应轻,耐受性好.     

周剂量紫杉醇联合低剂量FP方案治疗晚期胃癌临床观察

目的　研究周剂量紫杉醇联合低剂量氟脲嘧啶 ( 5 Fu)持续滴注及低剂量顺铂 (PDD)治疗晚期胃癌的近期疗效和毒副反应。方法　晚期胃癌 2 2例 ,紫杉醇 60mg/m2 ,静滴 3h ,每周一次 ,连用 3周 ;5 Fu 2 0 0mg/(m2 ·d) ,连用 2 1天 ;PDD 6mg/(m2 ·d) ,静滴 2h ,每周 5天 ,连用 3周 ;以上化疗方案每 4周重复 ,2周期后评定疗效。结果　 2 2例晚期胃癌总有效率 68 2 %,其中CR 1例 ,PR 14例。化疗中主要毒性反应表现为骨髓抑制、消化道反应、脱发等。结论　紫杉醇作为一种新抗肿瘤药 ,周剂量使用与低剂量 5 Fu持续滴注及低剂量PDD联合 ,对晚期胃癌近期效果显著 ,毒副反应小。     

紫杉醇联合氟脲嘧啶和亚叶酸钙方案治疗晚期胃癌的临床观察

 目的观察含紫杉醇联合氟脲嘧啶/亚叶酸钙方案治疗晚期胃癌的近期疗效及毒副反应。方法晚期胃癌43例患者均给予紫杉醇(PTX)135mg/m2,静滴3h,第一天给药;亚叶酸钙(CF)200mg/m2静脉滴注2h,给予氟脲嘧啶(5-Fu)500mg/m2静脉推注,后续5-Fu3000mg/m2,持续静脉输注泵泵注48h,21天为1周期,至少应用3周期后按WHO标准评价疗效和毒副反应。结果全组43例可评价疗效41例,完全缓解(CR)4例,部分缓解(PR)21例,稳定(SD)12例,进展(PD)4例,近期客观有效率60.98%,中位TTP为8.3个月。可评价毒性患者41例,主要毒副反应为骨髓抑制、胃肠道反应和脱发。结论PTX联合5-Fu/CF治疗晚期胃癌有较好的疗效,毒性反应轻可耐受,值得在临床上推广。     

周剂量多西紫杉醇联合顺铂治疗晚期食管癌的临床观察

目的 观察分析周剂量多西紫杉醇(DTX)联合顺铂(DDP)方案治疗晚期食管癌的近期疗效和毒副反应.方法 29例Ⅲ、Ⅳ晚期食管癌,给予周剂量 DTX+DDP,即 DTX 30 mg/m2,d1.8.15,DDP 40 mg,d1-3,21 d为1周期,2个周期后按 WHO 标准评价疗效和毒副反应.结果 全组29例,均可评价疗效,总有效率55.2%,初治组(16例)有效率为62.5%,复治组(13例)有效率为46.2%.毒副反应主要表现为白细胞减少、胃肠道反应和脱发.结论 周剂量多西紫杉醇联合顺铂治疗晚期食管癌的近期疗效较高,毒副反应轻,值得进一步观察应用.     

改良FOLFOX-6方案治疗晚期胃癌的临床观察

目的 观察奥沙利铂(OXA)联合亚叶酸钙(CF)、氟脲嘧啶(5-Fu)治疗晚期胃癌的近期疗效和毒副反应.方法 24例均接受奥沙利铂85 mg/m2静脉滴注3 h,d1;CF 200 mg/m2静脉滴注2 h,给予5-Fu 400 mg/m2静脉推注,d1;后续5-Fu 2 000 mg/m2静脉持续输注约44 h.14 d为1周期,应用2周期后判定疗效.结果 完全缓解(CR)2例,部分缓解(PR)10例,总有效率为50%.24例共完成99个周期化疗,骨髓抑制为主要毒副反应,白细胞减少达90.9%;其次为胃肠道反应发生率87.4%,腹泻则为45.5%;另外周围神经毒性高达51.5%.结论 OXA联合CF 5-Fu治疗晚期胃癌有较好疗效,毒副反应可耐受,值得临床进一步推广应用.     

草酸铂联合小剂量5-Fu微泵持续输注治疗老年晚期胃肠道肿瘤的临床观察

目的观察草酸铂联合小剂量5-Fu微泵持续输注治疗老年晚期胃肠道肿瘤的疗效及不良反应.方法草酸铂100 mg,静脉滴注,第1,8天;5-Fu 250 mg/(m2·d),持续深静脉微泵输注21 d,28 d为一周期,2个周期后评定疗效.结果全组27例,总有效率51.9%;胃癌有效率55.5%,肠癌有效率44.4%;初治有效率57.1%,复治有效率46.2%.中位生存期5个月,临床受益总反应率74.5%.不良反应主要以轻度的神经毒性为主,胃肠道反应、白细胞及血小板下降也较轻.结论草酸铂联合5-Fu小剂量微泵持续输注治疗老年晚期胃肠道肿瘤疗效好,毒副反应轻,可显著提高患者的生活质量.     

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.