113例抗肿瘤药物不良反应报告分析

目的分析抗肿瘤药物所致药物不良反应(ADR)发生特点,为合理使用抗肿瘤药提供参考。方法统计分析三门峡市中心医院2016年6月至2019年6月上报的113例抗肿瘤药物ADR报告。结果113例ADR中,男45例(39.82%)、女68例(60.18%),女性明显多于男性,其中40岁以上患者较多(87例,76.99%);ADR发生时间多在用药后24 h以内(80例,70.80%),其中发生时间在用药后0.5 h以内的最多(43例,53.75%);ADR涉及最多的给药途径为静脉滴注(75例,66.37%);ADR累及的系统或器官主要为消化系统(67例,30.88%)、血液系统(46例,21.20%)、皮肤及其附件(41例,18.89%);ADR涉及抗肿瘤药物有20种,其中铂类抗肿瘤药物的发生例数最多(43例,38.05%);铂类中顺铂发生ADR排首位(21例,53.49%)。结论临床上应当加强抗肿瘤药物ADR监测工作,规范抗肿瘤药物的临床应用,减少和预防ADR的发生,保证患者安全用药。     

免疫治疗联合分子靶向药物治疗中晚期肝细胞癌的临床疗效及安全性分析:一项单臂回顾性研究

目的 探讨免疫治疗联合分子靶向药物治疗中晚期肝细胞癌(HCC)的临床应用价值和安全性。方法 按照入组标准,纳入33例接受免疫治疗联合分子靶向药物治疗的中晚期HCC患者。记录患者用药前的血液生化指标、肿瘤分期、肿瘤影像学特征、既往接受的治疗策略等临床资料,随访患者的影像学复查结果及患者用药过程中发生的不良反应事件,直至随访截止、失访或患者死亡。主要研究终点为客观缓解率(ORR)及安全性,次要研究终点为无进展生存期(PFS)和总生存期(OS)。采用Kaplan-Meier法分析用药患者的临床疗效。结果 截至末次随访,共33例中晚期HCC患者接受了免疫药物与分子靶向药物的联合治疗,ORR为24.2%,疾病控制率(DCR)为66.7%。中位无进展生存期(mPFS)为10.9个月,中位总生存期(mOS)为11.8个月。治疗相关1~2级不良反应事件及发生率分别为恶心呕吐2例(6.1%)、手足皮肤反应2例(6.1%)、反应性皮肤毛细血管增生症2例(6.1%)、乏力1例(3.0%)、胃痛1例(3.0%)、蛋白尿1例(3.0%)、腹痛9例(27.3%)、发热1例(3.0%)、胀气1例(3.0%)、低蛋白血症1例(3.0%)、高胆红素血症5例(15.2%)、谷丙转氨酶升高4例(12.1%)以及谷草转氨酶升高10例(30.3%)。治疗相关3级以上不良反应事件及发生率分别为恶心呕吐1例(3.0%)、腹痛1例(3.0%)和谷草转氨酶升高1例(3.0%)。未观察到与治疗相关死亡事件,不良反应事件均得到有效处理。结论 免疫药物与分子靶向药物的联合使用在中晚期HCC的治疗中,DCR高,不良事件发生率低,可作为中晚期HCC患者一线治疗的选择,值得进一步探索。     

正常小鼠SRC法测定人体乳腺癌药物敏感性分析

本文报告用正常小鼠肾包膜下移植的方法(SRC)测定人体乳腺癌对6种化疗药物的敏感性。共83例女性乳腺癌均为晚期,可评价的为64例77.1％,后者中20例对所测化疗药物不敏感(32％),8例只对一种药物敏感(13％)。原发癌比局部复发癌对药物敏感性显著高(P<0.05)。原发癌与淋巴结转移癌组之间药敏有差别,但无统计学意义。癌细胞分化差者(Ⅲ级)比分化好者(Ⅰ、Ⅱ级)敏感率高,但无统计学意义之差别。乳腺癌对CTX、5Fu、ADM、MTX、MMC、DDP化疗药物的敏感率与国外类似工作以及临床效果相符。     

恶性肿瘤介入化疗的药物选择

目的 报告临床935例中晚期恶性肿瘤进行介入化疗及栓塞的治疗效果,重点对介入所用化疗药物的优化组合进行了临床观察与研究。方法 在总结国内外大量病例化疗方案的基础上,结合临床对化疗药物的作用原理及特性进行了认真的研究。从数十种化疗药物中筛选出10多种疗效高、毒副作用较小的药物,通过观察比较形成了较恒定的配方,即:(以60公斤体重计算)(1)表阿霉素30mg 卡铂300mg 5—FU1000mg。(2)卡铂300mg 丝裂霉素16mg 5—FU1000mg。(3)西艾克(长春地辛)3mg 鬼臼乙甙(VP16)300mg 卡铂300mg。(4)羟基喜树碱6mg 西艾克3mg 表阿霉素30mg。(5)威猛(VM26)100mg 丝裂霉素16mg 顺氯胺铂60mg。(6)吡柔比星40mg 卡铂300mg 5—FU1000mg。结果 利用上述配方对935例各类中晚期肿瘤总共进行介入化疗及栓塞2715次,平均每例2.9次,CR113例,PR201例,MR288例,总有效率(CR PR MR)为63.2％,生存3个月以内者876例,3～6个月者668例,6～12个月467例,1～2年238例,2年以上116例。56例经介入治疗后获二次手术。结论 对介入化疗栓塞的机理,化疗药物配伍组合的原则以及筛选药物的理论依据进行了深入的讨论,并对中晚期恶性肿瘤如何提高疗效提出了见解。     

人脑胶质瘤原代细胞培养及体外药物敏感度的实验

目的 探索人脑胶质瘤细胞原代培养的方法,研究不同胶质瘤患者对抗肿瘤药物的敏感度。　方法 采用组织块培养法对39例人脑胶质瘤细胞进行原代培养,用MTT法检测胶质瘤细胞对阿霉素(ADM)、顺铂(DDP)、长春新碱(VCR) 、威猛(teniposide,VM 26)和5 氟尿嘧啶(5 Fu) 5种化疗药物的敏感度,并对其结果进行分析。结果 脑胶质瘤细胞原代培养37例成功,2例失败,成功率94.9%;37例培养成功者药敏检测显示不同个体对不同抗肿瘤药物的抑制率存在明显差异,各药物的平均抑制率依次为VM 26>DDP>5 Fu>ADM>VCR,其敏感率分别为56.8%、51.4%、37.8%、24.3%和13.5%。 结论 体外胶质瘤细胞原代培养和MTT法检测化疗药物的敏感度是可行的,检测化疗药物敏感度对胶质瘤患者个体化的化疗具有一定价值。     

新疆喀什地区维吾尔族宫颈癌术前动脉插管化疗临床病理分析及疗效观察

 本文对37例维吾尔族中晚期宫颈癌行术前动脉插管化疗，结果显示:(1)肿瘤化疗后肉眼观察，肿瘤完全消失22例(59.46%)，缩小50%以上7例(18.92%)，缩小50%以下6例(16.12%)，总显效率为94.59%。(2)切片观察癌组织完全消失7例(18.92%)，部分癌组织消失27例(72.97%)，癌组织无变化者2例(5.4%)。(3)动脉插管化疗使宫颈局部药物浓度增高，有选择性的将药物作用于靶器宫，具有全身毒副作用小，疗效显著等特点，三年存活率达86.49%。     

心理干预减轻含大剂量顺铂化疗致恶心呕吐反应的临床效果分析

目的研究心理干预减轻含大剂量顺铂化疗致恶心呕吐的临床效果。方法103例恶性肿瘤患者接受含大剂量顺铂(70~120 mg/m2)化疗,随机抽取50例单纯应用药物进行镇吐治疗,另53例在药物镇吐基础上配合心理干预,比较两组的止吐效果。结果单纯药物组抗肿瘤药物致恶心呕吐反应Ⅰ度(含Ⅰ度)以下(WHO标准)发生率为20.0%,Ⅱ度发生率为8.0%,配合心理干预组恶心呕吐反应Ⅰ度(含Ⅰ度)以下发生率为9.0%,Ⅱ度发生率为4.0%(P<0.005)。结论心理干预联合药物镇吐是防治含大剂量顺铂化疗致恶心呕吐的理想方法。     

全身照射在急性白血病同种骨髓移植首次完全缓解中的作用

作者对1988～1990年间日本22个医院完成的同种骨髓移植(ABMT)进行回顾性分析。首次完全缓解的急性白血病患者123例,其中接受全身照射(TBI)组为81例,未接受TBI、用白消安(BU)、环磷酰胺(Cy)和其它药物(NTBI)组为42例。TBI组和NTBI组的急性淋巴白血病(ALL)和急性非淋巴白血病(ANLL)分别为36例和17例,45例和25例。 TBI组中位年龄22岁(1～44岁),男44例,女37例。NTBI组中位年龄22.5岁( 1～44岁),男29例,女13例。 TBI组35例接受TBI/Cy,25例接受TBI/Cy和其它药物,13例接受TBJ/Ara-C, 9例接受TBI/Ara-C和其它药物。NTBI组29人接受Bu/Cy,12例接受     

人膀胱癌原代培养体外药敏试验的研究

目的:探讨用ATP生物荧光肿瘤体外药敏检测技术(ATP-TCA)研究膀胱癌药敏的异质性和个体化疗的可行性。方法:用ATP-TCA检测来自45例初发和6例复发膀胱癌患者的手术标本对4种化疗药物的敏感程度。结果:51例标本中有49例获得药敏结果,可评价率为96·0%。最有活性的药物是吡柔比星,有43·8%(21/48)的标本对它表现强敏感;28·6%(14/49)的标本无强敏感药物;69·4%(34/49)的标本无耐药药物。结论:膀胱癌对抗癌药物的敏感程度存在着异质性。ATP生物荧光肿瘤药敏检测技术可用于为膀胱癌选择合适的化疗药物。     

食管癌化疗体外药敏试验方法

本文对43例食管癌手术切除标本(无化疗、放疗史)进行短期器官培养。其中20例体外培养生长良好用于药敏试验。以形态学观察结合显微分光光度术判断药物的敏感性,形态观察20例中体外敏感的有9例。1G 例 MSP(Microspectrophotometry)测定结果表明,敏感的药物作用后核的 DNA 含量发生变化,(1)DNA 平均含量增加(P<0.01);(2)组方图低平、分散,表明化疗药物损伤的细胞不能进行核分裂,核膜尚未破裂而出现的暂时核内 DNA 含量的增加。16例中体外敏感的占7例,与形态学结果符合的占11例。     

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.