卡培他滨联合放疗治疗老年食管癌的疗效观察

目的:评价卡培他滨联合放疗治疗老年食管癌的疗效。方法:回顾分析30例≥70岁的老年食管癌患者经卡培他滨联合放疗治疗的疗效、生活质量和不良反应。结果:全组患者总有效率96.7%,1、2、3年生存率分别为96.7%、74.2%、50.8%;全组患者生活质量增加率为53.3%,稳定率为46.7%,无生活质量恶化患者。治疗过程中未出现Ⅳ级放化疗毒副反应;Ⅲ级白细胞减少发生率为10%;Ⅲ级放射性食管炎发生率为13.3%;无Ⅲ级恶心、呕吐及放射性气管炎病例发生;I、II级手足综合症发生率分别为23.3%(7/30),3.3%(1/30),未出现III级手足综合症病例。结论:卡培他滨联合放疗治疗老年食管癌疗效较好,患者的生活质量得以明显改善,不良反应轻微,值得临床进一步推广。     

卡培他滨节拍化疗在晚期结直肠癌维持治疗中的疗效观察

摘 要：［目的］ 探讨卡培他滨节拍化疗维持治疗晚期结直肠癌的疗效及安全性。［方法］ 入组69例复发转移性结直肠癌患者,完成联合化疗后疗效评价无疾病进展,根据治疗方法不同分为节拍化疗组、常规化疗组。节拍化疗组32例给予小剂量卡培他滨节拍化疗500mg,2次/d,持续口服,28d为1个周期;常规化疗组37例每次给予卡培他滨 1250mg/m2,2次/d,连续14d,休7d,21d为1个周期;4个周期后观察毒副反应及近期疗效,Kaplan-Meier法绘制中位无进展生存期（PFS）生存曲线图。［结果］ 节拍化疗组与常规化疗组有效率分别为15.63%和16.22%（χ2=0.004,P=0.947）,疾病控制率分别为71.88%和70.27%（χ2=0.021,P=0.884）,差异均无统计学意义。节拍化疗组中位PFS为8.6个月,常规化疗组为7.9个月,差异无统计学意义(χ2=0.367,P=0.554)。节拍化疗组不良反应发生率均低于常规化疗组,且骨髓抑制及手足综合征发生率两组比较差异有统计学意义(P<0.05)。［结论］卡培他滨节拍化疗较常规化疗在结直肠癌晚期维持治疗中显示出等效低毒的特点,值得临床进一步推广。     

卡培他滨联合肝动脉栓塞化疗治疗原发性肝癌

目的 :探讨卡培他滨联合经肝动脉栓塞化疗 (TACE)治疗晚期肝癌的有效性。方法 :6 2例不能手术切除的晚期肝癌患者 (TNM分期Ⅱ～Ⅳ )随机分成两组 :①单纯TACE组 30例 ;②卡培他滨联合TACE组 32例 ,在TACE治疗后第 2天 ,口服给药 14天。全部患者随访两年。比较两组患者的中位生存时间 ,死亡患者平均生存时间、一年生存率、二期手术切除率。结果 :卡培他滨联合TACE治疗组患者的中位生存时间为 14 .5个月 ,一年生存率为 75 .0 % ,二期手术切除率 2 5 .0 % ;而单纯TACE组患者的中位生存时间为 6个月 ,一年生存率为 39.3% ,二期手术切除率 6 .7% ,两组比较有显著差异 (P <0 .0 5 )。结论 :卡培他滨联合TACE治疗晚期原发性肝癌患者的疗效优于单纯TACE。     

节拍化疗模式下卡培他滨强化依西美坦抑制乳腺癌MCF-7细胞增殖的实验研究

目的:研究节拍化疗模式下卡培他滨联合依西美坦对乳腺癌MCF-7细胞的增殖抑制作用及信号通路机制。方法:实验分为7组,CCK-8法检测单药与联合用药组对MCF-7细胞增殖的抑制率。流式细胞仪检测分析药物作用对MCF-7细胞周期与细胞凋亡的影响。Western blot法检测各用药组MCF-7细胞p27、Bcl-2、PI3K和AKT蛋白的表达情况。结果:卡培他滨的半数抑制浓度（half maximal inhibitory concentration,IC50)为282.7 μmol/L、依西美坦IC50为103.5 μmol/L;联合用药组对MCF-7细胞增殖的抑制率高于单药组（P=0.003）;联合用药组中减小卡培他滨剂量不会显著降低细胞增殖抑制率（P=0.916）;与单药组影响细胞周期不同,联合用药会使MCF-7细胞停滞于S期或G1期;Western blot检测显示,联合用药会促进p27表达,抑制PI3K表达,促使细胞凋亡;低剂量卡培他滨会显著抑制Bcl-2表达（P=0.006）,使细胞停滞于S期。结论:小剂量卡培他滨节拍化疗联合依西美坦通过不同模式多方位影响MCF-7细胞周期及信号因子表达,显著抑制MCF-7细胞增殖。     

卡培他滨节拍化疗在晚期三阴性乳腺癌维持治疗中的疗效观察北大核心

目的:探讨卡培他滨节拍化疗在晚期三阴性乳腺癌患者维持治疗中的近远期疗效、生活质量以及不良反应。方法:将经联合化疗有效的58例晚期三阴性乳腺癌患者随机分为卡培他滨节拍化疗组和卡培他滨常规剂量组两组,每组患者各29例。节拍化疗组患者给予卡培他滨节拍化疗,常规剂量组患者给予常规剂量卡培他滨化疗。治疗2个月后评价近期疗效,每个月评价不良反应,并统计两组患者的中位疾病进展时间、中位生存时间、1年生存率、2年生存率和生活质量的变化。结果:58例患者均可评价疗效。节拍化疗组患者中CR 0例,PR 5例,SD 22例,PD 2例,客观缓解率(ORR)和疾病控制率(DCR)分别为17.2%和93.1%;常规剂量组患者中CR 0例,PR 6例,SD 20例,PD 3例,客观缓解率(ORR)和疾病控制率(DCR)分别为20.7%和89.7%。两组患者的ORR和DCR相比差异无统计学意义(P>0.05)。节拍化疗组患者的中位肿瘤无进展生存时间(PFS)为7.1个月,与常规剂量组患者(6.9个月)比较,差异无统计学意义(P>0.05);节拍化疗组患者的1年、2年生存率分别为72.4%、58.6%,与常规剂量组患者(69.0%、55.2%)比较,差异无统计学意义(P>0.05)。生活质量改善方面,节拍化疗组患者显著优于常规剂量组患者(P<0.05);节拍化疗组患者的主要不良反应为骨髓抑制、消化道反应和手足综合征等,均以Ⅰ-Ⅱ度为主,均可耐受,常规剂量组患者的消化道反应、骨髓抑制、手足综合征等不良反应的发生率和严重程度均显著高于节拍化疗组(P<0.05)。结论:卡培他滨节拍化疗作为晚期三阴性乳腺癌患者的维持治疗,其近远期疗效与常规剂量维持化疗相当,同时可提高患者生活质量,不良反应轻且发生率低,值得临床推广应用。     

卡培他滨节拍化疗在转移性结直肠癌维持治疗中的探索性Ⅱ期研究

背景与目的：转移性结直肠癌患者一线诱导化疗后的维持治疗方案如何选择，尚存在争议。本研究将卡培他滨节拍化疗应用于转移性结直肠癌维持治疗，评估其疗效与安全性。方法：本研究是单臂、单中心探索性研究。接受一线诱导化疗（XELOX、mFOLFOX6、FOLFIRI）18~24周的转移性结直肠癌患者，评估为临床获益后接受卡培他滨500 mg，每天2次口服维持治疗，直至疾病进展。研究首要终点是无进展生存期（progression-free survival，PFS），包括卡培他滨维持治疗的PFS和诱导化疗续贯维持治疗的PFS。次要终点为总生存期（overall survival，OS）和不良反应。结果：2014年10月16日—2017年12月31日于上海交通大学医学院附属瑞金医院接受治疗的转移性结直肠癌患者37例接受节拍化疗维持治疗。中位随访时间15.0个月（4.0~41.4个月）。节拍化疗维持治疗的中位PFS为5.6个月（1.7~38.5个月），诱导化疗续贯维持治疗的中位PFS为11.4个月（6.8~44.3个月）。主要的不良反应为白细胞减少（8/37，21.6%）、恶心呕吐（5/37，13.5%）和手足综合征（3/37，8.1%）。没有1例患者出现3~4级严重不良反应。结论：卡培他滨节拍化疗应用于转移性结直肠癌诱导化疗后维持治疗安全、有效。     

小剂量卡培他滨单药治疗高龄恶性肿瘤患者的疗效和安全性

目的：观察小剂量卡培他滨单药治疗高龄恶性肿瘤患者的疗效和不良反应。方法：67例高龄（75—84岁,中位年龄79岁）初治恶性肿瘤患者（结直肠癌15例,胃癌13例,喉癌9例,口腔癌8例,卵巢癌9例,胰腺癌8例,肝细胞癌5例）,每次给予卡培他滨700mg/m^2,每天2次,连用14天,休息1周,每21天重复,直到疾病进展为止。结果：PR8例（结肠癌2例,胃癌3例,喉癌1例,卵巢癌1例,胰腺癌1例）,SD42例,PD17例,总有效率（ORR）11.9％,肿瘤控制率（DCR）74.6％,中位肿瘤进展时间（mTTP）5.9个月,中位生存期（mS）9.2个月。不良反应有手-足综合征发生率90％,均为Ⅰ—Ⅱ度,Ⅰ度,Ⅱ度粒细胞减少9.0％,恶心7.5％,Ⅰ度腹泻10.4％。结论：小剂量卡培他滨单药治疗高龄恶性肿瘤患者有较高肿瘤控制率,不良反应轻微。     

放疗联合卡培他滨同期治疗术后直肠癌疗效分析

目的探讨放疗联合卡培他滨同期治疗术后直肠癌的疗效和毒性。方法直肠癌术后患者67例,术后3～4周后先行改良的FOLFOX4方案化疗4次后行盆腔放疗,其中36例行单纯放疗,31例行同期放化疗。同期放化疗者从放疗的第1天开始给予卡培他滨825 mg/m2,2次/天,用至放疗结束。所有患者放疗结束后再用先前的化疗方案化疗4次。结果 67例患者中有66例完成了放疗。中位随访时间为26个月,有7例患者死亡,其中同期放化疗者中4例死亡,单纯放疗者中3例死亡。同期放化疗者中有1例盆腔复发,1例肝转移。单纯放疗者中有1例盆腔复发,2例肝转移和1例肺转移。结论直肠癌术后同期放化疗较单纯放疗有降低远处转移的趋势。     

吉西他滨联合卡培他滨治疗难治性乳腺癌的临床研究

目的:观察吉西他滨联合卡培他滨治疗难治性乳腺癌的疗效和不良反应.方法:37例难治性乳腺癌患者,应用吉西他滨联合卡培他滨,持续应用至疾病进展或出现不能耐受的不良反应.并按WHO标准评价疗效及不良反应,随访生存情况.结果:在37例可评价的患者中,CR 3例,PR 12例,SD 13例,PD 9例.RR为40.54%;DCR为75.68%.中位TTP为9个月(95%CI:6.115-11.885M);中位OS为15个月(95%CI:10.663-19.337M).主要不良反应为骨髓抑制,其次为胃肠道反应.结论:吉西他滨联合卡培他滨治疗难治性乳腺癌有较好的疗效,不良反应可以耐受.     

卡培他滨治疗35例晚期大肠癌

卡培他滨 (希罗达 ,capecitabine ,xeloda)是一种口服并经肿瘤激活、选择性的抗肿瘤药物 ,对大肠癌的Ⅲ期临床试验结果显示 ,其抗肿瘤作用良好 ,毒副作用轻微[1 ,2 ] 。我们从2 0 0 1年 4月～ 2 0 0 2年 4月用卡培他滨治疗晚期结直肠癌 35例 ,其中包括部分原不愿再接受化疗的晚期癌肿病例 ,我们也应用本药物治疗 ,结果令人满意。材料和方法一　研究对象　本组共 35例 ,男 2 3例 ,女 1 2例 ,年龄56～ 74岁 ,中位年龄 63岁。结肠癌 9例 (其中 1例为家族性息肉病癌变 ) ;直肠癌 2 6例。所有病例均经手术及病理组织学检查证实 ,其中腺癌 2 7例 ,…     

Phase ii trial of a metronomic schedule of docetaxel and capecitabine with concurrent celecoxib in patients with prior anthracycline exposure for metastatic breast cancer

Background

This phase ii clinical trial examined the activity of a metronomic dosing schedule of docetaxel and capecitabine chemotherapy in patients with advanced breast cancer. Patients also received daily oral celecoxib in an effort to improve outcome measures and to ameliorate some of the common side effects of chemotherapy.

Methods

Patients received docetaxel at a starting dose of 15 mg/m² weekly, oral capecitabine 1250 mg/m² once daily, and oral celecoxib 200 mg twice daily. The primary endpoint was clinical benefit: percentage of patients experiencing either an objective response or stable disease (sd) for more than 6 months. In the absence of significant neutropenia, the dose of docetaxel was escalated after 4 and 8 weeks of treatment. Therapy was given until disease progression or development of unacceptable toxicity. The level of thymidine phosphorylase expression in peripheral white blood cells of patients was measured before and during treatment to determine the effect on this capecitabine-activating enzyme.

Results

Of 47 patients enrolled, 38 (81%) completed treatment to a disease endpoint. No complete responses were achieved, but 13 of the 38 patients (34%) experienced a partial response, and another 3 patients (8%) experienced sd for more than 6 months. The clinical benefit rate was therefore 42% (95% confidence interval: 27% to 57%). The median time to disease progression for all evaluable patients was 3.6 months (range: 0.9–21.7 months). The most common nonhematologic toxicities were diarrhea, plantar– palmar erythrodysesthesia, fatigue, mucositis, and vomiting. Most patients (89%) received combination chemotherapy until disease progression.

Conclusions

The present study demonstrates that metronomic docetaxel–capecitabine chemotherapy with daily celecoxib can produce significant anticancer activity, with predictable toxicity. Efficacy fell short of expectations, with outcome measures being similar to those obtained when the study agents are given in conventional dosing. Furthermore, there is mounting evidence to indicate that a low dose of taxanes fails to induce thymidine phosphorylase expression, an effect believed to be important in achieving therapeutic synergism when taxanes are given concurrently with capecitabine.     

卡培他滨联合沙利度胺节拍化疗治疗晚期结直肠癌的疗效观察及其对生活质量的影响

目的:探讨卡培他滨联合沙利度胺对晚期结直肠癌进行节拍化疗的临床疗效及其对患者生活质量的影响.方法:选取50例晚期结直肠癌患者采用卡培他滨联合沙利度胺进行节拍化疗,分别于节拍化疗前及化疗2周期后检测外周血清中CEA、CA19-9水平,并评估疗效及患者生活质量.结果:总有效率(RR)为26.0％,临床获益率为(CBR)为74.0％.行节拍化疗后外周血中CEA及CA19-9水平均较化疗前明显降低(P=0.014,P=0.004).生活质量方面,经节拍化疗后患者社会功能、躯体功能、情绪功能较治疗前明显改善,疲乏、疼痛症状及睡眠障碍较前明显减轻,角色功能、认知功能及食欲减退情况无明显改变.结论:卡培他滨联合沙利度胺节拍化疗是治疗晚期结直肠癌的一种有效、安全、经济、依从性高的手段,能够提高患者生存质量,值得进一步研究及临床推广.     

化疗联合消癌平注射液治疗食管癌的疗效及安全性的Meta分析化

目的:应用Cochrane系统的方法来评价化疗联合消癌平注射液与单独应用化疗的方案在食管癌治疗中的疗效及安全性。方法:计算机检索Cochrane Library、PubMed、(SCI)Web of Science、Embase、万方、VIP、CNKI 等数据库,检索时间从建库至2017年5月31日,检索有关食管癌治疗中应用化疗联合消癌平注射液与单独应用化疗方案的临床随机对照试验的文献,对两种治疗方式的疗效及不良反应方面进行Meta 分析。结果:共纳入8篇随机对照试验（randomized controlled trial,RCT）文献,包含496例患者;Meta 分析结果显示,化疗联合消癌平注射液的治疗方案在改善食欲［RR=1.18,95%CI(1.08,1.28),P=0.000 2］、改善吞咽困难［RR=1.18,95%CI(1.07,1.30),P=0.000 7］、减轻疼痛［RR=1.08,95%CI(1.02,1.14),P=0.01］、提高KPS评分［RR=1.25,95%CI(1.05,1.49),P=0.01］方面较单纯化疗方案具有明显优势,而在治疗有效率 ［RR=1.26,95%CI(1.00,1.58),P=0.05］、白细胞下降水平［SMD=0.77,95%CI(-0.35,1.89),P=0.18］、肝肾功能［RR=1.05,95%CI(1.00,1.11),P=0.05］、改善恶心呕吐［RR=1.12,95%CI(1.00,1.25),P=0.05］方面,两种治疗方案的差异无统计学意义。结论:与单纯化疗方案相比,化疗联合消癌平注射液的治疗方案可明显改善食欲、改善吞咽困难、减轻疼痛、提高患者KPS评分,但在治疗有效率、白细胞下降水平、肝肾功能及改善恶心呕吐方面无改善。     

胸腹腔镜联合根治术治疗老年食管癌患者的疗效及安全性分析

目的:探讨胸腹腔镜联合根治术治疗老年食管癌患者的临床疗效。方法:选取本院收治的老年食管癌患者64例,按手术方式将其分为开放组（n=29）及胸腹腔镜组（n=35）,分别行开放式食管癌根治术及胸腹腔镜联合食管癌根治术治疗。统计并比较两组患者手术情况,检测并比较术前及术后1周两组患者细胞免疫功能变化,术后定期随访1年,比较两组患者生存情况、复发情况、并发症发生情况及生活质量,并分析两组患者并发症情况相关因素。结果:与开放组比较,胸腹腔镜组患者手术时间、术后拔管时间、住院时间均显著缩短（P＜0.01）,手术切口显著减小（P＜0.01）,术中失血量、术后胸腔引流量均显著降低（P＜0.01）。与术前比较,术后1周两组全血CD4+ T淋巴细胞比例、CD4+/CD8+均显著降低（P＜0.05或P＜0.01）,且胸腹腔镜组显著高于开放组（P＜0.01）;术后1周胸腹腔镜组CD8+ T淋巴细胞比例较术前及开放组均显著降低（P＜0.05）。与开放组比较,胸腹腔镜组患者术后吻合口瘘发生率及总并发症发生率均显著降低（P＜0.05或P＜0.01）。随访期间胸腹腔镜组患者SF-36评分显著升高（P＜0.01）,而复发率显著降低（P＜0.05）;两组1年生存率比较无显著性差异（P＞0.05）。结论:胸腹腔镜联合根治术可有效减轻老年食管癌患者手术创伤,保护机体免疫功能,还可降低患者术后并发症,改善其生活质量,安全性良好。     

Efficacy and safety of low-dose metronomic chemotherapy with capecitabine in heavily pretreated patients with metastatic breast cancer

Aim

Registered dose capecitabine monotherapy is active against metastatic breast cancer (MBC), but retrospective analyses indicate that lower doses may be as effective and better tolerated. This study was conducted to assess the safety and efficacy of metronomic capecitabine in heavily pretreated patients with MBC.

Patients and methods

In this phase II study 60 MBC patients received continuous metronomic capecitabine monotherapy (1500 mg once a day). Primary endpoint was clinical benefit rate, secondary end points were clinical benefit rates (CBRs), tumour response rates (RRs), overall survival (OS), time to progression (TTP), duration of response (DOR) and toxicity.

Results

Fifty eight assessable patients received two or more 28-day cycles of metronomic capecitabine. The CBR was 62%. Median DOR was 7 months. Median TTP and OS were 7 and 17 months, respectively. Two partial responses and 7 cases of stable disease were recorded in 13 patients who had previously received capecitabine intermittently (2000 mg/m²/day on days 1-14 every 21 days) as first- or subsequent-line treatment for MBC. Grade 3-4 adverse events were uncommon; haematologic toxicity was infrequent (5%) and consistently mild.

Conclusion

This regimen of metronomic capecitabine displayed good activity and excellent tolerability in MBC patients, including those who had previously received the drug at standard doses.     

三维适形放疗同步卡培他滨化疗治疗老年胃癌

目的:研究三维适形放疗同步卡培他滨化疗治疗老年胃癌患者的疗效、生存时间和不良反应。方法:本院收治的45例老年胃癌患者随机分为卡培他滨单药化疗组（21例）和三维适形放疗同步卡培他滨化疗组（24例）。PTV剂量1.8Gy/(25f·5w),放疗开始同步卡培他滨化疗。比较两组患者的疗效、生存时间和不良反应。结果:卡培他滨单药化疗组客观缓解率61.9%,三维适形放疗同步卡培他滨化疗组客观缓解率87.5%,有显著统计学差异(P＜0.05)。两组不良反应、生活质量无显著差异。卡培他滨单药化疗组2年生存率23.8%,三维适形放疗同步卡培他滨化疗组2年生存率50.0%,有显著统计学差异(P＜0.05)。结论:三维适形放疗同步卡培他滨化疗治疗老年胃癌可以有效提高患者的治疗效果,改善预后,不良反应可以耐受,是一种安全有效的治疗方案。     

Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital-based cancer registries in 2008-2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3-year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II-IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first-line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions.