替吉奥与卡培他滨治疗老年晚期胃癌30例疗效比较

正胃癌,是世界第四大常见恶性肿瘤和第二大癌症死亡原因。当前胃癌的发病率和死亡率仍然较高,局部进展与胃癌转移占胃癌总病例的80%～90%〔1〕。由于胃癌起病隐袭、症状不典型,许多患者就诊时已经属于晚期,失去了手术的机会。进     

替吉奥对比卡培他滨一线治疗老年晚期胃癌的疗效分析

目的比较一线替吉奥或卡培他滨方案治疗老年晚期胃癌患者的疗效和不良反应。方法回顾性分析56例一线替吉奥或卡培他滨方案治疗经病理确诊的老年晚期胃癌患者的临床数据。替吉奥组30例,卡培他滨组26例。替吉奥用法:体表面积<1.25m2,每次40mg,每日2次;体表面积≥1.25m2,每次50mg,每日2次。持续28d,每42d重复;卡培他滨用法:卡培他滨1250mg/m2,每日2次,持续14d,每21d重复。2组化疗均持续至疾病进展或出现无法耐受的不良反应。结果替吉奥组客观有效率(RR)为26.7%,肿瘤控制率(TGCR)为53.3%,中位无疾病进展时间(PFS)为4.3月,中位总生存时间(OS)为7.8月;卡培他滨组RR为30.8%,TGCR为57.7%,PFS为4.5月,OS为8.1月。2组疗效无显著性差异。2组生存质量评分均改善,组间无显著性差异。替吉奥组和卡培他滨组总3级～4级不良反应发生率分别为20.0%(6/30)和46%(12/26),2组有显著性差异(P<0.05),其中3级～4级血液学不良反应方面差异无显著性,而3级非血液学不良反应方面2组有显著性差异(P<0.05)。2组均无4级非血液学不良反应。结论老年晚期胃癌患者可从替吉奥或卡培他滨单药口服化疗中获益,不良反应可耐受。替吉奥组治疗不良反应更轻微。     

奥沙利铂联合卡培他滨或替吉奥治疗进展期胃癌的疗效比较

胃癌现已居恶性肿瘤死因的第2位,是我国常见的恶性肿瘤之一,就诊时大多数患者已经发展为进展期胃癌,无法行根治术,因此化疗成为进展期胃癌的重要治疗手段之一。以往5-氟尿嘧啶、顺铂及阿霉素等组成的化疗方案虽然取得一定疗效,但其毒副作用大;近年来随着奥沙利铂、卡培他滨和替吉奥胶囊等新药问世,给进展期胃癌患者带来了新的希望。本文分别采用奥沙利铂联合卡培他滨或替吉奥治疗进展期胃癌患者,比较两种方法的治疗效果。     

热疗联合替吉奥治疗老年晚期胃癌的临床疗效

目的:评价替吉奥胶囊(S-1)联合热疗治疗老年晚期胃癌的临床疗效及不良反应,旨在为65岁以上的老年晚期胃癌患者寻找有效、不良反应轻的治疗方式.方法:选择2010-02/2012-09的石河子大学医学院第一附属医院的老年胃癌晚期患者(年龄≥65岁)90例,采用随机对照研究将90例患者随机分为3组.A组给予替吉奥胶囊单药化疗,B组给予替吉奥联合热疗,C组给予卡培他滨联合热疗,治疗时间超过两周期,观察近期、远期疗效以及不良反应,进行统计学分析.结果:A、B、C组临床获益率分别是50%、80%,70%,B组较A组临床获益率高(P0.05),与C组差异无统计学意义(P0.05).远期疗效评价:B组、C组中位无进展生存时间(6.6、5.8 m o)较A组(3.8 m o)有所延长(P0.05).替吉奥较卡培他滨化疗不良反应轻,主要是乏力、腹泻、手足综合症反应较轻,差异有统计学意义(P0.05).结论:替吉奥联合热疗或卡培他滨联合化疗治疗老年晚期胃癌比替吉奥单药疗效好,替吉奥联合热疗与卡培他滨联合热疗疗效无差异,但替吉奥较卡培他滨不良反应轻,老年患者耐受性好.     

替吉奥或卡培他滨同步三维适形放疗治疗中老年复发直肠癌的临床疗效

目的探讨替吉奥胶囊或卡培他滨片同步采用三维适形放疗治疗中老年复发直肠癌的临床疗效。方法将2008年1月至2011年1月该院收治的78例中老年直肠癌术后复发患者随机分为研究组38例,采用替吉奥联合三维适行放疗给予放疗,剂量为1.8~2.0 Gy/d,5 d/w,总量为54~66 Gy;对照组40例,采用卡培他滨配合三维适行放疗,放疗剂量同研究组,观察两组的治疗效果、不良反应及3年内的生存率。结果研究组治疗后有效率〔81.58%(31/38)〕高于对照组〔60.00%(24/40)〕(χ2=4.364,P0.05);两组患者主要存在消化道反应、放射性直肠炎、骨髓抑制以及手足综合征等不良反应,经及时处理后恢复,组间无显著差异(P0.05);研究组3年内生存率均高于对照组(均P0.05)。结论三维适形放疗同步替吉奥治疗中老年复发直肠癌的短期疗效及生存率控制均优于卡培他滨方案,对于机体状况承受力较差的老年患者更适用。     

卡培他滨维持治疗晚期胃癌临床疗效分析

目的 分析晚期胃癌患者一线治疗后使用卡培他滨维持治疗的临床疗效。方法 分析该院2014-02～2016-02一线化疗后(奥沙利铂130 mg/m2,d1+卡培他滨1 000 mg/m2bid,d1～14,21 d为一个周期)病情稳定的晚期胃癌患者64例。按照患者意愿分为卡培他滨维持治疗组和对照组各32例,维持治疗组给予卡培他滨1 000 mg/m2bid,d1～14,21 d为一个周期;对照组仅给予对症支持。通过Kaplan-Meier法对两组患者的疾病进展时间(TTP)及总生存时间(OS)进行差异性检验。并分析卡培他滨维持治疗的不良反应。结果 维持治疗组与对照组的中位TTP分别为7. 6个月和6. 0个月(P 0. 05),中位OS分别为11. 9个月和9. 5个月(P 0. 05)。卡培他滨不良反应主要为1～2度的恶心呕吐、手足综合征等。结论 卡培他滨单药维持治疗可延长胃癌患者TTP及OS,且毒副作用小。     

替吉奥或卡培他滨同步三维适形放疗治疗中老年复发直肠癌疗效

目的:观察三维适形放疗联合替吉奥或卡培他滨治疗老年局部复发直肠癌的近期疗效和安全性.方法:58例直肠癌术后局部复发患者,随机分为2组,试验组30例,给予放疗(1.8-2.0 Gy/d,5d/wk,总量为54-66 Gy)联合替吉奥;对照组28例,给予放疗(1.8-2.0 Gy/d,5 d/wk,总量为54-66 Gy)联合卡培他滨,21 d为1周期,接受2个以上周期治疗后,评价疗效和不良反应.结果:58例患者均可评价疗效,试验组和对照组有效率(response rate,RR)分别为73.3%(22/30)、71.4%(20/28),中位进展时间分别为9.2和8.2 mo,中位生存时间分别为16.9、17.2 mo,两组差异无统计学差异(P>0.05).试验组与对照组主要不良反应为骨髓抑制、胃肠道反应、皮疹、放射性直肠炎,均可耐受,两组差异无统计学意义(P>0.05),对照组手足综合征明显高于试验组,差异有统计学意义(P<0.05).结论:两组疗效相似,替吉奥联合三维适形放疗方案组手足综合征发生率较低,耐受性优于卡培他滨联合组,为中老年直肠癌复发临床治疗提供参考.     

替吉奥联合沙利度胺治疗老年晚期胃癌的疗效

老年晚期胃癌患者由于各脏器储备功能差、合并多种慢性或老年性疾病等原因大多不能耐受强烈化疗,既往多采用保守的对症支持治疗.为探讨对老年晚期胃癌有效而耐受性好的治疗方案,本文观察了替吉奥胶囊联合沙利度胺治疗老年晚期胃癌的临床疗效. 1 资料与方法 1.1 临床资料 选择2008年11月至2012年5月在我院治疗的老年晚期胃癌患者42例.其中男30例,女12例,年龄66～88[平均(76.2±10.9)]岁.     

吉西他滨联合替吉奥对进展期胰腺癌的临床疗效观察

目的比较吉西他滨单药和吉西他滨联合替吉奥治疗进展期胰腺癌的临床疗效。方法回顾性分析我院2010年7月至2014年1月收治的90例进展期胰腺癌患者的临床资料,其中,对照组45例患者采用吉西他滨单药进行治疗,观察组45例患者采用吉西他滨联合替吉奥进行治疗,比较两组患者的临床疗效。结果治疗后,观察组患者的总有效率为31.11%,明显高于对照组11.11%,组间差异具有统计学意义,而且观察组患者的中位总生存期、中位无进展生存时间以及生存率均明显优于对照组患者,组间差异均具有统计学意义,而两组患者的不良反应发生情况基本相当,组间差异无统计学意义。结论吉西他滨联合替吉奥治疗进展期胰腺癌具有十分显著的效果,可明显改善患者的临床症状,延长患者的生存期,提高患者的生存率,改善患者的预后,其疗效明显,且安全可靠,值得临床应用。     

卡培他滨治疗老年晚期胃癌126例

胃癌做为消化道常见恶性肿瘤之一,发病率和死亡率均较高,世界范围内每年新发胃癌患者93.4万例,死亡患者70万例[1].晚期发现者达75％以上[2],目前治疗仍然以化疗为主.老年人多合并多种内科基础疾病,身体机能下降,化疗耐受性较差,预后不佳[3].因此,采用疗效确切、副作用低的化疗药物至关重要.本文观察老年晚期胃癌患者服用卡培他滨做为一线用药的疗效.     

紫杉醇联合希罗达治疗晚期胃癌的初步观察

目的 观察联合希岁达与紫杉醇治疗晚期胃癌的疗效与毒副反应。方法 对68例晚期胃癌患者进行回顾性统计分析。结果 CR6％，PR47％，NC22％，PD25％。症状缓解率81％。一年总生存率72％。平均缓解时间5．5月。化疗副反应包括恶心呕吐（86％），手足综合征（45％）；Ⅰ、Ⅱ度骨髓抑制（55％）及Ⅲ、Ⅳ度骨髓抑制（12％）；无化疗相关死亡。结论 希罗达加紫杉醇方案对晚期胃癌疗效较好，毒副作用较轻。     

A randomized phase II trial comparing capecitabine with oxaliplatin or docetaxel as first-line treatment in advanced gastric and gastroesophageal adenocarcinomas

Background:A combination of fluoropyrimidines and platinum is widely accepted as the standard first-line treatment for advanced gastric and gastroesophageal adenocarcinomas. However, the benefit compared with platinum-free chemotherapeutic regimens remains controversial. We compared the efficacy and safety of capecitabine with oxaliplatin or docetaxel, as first-line therapy in advanced gastric cancer.Methods:Eligible patients were randomly assigned to receive either capecitabine and oxaliplatin (XELOX) (capecitabine 1,000 mg/m²; twice daily for 14 days with oxaliplatin 130 mg/m² on day 1, every 21 days), or DX (capecitabine 1,000 mg/m²; twice daily for 14 days with docetaxel 75 mg/m² on day 1, every 21 days). The primary endpoint was the objective response rate (ORR). Secondary endpoints included the disease control rate (DCR), progression-free survival, overall survival, and prespecified safety endpoints.Results:Ninety patients were enrolled in the West China Hospital from April 2012 to August 2016; a total of 83 and 66 patients were eligible for safety and efficacy analyses, respectively. Between the XELOX and DX groups, ORR (24.2% vs 24.2%, p = 1.000), DCR (90.9% vs 75.8%, p = 0.099), progression-free survival (6.1m vs 4.1m, p = 0.346), and overall survival (8.8m vs 9.0m, p = 0.973) were similar. There was no significant difference in toxicity between the two regimens. The frequent grade 3 or higher toxicities in the XELOX and DX groups were peripheral neuropathy and hematological toxicity, respectively. Toxicity was tolerable; no treatment-related deaths occurred in either group.Conclusions:The DX regimen was not superior to XELOX, but instead, similar. The platinum-containing regimen remains the preferred first-line option for advanced gastric and gastroesophageal adenocarcinomas, and DX might be considered as an alternative for patients unsuitable for platinum-containing chemotherapy.     

S-1-based combination therapy vs S-1 monotherapy in advanced gastric cancer:A meta-analysis

AIM:To assess the efficacy and safety of combination therapy based on S-1,a novel oral fluoropyrimidine,vs S-1 monotherapy in advanced gastric cancer(AGC).METHODS:We searched PubMed,EMBASE and the Cochrane Library for eligible studies published before March 2013.Our analysis identified four randomized controlled trials involving 790 participants with AGC.The outcome measures were overall survival(OS),progression-free survival(PFS),overall response rate(ORR)and grade 3-4 adverse events.RESULTS:Meta-analysis showed that S-1-based combination therapy significantly improved OS(HR=0.77,95%CI:0.66-0.91,P=0.002),PFS(HR=0.58,95%CI:0.46-0.72,P=0.000)and ORR(OR=2.23,95%CI:1.54-3.21,P=0.000).Sensitivity analysis further confirmed this association.Lower incidence of grade 3-4 leucopenia(OR=4.06,95%CI:2.11-7.81),neutropenia(OR=3.94,95%CI:2.1-7.81)and diarrhea(OR=2.41,95%CI:1.31-4.44)was observed in patients with S-1 monotherapy.CONCLUSION:S-1-based combination therapy is superior to S-1 monotherapy in terms of OS,PFS and ORR.S-1 monotherapy is associated with less toxicity.     

Apatinib combined with S-1 as second-line therapy in advanced gastric cancer

Advanced gastric cancer (AGC) patients are not tolerant to the toxicities of traditional chemotherapy and its second-line therapeutic regimens are limited. The aim of the present study is to evaluate the efficacy and safety of apatinib combined with S-1 as the second-line therapy for AGC patients.Patients with AGC were enrolled in this study. Patients received oral apatinib (250 mg to 500 mg once daily) and S-1(40 mg/m² twice daily) on days 1–14. Each cycle was 28 days and one course of treatment consisted of 2 cycles. Clinical efficacy and adverse events (AEs) were observed. Kaplan–Meier method was used for survival analysis.From November 2015 to December 2017, 58 AGC patients who failed first-line chemotherapy were enrolled and assessed retrospectively. According to the Response Evaluation Criteria in Solid Tumors (RECIST) standard, all patients were evaluable for response. None achieved CR, and 10 (17.2%) achieved PR (95% CI 7.2%–27.3%). SD was observed in 58.6% (34/58) of patients (95% CI 45.6%–71.7%) and NR in 24.1% (14/58) of patients (95% CI 12.8%–35.5%). The objective response rate (ORR) and the disease control rate (DCR) were 17.2% and 75.8% respectively. The median progression-free survival (PFS) and median overall survival (OS) were 143.1 days (95% CI 121.7–164.5) and 211.6 days (95% CI 162.9–219.7) respectively. The multivariate analysis showed that the ECOG PS was the independent factor of PFS and OS for AGC patients (PFS: HR = 3.565, 95% CI: 2.25–5.65, P < .001; OS: HR = 3.676, 95% CI: 2.29–5.89, P < .001). The main AEs were fatigue (72.4%), hypertension (46.6%), and leukopenia (48.3%).Apatinib combined with S-1 showed promising efficiency and was well tolerated as the second-line therapy for AGC patients. ECOG PS was the independent factor of PFS and OS for AGC patients. AEs were moderate and controllable, and leukopenia or hypertension was predictable factors for the PFS and OS of AGC patients.     

Capecitabine for the treatment of gastric cancer

Capecitabine is an orally administered prodrug of 5-fluorouracil (5-FU) and was designed to specifically affect tumor cells more than normal tissues. Capecitabine is as effective and well tolerated as infusional 5-FU in the treatment of advanced gastric cancer (AGC). Following the REAL-2 and ML17032 studies, capecitabine has replaced infusional 5-FU for treating GC. Capecitabine plus platinum is one of the most widely used regimens for the first-line treatment of AGC, regardless of HER2 status. The adjuvant capecitabine/oxaliplatin regimen is one therapeutic option for resectable gastric cancer, especially after D2 resection. Compared with S-1, capecitabine has been shown to have a similar efficacy, but is associated with fewer ethnic differences than S-1, which accounts for the more widespread usage of capecitabine worldwide.     

健脾益气法联合化疗治疗晚期胃癌的临床观察

[目的]探讨健脾益气方配合TP(紫杉醇脂质体+顺铂)方案化疗治疗晚期胃癌的疗效。[方法]将40例接受含氟尿嘧啶类方案或含紫杉类方案或含铂类方案化疗的胃癌患者,随机分为对照组和治疗组,对照组20例不服用健脾益气方,常规化疗;治疗组20例在化疗前1周开始口服自拟健脾益气方中药,至化疗结束。在化疗结束后评估恶心呕吐评分、生活质量评分及骨髓抑制评分。[结果]治疗组的恶心呕吐评分、生活质量评分及骨髓抑制评分均明显优于对照组,差异有统计学意义(P0.05)。[结论]健脾益气方配合化疗能明显减轻胃癌化疗后的不良反应,增强化疗疗效。     

Efficacy of S-1 vs capecitabine for the treatment of gastric cancer: A meta-analysis

AIM: To rationally evaluate the effect of S-1 vs capecitabine for the treatment of gastric cancer.METHODS: MEDLINE, EMBASE, Cochrane Controlled Trials Register, Google Scholar, and China Journal Full Text Database were accessed to collect clinical randomized controlled trials regarding the effect of S-1 vs capecitabine for the treatment of gastric cancer patients. Statistical analysis was performed by metaanalysis. Four randomized controlled trials met the inclusion criteria.RESULTS: Compared with capecitabine regimens, the 1-year survival rate in gastric cancer patients was 0.80(95%CI: 0.52-1.21, P = 0.29). The overall response rate of S-1 vs capecitabine was 0.94(95%CI: 0.59-1.51, P = 0.93). Compared with capecitabine regimens, the most frequent hematologic toxicities were neutropenia( O R = 0. 9 9, 9 5 % C I : 0. 6 5- 1. 4 9, P = 0. 9 4) a n d thrombocytopenia(OR = 0.72, 95%CI: 0.31-1.67, P = 0.44). The most frequent non-hematologic toxicities included nausea(OR = 0.85, 95%CI: 0.56-1.28, P = 0.43) and hand-foot syndrome(OR = 0.16, 95%CI: 0.10-0.27, P < 0.00001).CONCLUSION: The existing studies suggest that S-1 is not more effective than capecitabine in the treatment of gastric cancer patients, but does exhibit less toxicity with regard to hand-foot syndrome.     

S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer: A meta-analysis

AIM: To assess the efficacy and tolerability of S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer (AGC).METHODS: We extracted reported endpoints, including overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), objective response rate (ORR) and adverse effects, from randomized controlled trials identified in PubMed, the Cochrane library, Science Direct, EMBASE and American Society of Clinical Oncology meetings. Stata software was used to calculate the pooled values.RESULTS: Seven randomized controlled trials involving 2176 patients were included in this meta-analysis. Compared to non-S-1-based regimens, the use of S-1-based regimens were associated with an increase in ORR (RR = 1.300; 95%CI: 1.028-1.645); OS (HR = 0.89; 95%CI: 0.81-0.99; P = 0.025), TTF (HR = 0.83; 95%CI: 0.75-0.92; P = 0.000), and a lower risk of febrile neutropenia (RR = 0.225; P = 0.000) and stomatitis (RR = 0.230; P = 0.032). OS, PFS and TTF were prolonged, especially in the Asian population. In subgroup analysis, statistically significant increases in ORR (RR = 1.454; P = 0.029), OS (HR = 0.895; P = 0.041) and TTF (HR = 0.832; P = 0.000) were found when S-1-based chemotherapy was compared to 5-fluorouracil (5-FU)-based chemotherapy. The incidence of leukopenia (RR = 0.584; P = 0.002) and stomatitis (RR = 0.230; P = 0.032) was higher in the 5-FU-based arm. S-1-based regimens had no advantage in ORR, OS, PFS, TTF and grade 3 or 4 adverse events over capecitabine-based regimens.CONCLUSION: S-1-based chemotherapy may be a good choice for AGC because of longer survival times, better tolerance and more convenient use.     

紫杉醇与卡培他滨联合治疗进展期胃癌38例的临床疗效和安全性

目的评价紫杉醇与卡培他滨联合治疗进展期胃癌的临床疗效及安全性。方法随机抽取徐州医学院附属医院2012年11月-2014年4月收治的进展期胃癌患者76例作为研究对象,将其分为观察组和对照组,分别给予紫杉醇联合卡培他滨治疗和紫杉醇、顺铂和5-FU联合治疗,在治疗期间对其临床疗效和毒副反应进行评估分析。结果两组患者的有效率相比,差异无统计学意义(P0.05),而骨髓抑制和手足综合征的毒副反应相比,差异有统计学意义(P0.05)。结论紫杉醇联合卡培他滨联合治疗进展期胃癌安全有效,患者能够耐受毒副反应,值得临床推广使用。     

替吉奥胶囊联合奥沙利铂治疗晚期胃癌的临床观察

［摘要］　目的　观察替吉奥胶囊联合奥沙利铂治疗晚期胃癌的疗效及不良反应。方法　将60例晚期胃癌患者随机分为治疗组30例和对照组30例。治疗组给予替吉奥胶囊联合奥沙利铂方案治疗,对照组给予奥沙利铂联合亚叶酸钙和5-氟尿嘧啶方案治疗,全部患者均接受至少4个周期的化疗。结果　治疗组完全缓解0例,部分缓解19例,稳定10例,进展1例;对照组完全缓解0例,部分缓解9例,稳定17例,进展4例。两组主要不良反应为血液学毒性、胃肠道反应和神经系统毒性,治疗组的不良反应发生率明显低于对照组(P<0.05）。结论　替吉奥胶囊联合奥沙利铂治疗晚期胃癌安全有效。