Combination chemotherapy for advanced lung cancer

Lung cancer is now a major public health problem in Thailand. This study was undertaken to gain some preliminary data regarding the potential effectiveness in treating advanced non-small cell lung carcinoma (NSCLC) using an ifosfamide combination therapy IA(E)P. A clinical study was made of all 50 patients (Thais) with histologically proven, advanced NSCLC admitted to the University of Siriraj Hospital between 1985 and 1987 and followed up until February 1992. Survival was calculated for responders and non-responders as distinct groups, and for the different histological tumors among the responders. There were 22 cases of adenocarcinoma, 13 large cell carcinoma, and 15 squamous carcinoma. Twenty-seven out of 50 (54%) responded to treatment. The median survival of the response group was 17 months, compared with 5.5 months in the nonresponse group. The longest survival period was seen in patients with large cell carcinoma. The results suggest that moderate success might be expected in selected patients using the IA(E)P. Further work should be undertaken in developing countries using controlled clinical trials to more fully determine the efficacy of IA(E)P in treating NSCLC.     

晚期非小细胞肺瘤的双途径化疗

目的研究不同的化疗方法治疗晚期非小细胞肺癌（NSCLC）并观察其疗效和毒副反应。方法将55例晚期NSCLC患者分4组,A组经皮肺穿刺瘤体内注射卡铂（PCI）+支气管动脉灌注（BAI）双途径化疗13例,B组PCI+VP-16静滴12例,C组单纯BAI18例,D组传统静脉化疗12例进行临床对比观察。结果近期有效率A组为76.9%,B组为58%高于C组33.3%,明显高于D组的16.7%（P<0.01）。一年生存率A组69.2%,B组75%,优于C组的38.9%,更明显优于D组8.3%（P<0.01）。一般状况的改善A、B、C三组明显优于D组（P<0.01）;而毒副反应均明显低于D组（P<0.01）。结论PCI是一种安全、简便的直接介入疗法,联合BAI或VP-16静滴双途径化疗是晚期NSCLC较为理想有效的综合性治疗手段,且PCI+VP-16疗法较PCI+BAI疗法更安全、简便、费用少,并发症少。     

Outpatient cancer chemotherapy employing implantable systems]

Outpatient cancer chemotherapy (OCC) employing implantable systems was introduced and the objects, conditions and problems of OCC were discussed based on experiences in 324 cases. The aims of OCC are improved QOL and the continuation of chemotherapy. Our requirements are safety, effectiveness, easy management and non-disturbance of activity. Implantable systems are very useful for OCC, especially continuous infusion combined with ambulatory pumps. However, the improvement of ambulatory pumps and the establishment of methods to evaluate OCC are required to further develop OCC.     

Outpatient chemotherapy of an advanced or metastatic colorectal cancer

We report the outpatient chemotherapy of an advanced or metastatic colorectal cancer. From April 2005 to May 2006, 50 patients were treated with FOLFIRI or FOLFOX in our hospital. Forty five patients (90%) had an intravenous catheter and a port for the chemotherapy, 23 patients (46%) were treated at the outpatient booths. We used the clinical pathway in chemotherapy for patients and co-medical roles. We were not experiencing emergency admission of side effects. Outpatient chemotherapy utilizing FOLFIRI or FOLFOX for advanced or metastatic colorectal cancer can be enforced safely by using the clinical pathway.     

State-of-the-art chemotherapy for advanced non-small cell lung cancer

The treatment of advanced non-small cell lung cancer (NSCLC) has continued to evolve over recent years. We have moved from an era of therapeutic nihilism to optimism, largely because of the advent of the newer cytotoxic agents developed in the 1990s that have complemented the platinum compounds for treatment of advanced NSCLC. Doublet chemotherapy combinations have become the current standard of care for patients with advanced NSCLC who have a good performance status. For patients with poor performance status and the elderly, single-agent chemotherapy results in modest improvements in survival. Prolongation of survival and improved quality of life have also been shown with second-line chemotherapy for patients who are either refractory to or relapse following first-line chemotherapy. Noncytotoxic, molecularly targeted agents currently under various phases of development for the treatment of lung cancer will serve as the cornerstones for further innovations in the treatment of NSCLC.     

Outpatient chemotherapy with infusional 5-fluorouracil in advanced gastrointestinal cancer

These studies were designed to evaluate the efficacy, toxicity, and resulting quality of life (QOL) of outpatient chemotherapy with infusional 5-FU for advanced gastrointestinal cancer. Schedule, sch. A: Treatment consisted of CI 5-FU 200 mg/m2/day, days 1-28, IVB Leucovorin 20 mg/m2 q week. Fifteen patients with advanced gastrointestinal cancer were treated to maintain the efficacy of prior inpatient chemotherapy. Twenty-one patients treated with adjuvant chemotherapy were added to evaluate toxicity and QOL. The mean time to progression (TTP) was 2.6 months. Grade 2 toxicities were seen, including mucositis (23%) and diarrhea (7%). Hand-foot syndrome was seen 60% of patients. The mean QOL score was 89.5 +/- 7.8. Sch.B: Treatment consisted of weekly 24 h infusion of 5-FU 2,600 mg/m2. 5-FU was administered using a Groshong catheter and Baxter infusor LV5 (5 ml/hr). Nine patients with advanced gastrointestinal cancer were treated. Twenty-one patients were treated with adjuvant chemotherapy. The mean TTP was 3.6 month. Grade 2 toxicities were seen, including leucocytopenia (7%), mucositis (3%), diarrhea (10%), and nausea and vomiting (10%). The mean QOL score was 82.6 +/- 10.7. In conclusion, both 5-FU schedules are feasible for outpatient chemotherapy for advanced gastrointestinal cancer.     

Neoadjuvant chemotherapy for advanced epithelial ovarian cancer]

Primary surgical cytoreduction followed by paclitaxel/carboplatin combination chemotherapy currently is the treatment of choice for advanced epithelial ovarian cancer. Aggressive surgery is widely accepted as a valid approach to initial cytoreduction of stage III disease, but suboptimal residual disease following primary surgical resection is one of the most important adverse prognostic factors in these patients. Neoadjuvant chemotherapy has been proposed as an alternative approach to conventional surgery for initial management of bulky ovarian cancer, with the goal of improving surgical quality. General acceptance of neoadjuvant chemotherapy as an alternative to primary surgery for patients who are not ideal surgical candidates remains limited, because equivalent or superior survival has not yet been demonstrated in a prospective randomized study. A large-scale, prospective, randomized study is being conducted by the European Organization for Research and Treatment of Cancer (EORTC) Gynecologic Cancer Cooperative Group and Gynecologic Oncology Group (GOG) to compare outcomes (overall and progression-free survival, quality of life, treatment complications) of neoadjuvant chemotherapy/interval debulking surgery versus primary cytoreductive surgery/adjuvant chemotherapy in patients with advanced epithelial ovarian carcinoma.     

同步放化疗治疗非小细胞肺癌临床结果

目的探讨同步放化疗联合治疗Ⅲ期非小细胞肺癌的近期疗效、生存期、生活质量及毒性反应。方法将44例Ⅲ期非小细胞肺癌按治疗方法归入两组,同步放化疗联合治疗组(同步组)27例(ⅢA期14例,ⅢB期13例);序贯放化疗组(序贯组)17例(ⅢA期8例,ⅢB期9例)。全组病例化疗采用以铂类药物为主组成的化疗方案,中位周期数为2.0。放疗采用6、15MVX线,DT<60Gy6例,60～70Gy19例,>70Gy2例;分割剂量为2Gy/(次·d),5次/周。分别比较两组的近期疗效、生存率、卡氏评分(KPS)变化及骨髓毒性。结果同步组与序贯组病例的完全缓解率、有效率、KPS改善率分别为26%和23%,74%和65%、75.6%和68.3%,经统计学检验差异均无显著性意义。两组病例的生存曲线和治疗毒性相似。结论同步放化疗联合治疗局部晚期非小细胞肺癌有优于序贯放化疗综合治疗的趋势;同步放化疗联合治疗未增加治疗毒性。     

晚期非小细胞肺癌的维持化疗

维持化疗对晚期非小细胞肺癌(NSCLC)可延长生存期.诱导化疗方案中证实有效的药物可用于维持化疗,二线、三线化疗药物及分子靶向药物似乎更适合用于晚期NSCLC维持化疗.     

NP方案治疗晚期非小细胞肺癌疗效观察

目的　观察NVB加PDD治疗晚期非小细胞肺癌疗效。方法　 1999年 7月～ 2 0 0 1年 8月我们应用进口长春瑞滨 (法国皮尔法伯制药公司生产 ) ,NVB 2 5～ 30mg/m2 ,d1,d8,溶于 0 .9%生理盐水15 0ml中快速静滴 ,再以 2 5 0ml0 .9%生理盐水快速静滴 ,DDP 4 0～ 5 0mg/d1,2 ,3,静脉滴注 ,同时给予水化。 2 1天为一周期。结果　本联合化疗方案治疗晚期非小细胞肺癌 4 0例 ,取得了较好疗效 ,其中CR 4例、PR 2 6例 ,总有效率 75 %。结论　NP联合方案治疗晚期肺癌是合理、方便、安全、有效的一种可行的方案 ,可以作为一线方案推荐临床推广。     

New developments in chemotherapy for advanced non-small cell lung cancer

PURPOSE OF REVIEW: The treatment of patients with advanced non-small cell lung cancer has changed considerably in the past decade. This paper reviews the most significant changes seen in chemotherapy and the most promising new agents in development for this disease. RECENT FINDINGS: Chemotherapy prolongs survival and improves quality of life in patients with a good performance status and appears to alleviate disease-related symptoms in patients with a lower performance status. Platinum-based regimens became standard; none of the third-generation drug combinations seemed to be superior to the others. Nonplatinum combinations are reasonable alternatives now and offer a better toxicity profile in certain populations. Attempts to add molecular-targeted therapy to combination chemotherapy have failed except for bevacizumab. New compounds such as pemetrexed, bortezomib, TLK286, bevacizumab, and the epothilones are currently being evaluated in non-small cell lung cancer. SUMMARY: Management of non-small cell lung cancer has improved considerably in the past decade. The overall benefit of chemotherapy over supportive care has been shown, platinum-based doublets have been established, nonplatinum regimens have been developed, chemotherapy has been used more broadly in subgroups of patients who have been previously neglected, and a shorter chemotherapy duration has been shown to be equally effective. After hitting a plateau in the benefit of chemotherapy, new drugs with novel action mechanisms such as the ones described here offer hope to improve therapy for this disease.     

晚期非小细胞肺癌化疗现状及进展

晚期非小细胞肺癌 (ＮＳＣＬＣ)包括不能手术切除的ⅢＢ、Ⅳ期和术后、放疗后复发转移者。患者预后极差 ,中位生存期 (ＭＳ)仅 16～ 17周 ,1年生存率为 10 %～ 15% [1,2 ] 。 80年代起 ,顺铂 (ＤＤＰ)、卡铂 (Ｃａｒｂｏ)、异环磷酰胺 (ＩＦＯ )、长春花碱酰胺 (ＶＤＳ)、丝裂霉素(ＭＭＣ)、足叶乙甙 (ＶＰ16)和替尼泊甙 (ＶＭ2 6)等的相继出现为晚期ＮＳＣＬＣ的治疗带来一些希望 ,但单药有效率均低于 15%。有作者对 52个随机临床试验的ＭＥＴＡ分析显示 ,联合化疗优于单一用药 ,含铂类的化疗方案能提高生存期、缓解全身症状及改善生活质量…     

Evaluation of chemotherapy with docetaxel and cisplatin in advanced non-small cell lung cancer]

Clinical study has been conducted to evaluate the efficacy of chemotherapy with docetaxel and cisplatin in six patients with advanced non-small cell lung cancer. Treatment schedule consisted of docetaxel 60 mg/m2 and cisplatin 80 mg/m2 on day 1 and repeated every 4 weeks. Eligible patients had histologically proven locally advanced or metastatic non-small cell lung cancer, PS < or = 2, age < or = 74, normal hematological, hepatic and renal functions and informed consent in writing. Six patients have been included; all were males, median age 64 (range 47-74), histology; adenocarcinoma 4, squamous cell carcinoma 2, stage III B 4, stage IV 2. Among these 6 patients, 3 PR (50%) were observed. Neutropenia was the most common adverse event (83%). The lowest granulocyte counts were most frequently seen on day 9.4 (range: 6-14). Non hematologic adverse events included alopecia (6 cases), general fatigue (5 cases), anorexia (5 cases) and emesis (3 cases). These events were recovered rapidly with no therapy. The results suggest that combination chemotherapy of docetaxel and cisplatin will be effective and safe under careful observation.     

不同化疗方案治疗中晚期非小细胞肺癌患者的疗效观察

目的探讨不同化疗方案治疗中晚期非小细胞肺癌患者的临床疗效。方法选取2013年1月至2016年3月间江苏省南通市肿瘤医院收治的68例中晚期非小细胞肺癌患者,采用随机数字表法分为观察组与对照组,每组34例。对照组患者行多西他赛联合顺铂常规化疗方案,观察组患者在对照组基础上增加华蟾素胶囊。治疗2个周期后,评价两组患者生活质量、临床疗效及不良反应。结果观察组患者生活质量总改善率为88.2%,高于对照组患者的70.6%,两组比较,差异有统计学意义(P<0.05)。观察组患者治疗总有效率为64.7%,高于对照组患者的47.1%,两组比较,差异有统计学意义(P<0.05)。两组患者不良反应情况比较,差异无统计学意义(P>0.05)。结论对中晚期非小细胞肺癌患者行华蟾素胶囊联合多西他赛与顺铂化疗,能够有效改善患者生活质量,提高临床疗效,可在临床上推广使用。     

老年晚期非小细胞肺癌化疗进展

老年肺癌的发病率逐年上升,多数医生对老年患者采用化疗并不积极,使许多身体状态尚好的老年患者丧失了延长生命的机会.现综述近年来应用于老年非小细胞肺癌患者的单药以及联合化疗方案.