脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗43例晚期胃癌的临床研究

[目的]评价脂质体紫杉醇（力扑素）联合顺铂、氟尿嘧啶（5-Fu）组成的PCF方案一线治疗43例晚期胃癌的临床疗效和毒副反应。[方法]脂质体紫杉醇135～175mg/m2,静滴3h,d1;顺铂20mg/m2,静滴2h,d1～5;5-Fu750mg/m2持续静脉滴注d1～5。21d为1个周期。按RECIST标准评定疗效,按WHO标准评价毒副反应,Kaplan-Meier法绘制生存曲线。[结果]全组共完成化疗167个周期,中位治疗3个周期。39例患者完成2个周期以上化疗并可评价疗效,其中CR1例,PR19例,SD11例,PD8例,总有效率51.3%。中位无进展生存时间6.0个月,中位总生存时间11.5个月,1年生存率41.0%。主要的Ⅲ~Ⅳ级血液学毒性为白细胞减少及中性粒细胞减少,发生率分别为16.2%和25.6%。全组仅1例发生过敏反应。无患者因毒性反应而停药,无治疗相关性死亡发生。[结论]脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗晚期胃癌疗效肯定,毒副反应轻,对患者生活质量改善明显。     

紫杉醇联合5-氟尿嘧啶和顺铂治疗晚期胃癌58例

[目的]观察紫杉醇联合5-氟尿嘧啶及顺铂(PCF方案)治疗晚期胃癌的临床疗效和毒副反应。[方法]晚期胃癌患者58例,给予紫杉醇(PTX)150mg/m2,静滴3h,d1;5-氟尿嘧啶(5-Fu)500mg/m2,d1～5或750mg/m2,d1～3;顺铂(DDP)15mg/m2,d1～5或30mg/m2,d1～3;21～28d为1个周期。至少2个周期后按RESCIST标准评价疗效和毒副反应。[结果]全组57例可评价疗效,初治组35例,无完全缓解病例,部分缓解15例,稳定17例,进展3例,近期客观有效率42.9%,中位达进展时间(TTP)为6.0个月。复治组22例,无完全缓解病例,部分缓解3例,稳定16例,进展3例,近期客观有效率13.6%,中位TTP为3.2个月。主要毒副反应为骨髓抑制、恶心呕吐和脱发。[结论]PCF方案治疗晚期胃癌近期疗效确切,毒副反应可以耐受,初治患者效果更佳。     

奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙联合方案治疗晚期胃癌42例

[目的]评价奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙联合治疗42例晚期胃癌疗效.[方法]羟基喜树碱10mg/m2静滴第1～5d,奥沙利铂100mg/m2静滴第1d;亚叶酸钙100 mg/d静滴第6～10d,氟脲嘧啶750 mg/d静滴第6～10d.28天为1个化疗周期,完成3周期后评价疗效.[结果]42例晚期胃癌患者中CR 3例(7.14%),PR 17例(40.48%),NC 14例(40.48%),PD 8例(33.33%).总有效率(CR PR)为47.62%(20/42).毒副反应为骨髓系和消化系不良反应,发生率较高,基本上为Ⅰ度和Ⅱ度.经对症处理后均能缓解.本组未发生严重不良反应而终止治疗者,也无与化疗相关死亡病例.[结论]奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙治疗晚期胃癌疗效好,毒副反应轻.     

全身化疗联合腹腔化疗治疗晚期卵巢癌的临床观察

目的 观察全身化疗联合腹腔化疗对晚期卵巢癌的疗效及毒副反应.方法 24例卵巢癌,用紫杉醇135 mg/m2,卡铂400 mg/m2静滴,每4周重复1次,共化疗2个周期,顺铂60 mg,地塞米松10 mg腹腔化疗,每2周1次,进行2～3个周期,中位疾病进展时间(MTTP)9个月(5～12个月),无复发生存期5个月,观察每次化疗毒副反应及疗效.结果 24例中CR 12例、PR 7例,RR 79.2%,毒副反应为剂量限制性骨髓抑制、消化道反应.结论 全身化疗联合腹腔化疗对晚期卵巢癌有较好疗效.     

紫杉醇、5-Fu联合DDP腹腔灌注配合热疗治疗中晚期胃癌疗效观察

目的探讨紫杉醇、5-Fu联合DDP腹腔灌注配合热疗治疗中晚期胃癌的疗效和毒副反应。方法34例Ⅲ～Ⅳ期胃癌患者,给予紫杉醇135～175mg／m^2,d1,静脉滴注;5-Fu500mg／m^2,d1-5,静脉滴注;DDP40～50mg／m^2,d1,8,腹腔灌注后行微波热疗,28天为一个周期,2～3个周期后进行评价。结果全组34例共化疗153周期,总有效率（CR＋PR）47．1％,其中CR14．7％（5／34）,PR 32．4％（11／34）,毒副反应主要为骨髓抑制。结论紫杉醇、5-Fu联合DDP腹腔灌注配合热疗治疗中晚期胃癌有效率高,毒副反应轻,可明显减轻患者痛苦,提高生存质量。     

紫杉醇联合氟尿嘧啶、亚叶酸钙治疗老年晚期胃癌

[目的]探讨紫杉醇联合氟尿嘧啶持续滴注加亚叶酸钙治疗老年晚期胃癌的疗效及毒副反应。[方法]32例胃癌患者应用紫杉醇135mg／m^2，分第1、8天静滴，亚叶酸钙（CF）100mg／m。第1、2、3天静滴，氟尿嘧啶（5-Fu）500mg,／m^2。第1天静滴2h，以后用5-Fu2500mg／m^2内持续滴注，持续70h，21～28天为1个周期，至少2个周期开始评价疗效。f结果]30例患者可评价疗效，获PR12例，NC8例，PD10例，全组未见CR病例，总有效率为40．0％，中位TrP为6．1个月；其中初治患者19例总有效率为42．2％，中位TTP为6．4个月；复治患者13例总有效率为36．4％．中位TTP为5．7个月。毒副反应主要为Ⅰ～Ⅱ度血液学毒性及消化道反应。[结论]紫杉醇联合氟尿嘧啶持续滴注加亚叶酸钙治疗老年晚期胃癌疗效肯定，患者均能耐受。特别对初治患者，值得深入研究。     

紫杉醇联合化疗方案治疗晚期胃癌的疗效观察

目的 观察国产紫杉醇(PTX)联合5-氟脲嘧啶(5-Fu)、羟基喜树碱(HCPT)、顺铂(DDP)方案治疗晚期胃癌的疗效和毒副反应.方法 采用PTX 135 mg/m2,加入生理盐水静滴3 h,d1;5-Fu 300 mg/m2,静滴,d1-5;HCPT 8 mg/m2,静滴,d1-5;DDP 20 mg/m2,静滴,d1-5;3～4周为1周期,行2周期治疗后判定疗效.结果 42例中38例可评价疗效,全组完全缓解(CR)1例(2.6%),部分缓解(PR)15例(39.5%),稳定(NC)16例(42.1%),进展(PD)6例(15.8%),有效率(CR PR)42.1%.毒副反应以骨髓抑制、脱发和关节肌肉痛为主,其它毒副反应均较轻微可耐受,无化疗相关死亡.结论 紫杉醇为主方案治疗晚期胃癌疗效肯定,毒副反应能耐受,值得进一步在临床使用.     

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。     

三维适形放疗同步紫杉醇顺铂方案治疗术后胃癌33例分析

[目的]评价适形放疗同步紫杉醇、顺铂方案治疗D2术后胃癌的临床疗效和毒副反应。[方法]采用三维适形放疗（3D-CRT）技术DT60Gy和紫杉醇135mg/m^2,d1、d29,DDP20mg/m^2,d1～3、d29～31同步化疗。[结果]2年生存率、2年无复发生存率分别为88.4%、68.7%。治疗相关毒性反应总体较轻,患者耐受好,1例患者出现治疗相关死亡。30.3%（10/33）患者治疗失败。[结论]胃癌D2术后的同步放化疗方案效果较好。适形放疗技术的应用可减轻放疗相关毒性反应,尤其是血液学和胃肠道反应。     

紫杉醇脂质体联合奥沙利铂、氟尿嘧啶治疗晚期胃癌

[目的]观察紫杉醇脂质体联合奥沙利铂、氟尿嘧啶方案(POF)治疗晚期胃癌的临床疗效和不良反应。[方法]对48例晚期胃癌患者采用POF方案治疗,具体用法:紫杉醇脂质体135mg/m2,第1d静滴3h;奥沙利铂135mg/m2,第2d静滴2h;氟尿嘧啶500mg/m2,化疗泵内持续推注,d1～5。21d为1个周期,每2个周期评价疗效。[结果]48例患者均可评价疗效及毒性,其中完全缓解(CR)2例(4.2%),部分缓解(PR)23例(47.9%),稳定(SD)14例(29.2%),进展(PD)9例,总有效率(RR)52.1%,中位疾病进展时间(TTP)6.2个月,中位生存时间(MST)11.5个月。临床受益反应评价总有效率75.0%(36/48)。不良反应主要是骨髓抑制和消化道反应,Ⅲ～Ⅳ度骨髓抑制发生率为22.9%;其他外周神经毒性、肌肉酸痛、脱发,多为Ⅰ～Ⅱ度;无化疗相关性死亡病例。[结论]紫杉醇脂质体联合奥沙利铂、氟尿嘧啶(POF)治疗晚期胃癌的疗效确切,不良反应患者能够耐受,可以作为晚期胃癌的一线或二线治疗方案。     

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.