泰索帝联合吡柔比星治疗晚期乳腺癌的疗效观察

目的：观察泰索帝联合吡柔比星治疗晚期乳腺癌临床疗效及不良反应。方法：26例均有组织病理学细胞学诊断及可评价客观指标。采用泰索帝75mg/m^2 dl,静脉滴注1小时，用泰索帝前1天口服地塞米松10mg，连续3天。吡柔比星40mg/m^2 d2化疗。21天为1周期，2个周期评价疗效。结果：26例可评价疗效和不良反应。CR3例，PR 16例，NC5例，PD2例，有效率73．1％。不良反应主要为白细胞减少Ⅲ度占34．6％，Ⅳ度占26．9％，脱发Ⅱ度占46．2％，Ⅲ度占23．1％，腹泻Ⅱ度占34．6％Ⅲ度占23．1％。结论：泰索帝联合吡柔比星治疗晚期乳腺癌有效率较高，不良反应可以耐受。     

泰索帝治疗晚期非小细胞肺癌及乳腺癌的临床观察

目的　观察以泰索帝为主的联合化疗方案治疗晚期非小细胞肺癌及乳腺癌的临床疗效和毒性反应。方法　泰索帝的剂量为 75mg/m2 ,静脉滴注 1h ,用泰索帝 2 4h前口服地塞米松 8mg ,2次 /d ,连服 3d。肺癌联合顺铂 90mg/m2 ,乳腺癌联合阿霉素 40mg/m2 ,2 1d为 1个周期 ,治疗 2个周期。结果　非小细胞肺癌 15例 ,PR 6例 ,NC 7例 ,PD 2例 ,有效率 40 0 % ;乳腺癌 9例 ,CR 2例 ,PR 6例 ,NC 1例 ,有效率 88.9%。全组 2 4例 ,有效 14例 ,总有效率 5 8.3%。毒性反应主要为白细胞减少、腹泻、乏力、肌肉痛和脱发。白细胞减少达到Ⅲ、Ⅳ度的分别是 9例和 4例 ,血红蛋白和血小板减少较轻 ,无Ⅲ、Ⅳ度者 ;腹泻 19例 ,达到Ⅲ、Ⅳ度的分别是 7例和 3例 ;Ⅲ度过敏反应 1例。结论　以泰索帝为主联合化疗治疗晚期非小细胞肺癌和乳腺癌具有较好疗效。毒性反应轻 ,耐受性好。     

多西紫杉醇联合表阿霉素及环磷酰胺治疗晚期乳腺癌的临床观察

目的：观察多西紫杉醇联合表阿霉素及环磷酰胺治疗晚期乳腺癌的疗效与不良反应。方法：采用多西紫杉醇联合表阿霉素及环磷酰胺治疗56例复发或转移的晚期乳腺癌患者,多西紫杉醇75mg/m2,d1,表阿霉素50mg/m2,d1,环磷酰胺500mg/m2,d1,21天为1周期,连续治疗2周期。结果：56例患者TEC方案治疗2周期后CR7例,PR22例,总有效率为51.8%。最常见不良反应为骨髓抑制、消化道反应及脱发,本组无一例发生过敏反应,其不良反应可耐受。结论：TEC方案治疗晚期乳腺癌可作为晚期乳腺癌的一线治疗方案。     

多西紫杉醇联合表阿霉素及环磷酰胺治疗晚期乳腺癌的临床观察

目的:观察多西紫杉醇联合表阿霉素及环磷酰胺治疗晚期乳腺癌的疗效与不良反应.方法:采用多西紫杉醇联合表阿霉素及环磷酰胺治疗56例复发或转移的晚期乳腺癌患者,多西紫杉醇75mg/m2,d1,表阿霉素50mg/m2,d1,环磷酰胺500mg/m2,d1,21天为1周期,连续治疗2周期.结果:56例患者TEC方案治疗2周期后CR 7例,PR 22例,总有效率为51.8%.最常见不良反应为骨髓抑制、消化道反应及脱发,本组无一例发生过敏反应,其不良反应可耐受.结论:TEC方案治疗晚期乳腺癌可作为晚期乳腺癌的一线治疗方案.     

紫杉醇与表阿霉素联合治疗晚期乳腺癌的临床观察

目的：观察紫杉醇联合表阿霉素治疗晚期乳腺癌的临床疗效及不良反应。方法：25例均有组织病理学或细胞学诊断及可评价客观指标。采用紫杉醇175mg／m^2 d1，静脉滴注3小时，用紫杉醇前12小时、6小时分别口服地塞米松20mg，给药前30分钟给予苯海拉明50mg口服及西米替丁300mg静脉滴注。表阿霉素40mg／m^2 d1、d2化疗。2l天为一周期，2个周期评价疗效。结果：CR4例，PR13例，SD5例，PD3例，有效率68．0％。不良反应主要为白细胞减少，Ⅲ度占36．O％，Ⅳ度占28．0％；脱发Ⅱ度占48．0％，Ⅲ度占16．0％；腹泻Ⅱ度占32．0％，Ⅲ度占16．0％。结论：紫杉醇联合表阿霉素治疗晚期乳腺癌有效率较高，不良反应可耐受。     

EC与CEF方案用于乳腺癌新辅助化疗临床观察

[目的]对比观察EC(表阿霉素 环磷酰胺)与CEF(环磷酰胺 表阿霉素 氟尿嘧啶)方案用于乳腺癌新辅助化疗的疗效及毒副反应.[方法]64例经病理组织学或细胞学证实的Ⅱ、Ⅲa期乳腺癌患者随机分为两组,EC组30例,表阿霉素75mg/m2静滴d1,环磷酰胺600mg/m2,d1,每2周重复;CEF组34例,环磷酰胺500mg/m2,d1,表阿霉素60mg/m2静滴d1,氟尿嘧啶500mg/m2静滴d1,8每3周重复.[结果]EC组CEF组的有效率分别为73.3%和76.5%,两组间差异无显著性(P＞0.05).两组不良反应也无显著性差异.[结论]EC方案和CEF方案用于乳腺癌新辅助化疗均有较高的疗效,EC方案能缩短术前化疗时间,避免延迟手术时机.     

泰索帝联合希罗达治疗21例晚期乳腺癌

[目的]观察泰索帝联合希罗达方案治疗晚期乳腺癌的疗效及不良反应。[方法]以泰索帝联合希罗达方案治疗术后晚期乳腺癌21例。泰索帝70mg/m2,静滴d1,希罗达2500mg/(m2·d)分2次口服,d1～14,21d为1个周期,2个周期评价疗效。[结果]21例均可评价疗效。完全缓解(CR)2例(9.5%),部分缓解(PR)9例(42.8%),稳定(SD)5例(23.8%),进展(PD)5例(23.8%),总有效率(CR PR)52.3%,中位达进展时间(TTP)6.2个月,主要毒性为骨髓抑制和手足综合征。[结论]泰索帝联合希罗达方案治疗晚期乳腺癌疗效好,毒性反应轻,是治疗晚期乳腺癌的有效解救治疗方案。     

多西紫杉醇联合米托蒽醌治疗晚期乳腺癌的疗效观察

目的评定多西紫杉醇联合米托蒽醌治疗晚期乳腺癌临床疗效及不良反应.方法52例病人均有病理学诊断及可评价客观指标.采用多西紫杉醇75mg/m2d1,静脉滴注1小时,用多西紫杉醇前1天口服地塞米松10mg,连续3天.米托蒽醌14mg/m2d1化疗.21～30天为1周期,2周期评价疗效.结果52例病人可评价疗效和不良反应.CR6例,PR32例,NC10例,PD4例,有效率73.08%,不良反应主要为白细胞减少Ⅲ度占32.69%,Ⅳ度占25.00%;脱发Ⅱ度占44.23%,Ⅲ度占21.15%;腹泻Ⅱ度占32.69%,Ⅲ度占21.15%.结论多西紫杉醇联合米托恩醌治疗晚期乳腺癌有效率较高,不良反应可以耐受.     

以多西紫杉醇为主联合化疗治疗晚期卵巢癌97例

目的 观察以多西紫杉醇(商品名:希存)为主联合化疗治疗晚期卵巢癌患者的疗效及不良反应.方法 对97例晚期卵巢癌患者施以1H多西紫杉醇75 mg/m2,第1天,静脉滴注(1 h),顺铂80mg/m2]或TC[多西紫杉醇75mg/m2,第1天,静脉滴注(1 h),卡铂300mg/m2第1天,静脉滴注并水化2 d]方案化疗,21 d为1个周期,化疗6～8个周期.以上两种方案在多西紫杉醇用药前12 h..给予地塞米松8mg口服,1次/12h,共3次.结果 CR9例,PR 74例,sD 6例,PD 8例,总有效率91.7%.最常见的不良反应为骨髓抑制,Ⅲ～Ⅳ度白细胞减少占15%,Ⅲ度血小板减少占6.5%,非血液学毒性轻微.结论 以多西紫杉醇为主联合化疗治疗晚期卵巢癌有较好的疗效,不良反应可以耐受.     

多西紫杉醇联合米托蒽醌治疗晚期乳腺癌

目的:评定多的紫杉醇联合米托蒽醌治疗晚期乳腺癌临床疗效及不良反应。方法:52例病人均有病理学诊断及可评价客观指标。采用多西紫杉醇75mg/m~2d1,静脉滴注1小时,用多西紫杉醇前1天口服地塞米松10mg,连续3天。米托蒽酿14mg/m~2d1化疗。21～30天为1周期,2周期评价疗效。结果:52例病人可评价疗效和不良反应。CR 6例,PR 32例,NC 10例,PD 4例,有效率73.08％,不良反应主要为白细胞减少Ⅲ度占32.69％,Ⅳ度占25.00％;脱发Ⅱ度占44.23％,Ⅲ度占21.15％;腹泻Ⅱ度占32.69％,Ⅲ度占21.15％。结论:多西紫杉醇联合米托蒽醌治疗晚期乳腺癌有效率较高,不良反应可以耐受。     

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.