吉西他滨联合卡铂在复发性上皮性卵巢癌治疗中的应用

目的 探讨吉西他滨联合卡铂治疗复发性上皮性卵巢癌的有效性和不良反应.方法 对76例复发性上皮性卵巢癌患者应用吉西他滨1 000 mg/m<'2>,第1天和第8天静脉滴注;CBP浓度-时间曲线下面积(AUC)=5,第1天静脉滴注;21天为一个疗程.依据世界卫生组织实体瘤疗效评估标准和国际妇科肿瘤学会卵巢癌疗效判断标准进行疗效评定,并观察化疗后不良反应.结果 76例患者中,完全缓解21例(27.63%),部分缓解36例(47.37%),稳定13例(17.11%),进展6例(7.89%);治疗总有效率75.0%(57/76).患者无进展生存期平均为4.1个月(2～10个月).化疗后第8天,中性粒细胞减少、血小板减少、红细胞减少、消化道不良反应的发生率分别84.21%、78.95%、26.32%和86.84%;其他不良反应的发生率均低于20%.无死亡病例.结论 吉西他滨联合卡铂是治疗复发性上皮性卵巢癌的有效方案,临床疗效较好,安全性高,其不良反应可控制,患者可耐受.     

吉西他滨联合卡铂治疗复发性上皮性卵巢癌48例近期疗效分析

目的：评价吉西他滨联合卡铂治疗复发性上皮性卵巢癌48例的近期疗效及不良反应。方法：选取复发性上皮性卵巢癌48例,采用吉西他滨联合卡铂化疗26例,随机采用顺铂联合环磷酰胺化疗22例作为对照组,吉西他滨为800 mg/m2第1 d和8 d,卡铂（AUC5）第1 d,顺铂70 mg/m2,环磷酰胺700 mg/m2,均静脉用药,3~4周重复1次,共6~8疗程。结果：48例均可评价疗效,吉西他滨联合卡铂组治疗有效率69.2%,顺铂联合环磷酰胺组治疗有效率40.9%,两组间疗效比较有统计学意义（P〈0.05）,吉西他滨联合卡铂组反应较轻。结论：吉西他滨联合卡铂可作为复发性上皮性卵巢癌化疗的首选药物,治疗有效率优于传统的顺铂联合环磷酰胺化疗方案,化疗反应轻,值得推广应用。     

吉西他滨联合奈达铂治疗铂类敏感复发上皮性卵巢癌的疗效观察

目的采用吉西他滨联合奈达铂治疗铂类敏感复发性上皮性卵巢癌,并观察治疗效果及毒副作用。方法患者进行治疗的第1天、第8天静脉滴注30分钟吉西他滨1000 mg/m2和生理盐水100 mL.每两个周期进行疗效评定合格后进行化疗。结果 5例患者完全缓解,12例患者部分缓解,治疗总有效率为65.38%;仅出现白细胞减少和血小板减少两项严重不良反应。结论采用吉西他滨联合奈达铂治疗铂类敏感复发上皮性卵巢癌具有良好的治疗效果,且毒副作用较小。     

吉西他滨联合卡铂治疗复发性卵巢癌

目的:评估吉西他滨联合铂类治疗复发性卵巢癌的疗效及毒性。方法:31例复发性卵巢癌化疗方案:第1、8天吉西他滨1000mg/m2静注;CBP浓度-时间曲线下面积(AUC)=5,第l天静脉滴注;21d为一疗程。结果:31例患者总有效率64.5%,其中5例CR(16.1%),15例PR(48.4%)。中位无进展生存期为7.2个月。毒性主要为白细胞减少和血小板减少。结论:吉西他滨联合卡铂是治疗复发性卵巢癌的有效方案,毒性可以耐受。     

吉西他滨联合顺铂治疗复发性卵巢癌的临床观察

目的 探讨吉西他滨与顺铂合用治疗复发性卵巢癌的疗效及毒副作用.方法 对28例复发性卵巢癌患者,给予吉西他滨1 000 mg/m2,静脉滴注,第1、8天;顺铂25mg/m2,第1、2、3天静脉滴注,每21天为1个疗程.结果 吉西他滨联合顺铂治疗复发性卵巢癌有效率57.1%,主要毒副作用为骨髓抑制和胃肠道反应.结论 吉西他滨与顺铂合用治疗复发性卵巢癌有-定的疗效,副作用能够耐受.     

吉西他滨联合铂类药物治疗转移性三阴乳腺癌的临床观察

目的 观察吉西他滨联合铂类药物(顺铂、卡铂或奈达铂)治疗蒽环类及紫杉类耐药的转移性三阴乳腺癌(triple-negative breast cancer,TNBC)的疗效、影响因素和不良反应.方法 38例转移性乳腺癌患者,既往蒽环类及紫杉类药物治疗失败,病理确诊为浸润性导管癌或小叶癌,其雌激素受体、孕激素受体和人类表皮生长因子受体2亚型均为阴性.采用吉西他滨联合铂类方案化疗,吉西他滨1 000 mg/m2,静脉滴注,第1、8天;顺铂25 mg/(m2·d),第1～3天,静脉滴注;或卡铂AUC=6,第1天,静脉滴注;或奈达铂80 mg/m2,第1天,静脉滴注.每21 d为1个周期,至少接受2个周期化疗.结果 38例患者中29例采用吉西他滨+顺铂方案化疗,5例采用吉西他滨+卡铂方案化疗,4例采用吉西他滨+奈达铂方案化疗.有效率为39.47%.中位无进展时间为4.3(2.5～8.2)个月,中位生存时间为14.3(8～22)个月.Ⅲ～Ⅳ度白细胞减少症为10.53%,无粒缺性发热.Ⅲ～Ⅳ度血小板减少症为10.53%.无化疗相关性死亡.结论 吉西他滨联合铂类方案对蒽环类及紫杉类均耐药的转移性TNBC有较好的近期疗效,不良反应可耐受,是有效的解救方案.     

高海拔地区吉西他滨联合顺铂治疗复发性卵巢癌的临床观察

目的:研究吉西他滨联合顺铂治疗复发性卵巢癌的疗效及毒性.方法:对32例复发性卵巢癌患者应用吉西他滨1 000mg/m2 ,第1天、第8天静注,联合顺铂75 mg/m2,分为第1天、第2天、第3天静注,每21天为1疗程.结果:32例患者有效率为53.1%.其中完全有效7例(21.8%),部分有效10例(31.3%),无进展生存期平均为3.5个月,毒副反应主要为白细胞减少,但均为可逆性.结论: 吉西他滨加顺铂是高海拔地区治疗复发性卵巢癌的有效方案,其毒副反应均可耐受.     

吉西他滨联合卡铂治疗复发卵巢上皮癌的临床观察

目的观察吉西他滨联合卡铂治疗复发卵巢上皮癌的临床疗效和毒副反应。方法58例复发卵巢上皮癌患者用吉西他滨1000mg／m^2 ＋生理盐水100ml,静脉滴注30min,第1天和第8天;卡铂剂量AUC5,第1天静脉滴注;21天为一个周期。观察治疗后近期总有效率、中住无进展生存期及不良反应。结果58例患者中,完全缓解13例,部分缓解28例,稳定12例,进展5例,治疗总有效率70．7％。患者中住无进展生存期5．8个月（2～11个月）。化疗主要毒副反应为骨髓抑制和胃肠道反应,未出现因化疗毒性而死亡的病例。结论吉西他滨联合卡铂是治疗复发性卵巢上皮癌的有效方法,化疗不良反应可耐受,安全性高,具有临床应用价值。     

吉西他滨联合顺铂治疗蒽环类和紫杉类化疗失败的晚期乳腺癌疗效观察

目的 探讨吉西他滨联合顺铂治疗蒽环类和紫杉类化疗后失败的晚期乳腺癌的临床疗效.方法 乳腺癌化疗后复发的患者50例,化疗方案为吉西他滨1000 mg/m2,于第1、8天静脉滴注;顺铂25 mg/m2,静脉滴注2～4 d,;每21 天为1个周期,2个周期后评价临床疗效及不良反应情况.结果 完全缓解8例(16%),部分缓解18例(36%),稳定13例(26%),进展11例(22%),总有效率21例(52%).不良反应为血小板和白细胞减少.结论 吉西他滨联合顺铂治疗蒽环类和紫杉类化疗后失败的晚期乳腺癌具有确切的疗效.     

GEMOX方案治疗铂类耐药复发及难治性卵巢癌疗效观察

目的：探讨GEMOX方案（吉西他滨联合奥沙利铂）治疗铂类耐药复发及难治性卵巢癌的疗效和不良反应。方法：我科自2008年10月至2013年10月应用吉西他滨联合奥沙利铂治疗复发、难治性上皮性卵巢癌患者20例,其中3例为难治性、17例为铂类耐药复发。所有患者均予吉西他滨1000mg/m2第1、8天静脉给药,奥沙利铂130mg/m2,第1天静脉给药。3周为1周期,每个患者至少接受2周期化疗用药。2个周期后评价疗效、疾病控制率,每周期均监测不良反应。结果：20例患者共完成96个化疗周期,有效率为40%（8/20）,疾病控制率为75%（15/20）;主要毒性反应为骨髓抑制、神经毒性和消化道反应。结论：GEMOX方案治疗铂类耐药复发、难治性上皮性卵巢癌疗效较好,毒性反应可以耐受。     

多西他赛与奥沙利铂联合治疗复发性上皮性卵巢癌疗效评价

目的 观察和评估多西他赛联合奥沙利铂方案治疗复发性上皮性卵巢癌的临床疗效及安全性.方法 对病理证实为复发性上皮性卵巢癌患者36例进行化疗.给药方案为:多西他赛75mg/m~2,静脉滴注1 h,第1天:奥沙利铂100mg/m~2,静脉滴注2h,第1天.每21 d重复,至少治疗2个周期.结果 接受治疗的36例患者均可评价疗效,完全缓解率为8.3%,部分缓解率为47.2%,总有效率55.6%.主要毒副反应为骨髓抑制和周围神经炎.结论 多西他赛联合奥沙利铂化疗方案治疗复发性上皮性卵巢癌有较好的疗效,毒副反应轻,耐受性好,值得进一步临床研究推广.

Abstract：

Objective To evaluate the efficacy and safety of docetaxel (Taxotere) (DTX) and oxaliplatin (OXA) for treatment of recurrent epithelial ovarian cancer. Methods Thirty-six patients with histologically confirmed recurrent epithelial ovarian cancer received chemotherapy with DTX and OXA. DTX at the dose of 75 mg/m2 was administered on day 1 by intravenous infusion in 60 min, followed by OXA at 100 mg/m~2 given by a 2 h infusion. The chemotherapy cycles were repeated every 21 days, and the patients received at least 2 cycles. Results All the patients were available for response evaluation, among whom 3 (8.3%) showed complete responses and 17 (47.2%) showed partial responses, with an overall response rate of 55.6%. The main adverse effects included hematological toxicities and peripheral neuropathy. Conclusion Combination of DTX and OXA produces good therapeutic effect with tolerable toxicity profile for treatment of recurrent epithelial ovarian cancer.     

GemOx方案治疗晚期复发转移卵巢癌的疗效观察

目的：探讨GemOx方案（吉西他滨联合奥沙利铂）治疗晚期复发转移卵巢癌的疗效及不良反应。方法：共入组22例患者,其中铂类敏感复发转移12例,铂类耐药复发转移10例。所有患者均予吉西他滨1000mg/m^2第1,8天静脉给药;奥沙利铂130mg／m^2,第1天静脉给药。3周为1周期,每个患者至少接受2周期化疗用药。每2个周期后评价疗效、临床受益反应及不良反应。结果：共完成82个化疗周期,可评价疗效的21例,有效率为31．8％,铂类敏感患者中,有效率为41．7％,铂类耐药为20．0％;临床受益反应率为57．1％;主要毒性反应为骨髓抑制和神经毒性,白细胞减少15例（68．2％）,血小板减少16例（72．7％）,神经毒性、感觉异常达71．4％。结论：GemOx方案治疗晚期复发转移卵巢癌患者是有效的,毒性反应可以耐受,生存质量明显提高。     

紫杉醇与异环磷酰胺治疗妇科恶性肿瘤临床比较研究

目的观察紫杉醇与异环磷酰胺治疗妇科肿瘤的疗效。方法采用紫杉醇治疗妇科恶性肿瘤37例,其中卵巢肿瘤27例,输卵管癌6例,宫颈癌3例,宫内膜癌1例。33例为术后或化疗后复发病例,4例为原发卵巢癌。异环磷酰胺（IFO）为相应时间内复发的37例妇科恶性肿瘤,其中卵巢癌30例,输卵管癌3例,宫颈癌3例,宫内膜癌1例。紫杉醇化疗前6、12?h给预防用药地塞米松、西咪替丁、苯海拉明,化疗前0.5h给地塞米松+甲氧氯普氨。然后紫杉醇135～150mg/m²静注3h(或腹腔灌注),联合卡铂。异环磷酰胺2.0g+卡铂。结果紫杉醇化疗组与异环磷酰胺总体生存期分别为37个月和25个月。有效率（CR+PR）分别为48.6%与28%,差异有统计学意义(P＜0.001)。化疗毒副反应主要是骨髓抑制与脱发。结论紫杉醇治疗卵巢癌及输卵管癌疗效好,毒副反应较轻。     

HSP70、突变型P53在复发性、耐药性卵巢癌中的表达及临床意义

目的:探讨卵巢初治和复发上皮癌组织中热休克蛋白70(HSP70)与突变型P53(mtP53)的表达情况及其在临床应用E1B-55KD缺陷型腺病毒联合化疗治疗卵巢癌中的意义,探索一种新的治疗方法。方法:采用免疫组化方法测定卵巢肿瘤组织中HSP70与mtP53的表达情况。同时用Western blot法测定卵巢癌患者血浆中HSP70在手术和化疗前后的表达情况。结果:卵巢癌组织中,复发性卵巢癌HSP70、mtP53阳性率明显高于初治卵巢癌(P<0.05);HSP70和mtP53的阳性强度在进展期、低分化卵巢癌中明显高于早期、高分化卵巢癌(P<0.05)。卵巢癌中HSP70和mtP53共同阳性率为55.9%(33/59);其中复发癌组织中,HSP70和mtP53共同阳性率明显高于初治癌。复发卵巢癌中,铂类耐药型卵巢癌HSP70、mtP53阳性率明显高于非耐药组(P<0.05)。血浆中HSP70在手术后第2～4天及化疗后第2天明显增高,术后第6天及化疗后第4天恢复原水平。结论:HSP70与mtP53在复发、耐药性卵巢癌中的高表达,使溶瘤性腺病毒的应用成为可能,腺病毒应用时机选择在手术或化疗后2 d之内可能效果更佳。     

HSP70与突变型P53在卵巢癌中的表达及临床意义

目的:探讨卵巢上皮癌组织中HSP70与突变型P53(mtP53)的表达情况及其在临床应用E1B-55KD缺陷型腺病毒联合化疗治疗卵巢癌中的指导意义。方法:采用免疫组化方法测定84例卵巢肿瘤(初治癌36例,复发癌23例,良性和交界性肿瘤25例)组织中HSP70与mtP53表达的阳性率。结果:卵巢癌组织中HSP70与mtP53的表达明显高于良性和交界性肿瘤(P<0.05),复发性卵巢癌HSP70与mtP53阳性率明显高于初治卵巢癌,且与卵巢恶性肿瘤的病理分级、进展期密切相关。卵巢癌中HSP70和mtP53共同阳性率为55.93%,复发癌组织中,HSP70和mtP53共同阳性率69.57%,明显高于初治癌(47.22%)。复发癌中铂类耐药型卵巢癌HSP70与mtP53阳性率分别为87.5%、87.5%,均明显高于非耐药组(57.14%、42.86%)。结论:mtP53和HSP70的表达与卵巢癌的进展期及细胞分化程度相关,晚期和低分化的卵巢癌中mtP53与HSP70阳性率明显高于早期和高分化型,提示两者可作为推测卵巢癌预后的指标。铂类耐药型卵巢癌mtP53与HSP70表达率明显高于非耐药型卵巢癌,且复发性卵巢癌mtP53与HSP70共同阳性率明显高于初治卵巢癌,表明mtP53与HSP70的相互作用可能在复发性卵巢癌发展中起作用。而溶瘤性腺病毒应用可能为难治性卵巢癌治疗提供新途径。     

腹腔与静脉应用托泊替坎治疗人卵巢癌细胞株SKOV3裸小鼠网膜移植瘤的疗效比较

Objective:To compare the therapeutic and toxic profile of topotecan given intraperitoneally with intravenously in human ovarian cancer xenografted into athymic nude mice.Methods: Eighty female Balb-c/nu-nu mice were randomized assigned into eight groups (n=10). Xeneografts resulted from intramesentery injection of cultured human ovarian cancer cells SKOV3 in athymic mice. Onset of intraperitoneal treatment with either topotecan or cisplatin (7.5 mg/kg) was on day 7. Animals scheduled for topotecan i.p. received intraperitoneal application of topotecan (1.5 mg/kg×2, 3.0 mg/kg×2, 6.0 mg/kg×2 or 10.0 mg/kg×1). Animals scheduled for topotecan i.v. received intravenous administration of topotecan (6.0 mg/kg×2 or 10.0 mg/kg×1). Two weeks after drug application animals were killed. Tumor growth inhibition were assessed and compared with untreated mice and cisplatin intraperitoneally administered mice. Acute toxicity was determined by loss of body weight. Cell cycle division and apoptosis after drug administration was determined by flow cytometric analysis.Results: In a panel of ten tumour xenografts, intraperitoneal topotecan was significantly more effective than intravenous administration. The toxicity profile suggested a better tolerability in terms of weight loss after intraperitoneal administration than cisplatin control. Topotecan 10.0 mg/kg i.p. per day (1 day) schedule was an optimal treatment for ovarian cancer and well tolerated by mice with no signs of acute toxicity. Topotecan and cisplatin induce cells G0-G1 arrest and apparent apoptosis. No significant difference among mice treated with topotecan intraperitoneally or intravenously or cisplatin was observed in term of apoptosis and cell cycle perturbation.Conclusion:The results may have implications for the future design of clinical studies on intraperitoneal application of topotecan. It suggests that apoptosis and cell cycle perturbation play an limited role in the mechanism of topotecan administration.     

PHASE Ⅱ STUDY OF GEMCITABINE COMBINED WITH PLATINUM CHEMOTHERAPY FOR RECURRENT EPITHELIAL OVARIAN CANCER

Objective To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer. Methods Phase Ⅱstudy of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50.5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractory. All patients received gemcitabine combined with carboplatin or oxaliplatin chemotherapy. Patients' response rate (RR) and toxicity of gemcitabine combined with platinum chemotherapy were evaluated. Results A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36.4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10.0 months (95%CI: 7.0-13.0) after initiation of gemcitabine combined with platinum chemotherapy. There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group (P=0.061). Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8% of patients. Grade Ⅱ/Ⅲ anemia (54.5%) and grade Ⅲ/Ⅳ neutropenia (54.5%) were most common toxicities. Ten (45.5%) patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen (63.6%) patients received granulocyte colony-stimulating factor to relieve neutropenia, and 8 (36.4%) patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treatment-associated death. Conclusion Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.     

PHASE Ⅱ STUDY OF GEMCITABINE COMBINED WITH PLATINUM CHEMOTHERAPY FOR RECURRENT EPITHELIAL OVARIAN CANCER

Objective To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer.Methods Phase Ⅱ study of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50. 5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractor. All patients received gemcitabine combined with carboplatin or oxaliplatin chemotherapy. Patients' response rate (RR) and toxicity of gemcitabine combined with platinum chemotherapy were evaluated.Results A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36.4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10. 0 months (95% CI: 7.0-13.0) after initiation of gemcitabine combined with platinum chemotherapy.There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group (P = 0. 061 ). Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8 % of patients. Grade Ⅱ/Ⅲ anemia (54.5%) and grade Ⅲ/Ⅳ neutropenia (54.5%) were most common toxicities. Ten (45.5%) patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen (63.6%) patients received granulocyte colony-stimulating factor to relieve neutropenia,and 8 (36. 4% ) patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treatment-associated death.Conclusion Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.     

伊立替康联合氟尿嘧啶/亚叶酸钙治疗晚期大肠癌疗效分析

目的:评价伊立替康联合氟尿嘧啶/亚叶酸钙方案治疗晚期大肠癌的疗效及不良反应。方法:第1天,应用伊立替康150~180mg/m2静脉滴注,90min;氟尿嘧啶500mg静脉推注;亚叶酸钙500mg静脉滴注,2h;氟尿嘧啶1250~1500mg/m2输液泵持续静脉滴注44h,每2周期重复,至少完成2周期。结果:全组共化疗73周期,20例化疗者,19例可评价疗效,完全缓解1例,部分缓解6例,疾病稳定5例,进展7例。主要不良反应为白细胞减少、迟发性腹泻、恶心、呕吐,无化疗相关性死亡。结论:伊立替康联合氟尿嘧啶/亚叶酸钙方案治疗晚期大肠癌疗效好,毒副反应可以预防、控制,可以广泛应用于临床。