紫杉醇化疗在宫颈癌中的临床应用

紫杉醇为广谱有效的抗实体瘤药物,用于宫颈癌患者治疗已进行广泛临床研究,证实其可靠有效。从单药、双药及三药化疗等方面,综述近年紫杉醇治疗宫颈癌的临床应用。紫杉醇（T）联合顺铂（P）或卡铂（C）化疗方案优于紫杉醇单药或三药化疗,安全有效。尤其在新辅助化疗中;与顺铂相比,卡铂肾毒性小,无需水化,TC方案相对简单;TP或TC配合放疗疗效显著;紫杉醇周疗与3周疗法比较疗效类似,不良反应较小。     

《2014年NCCN宫颈癌临床实践指南》解读(续)

<正>(指南解读前半部分请见2014年第6期)4宫颈癌的化疗原则宫颈癌的全身化疗适用于盆腔外转移及不适宜放疗或手术的复发病例。4.1一线联合化疗顺铂/紫杉醇和顺铂/托泊替康等以顺铂为主的联合化疗方案已经在临床试验中被广泛研究。一个Ⅲ期随机对照试验的初期数据表明:与顺铂联合紫杉醇相比,卡铂联合紫杉醇对转移或复发宫颈癌患者的效果相当。因卡铂方案易于实施且耐受性好,许多肿瘤内科医生使用这个方案。美国食品药品管理局(FDA)已批准顺铂/托泊替康用于治疗晚期宫颈癌。但是顺铂/紫杉醇或卡铂/紫杉醇方案     

中晚期宫颈鳞状细胞癌放化疗综合治疗的临床进展

宫颈癌是女性最常见的恶性肿瘤之一,在亚洲女性恶性肿瘤发病率中居第2位,仅次于乳腺癌,而死亡率位居第4位。目前,同步放化疗是中晚期宫颈癌的标准治疗方案,能提高治疗的有效率和患者的生存率,其不良反应患者可耐受,但同步放化疗的化疗方案,获益人群和靶向药物的联合应用仍有待于进一步研究。放疗可以在不同时段、与不同种类的化疗药物结合,提高治疗效果。相关研究表明,顺铂和奈达铂单药周疗方案与铂类联合氟尿嘧啶、替加氟等类药物联合化疗21天方案的疗效相当,但前者毒副作用较小。紫杉醇和奈达铂联合化疗是有效的巩固化疗方案。含顺铂的同步放化疗被推荐为局部晚期宫颈癌的首选治疗方案。     

多西紫杉醇或紫杉醇联合顺铂同步放化疗治疗晚期宫颈癌疗效比较

目的探究多西紫杉醇或紫杉醇联合顺铂同步放化疗治疗晚期宫颈癌的疗效。方法选取我院肿瘤科2012年3月~2015年3月收治的晚期宫颈癌患者80例作为研究对象。分别采用多西紫杉醇或紫杉醇联合顺铂化疗和多西紫杉醇或紫杉醇联合顺铂同步放化疗方案。患者处于进展期40例,慢性期40例。结果通过多西紫杉醇或紫杉醇联合顺铂化疗后,40例患者中完全缓解12例,部分缓解10例,无缓解18例,总缓解率为55%;通过多西紫杉醇或紫杉醇联合顺铂同步放化疗后,40例患者中缓解16例,部分缓解12例,无缓解12例,总缓解率70%。两组比较差异有统计学意义(P0.05)。结论对于晚期宫颈癌患者采取多西紫杉醇或紫杉醇联合顺铂同步放化疗方案能取得较好的疗效,值得临床推广。     

卵巢癌化疗现状

迄今为止，顺铂和卡铂仍然是治疗卵巢癌的主要药物。紫杉醇对顽固性卵巢癌有较高的疗效。目前，ＧＯＧ已将顺铂加紫杉醇列为治疗晚期卵巢癌新的标准联合化疗方案。最近的研究显示，卡铂（通过曲线下面积计算剂量）加紫杉醇（１７５ｍｇ／ｍ＾２静注３ｈ）治疗以前未接受过化疗的卵巢癌，其毒性并不大。     

3种方案同步放化疗治疗中晚期宫颈癌的疗效对比观察

目的:探讨治疗中晚期宫颈癌同步放化疗的化疗方案选择.方法:96例中晚期宫颈癌患者同步放化疗随机分成顺铂组(30例)、多西紫杉醇组(34例)及顺铂联合多西紫杉醇组(32例),观察3组的治疗效果和副反应,并进行比较.结果:外照射结束时3组的有效率分别为96.67%、100%及100%,差异无统计学意义(P＞0.05);顺铂组的4年生存率、局部复发率、远处转移率与另两组比较,差异有统计学意义(P＜0.05);多西紫杉醇组与顺铂联合多西紫杉醇组差异无统计学意义(P＞0.05);顺铂组及顺铂联合多西紫杉醇组有较明显的骨髓抑制和消化道反应,而且肾功损害明显,与多西紫杉醇组比较差异有统计学意义(P＜0.05).结论:多西紫杉醇单药同步放化疗与顺铂单药及两药联合同步放化疗比较,能明显提高患者的生存率,降低局部复发率及远处转移率,同时副反应相对较轻.     

国产紫杉醇治疗晚期卵巢癌32例临床分析

目的：探讨国产紫杉醇治疗晚期卵巢上皮性癌的疗效及其毒性。方法：３２例患者分为两组。单药组：１２例，紫杉醇剂量为１７５ｍｇ／ｍ２，溶于５％葡萄糖５００ｍｌ中，静脉滴注３小时，用于既往无化疗或仅用过１个疗程化疗的患者。联合组：２０例，第１天用紫杉醇，剂量为１３５ｍｇ／ｍ２，溶于５％葡萄糖５００ｍｌ，静脉滴注３小时，第２天用顺铂，７０～８０ｍｇ／ｍ２或卡铂３００ｍｇ／ｍ２，静脉滴注，主要用于顺铂化疗后肿瘤未控或复发患者。两组均为每４周１个疗程，除用药１个疗程后肿瘤进展而停药外，至少２个疗程。结果：全组有效率为３９％，单药组和联合组各为２７％和４５％。主要毒性包括中度骨髓抑制、末梢神经病变（肌肉痛、关节痛、末梢神经炎）及严重脱发等，但无过敏反应。１例死于肠穿孔。结论：国产紫杉醇是治疗卵巢癌的有效药物，特别是与顺铂联合用药，可用于顺铂耐药的复发或未控卵巢癌患者。其药物毒性是可耐受的。     

晚期卵巢癌卡铂、紫杉醇二联方案与表柔比星联合应用的研究

旨在改善晚期卵巢癌一线化疗药物的疗效，德国AGO-OVAR设计了联合卡铂、紫杉醇和表柔比星的三联疗法（TEC），联合法国GINECO开展Ⅲ期随机试验，比较TEC化疗方案和卡铂、紫杉醇（TC）方案对晚期卵巢上皮癌的疗效。     

复发性子宫颈癌化疗的研究进展

子宫颈癌是严重危害妇女健康的恶性肿瘤之一。复发性子宫颈癌治疗困难,预后极差,全身化疗作为一种姑息性疗法以延长生存和提高生活质量为目标,近年来以铂类和非铂类药物为基础的单药或联合方案及分子靶向药物逐渐被用于子宫颈癌的化疗。顺铂/卡铂+紫杉醇+贝伐珠单抗是复发性子宫颈癌的一线治疗方案,对于一线治疗无效的患者可考虑使用PD-1抑制剂派姆单抗。     

《中国实用妇科与产科杂志》2004年第3期国家级继续医学教育试题

(A型题 ,答题卡见下页 )1　新辅助化疗对宫颈癌主要适用于 :A　Ⅰa期　　B　Ⅰb1期　　C　Ⅰb2 期D　Ⅱa期　　E　Ⅲ期及Ⅳ期2　卵巢癌先期化疗的疗程 :A　 1～ 2个疗程　　B　 3～ 4个疗程C　 3～ 6个疗程　　D　 6个疗程　　E　不一定3　宫颈癌新辅助化疗的指征 :A　晚期宫颈癌　　　　B　宫颈鳞癌C　局部晚期宫颈癌　　D　宫颈浸润癌E　Ⅳb期宫颈癌4　目前卵巢上皮癌术后的一线化疗方案是 :A　米尔法兰B　环磷酰胺联合 5 氟尿嘧啶C　铂类联合紫杉醇或顺铂联合环磷酰胺或单药卡铂D　环磷酰胺联合阿霉素　　　E　VP165　下列哪…     

奥先达联合紫杉醇或卡铂联合紫杉醇治疗卵巢上皮癌的多中心随机对照初步研究

目的:比较奥先达联合紫杉醇或卡铂联合紫杉醇治疗卵巢上皮癌的疗效和安全性。方法:2010年8月到2012年4月入组了Ⅱ期以上行满意的肿瘤细胞减灭术的卵巢上皮癌患者182例。术后将患者随机分为奥先达组(92例)和卡铂组(90例),分别采用奥先达或卡铂联合紫杉醇方案治疗。奥先达剂量80mg/m2,或卡铂AUC=5,第2天给药;紫杉醇135mg/m2,第1天给药,21天1个疗程。研究两组患者治疗的近期疗效和药物安全性。结果:奥先达组、卡铂组患者完成的治疗周期数分别为5.02±1.63和5.39±1.30。奥先达组化疗第3、6个周期结束时,CA125下降到正常水平的比率分别为80.00%和86.36%,卡铂组为72.88%和86.00%,两组比较均无统计学差异;治疗后两组患者的KPS、QOL评分均明显改善,但两组间比较无统计学差异。奥先达组恶心呕吐发生率为3.26%,卡铂组为5.56%;奥先达组和卡铂的Ⅲ～Ⅳ度白细胞减少的发生率分别为10.87%和23.33%,两组差异有统计学意义(P<0.05);两组的其他毒性反应发生率无统计学差异(P>0.05)。结论:奥先达联合紫杉醇治疗卵巢上皮癌近期疗效与卡铂方案相似,但其毒副反应较轻,患者耐受性好。     

Devastating effects of chemotherapy: deafness and acute renal failure in a patient with epithelial ovarian cancer

Abstract.   Ozguroglu M, Sari O, Turna H. Devastating effects of chemotherapy: deafness and acute renal failure in a patient with epithelial ovarian cancer. Int J Gynecol Cancer 2006; 16(Suppl. 1): 394–396.
Paclitaxel and platinum combination is the standard chemotherapy regimen for patients with advanced epithelial ovarian cancer. The dose-limiting toxicity effects of this combination are myelosuppression and neuropathy. Herein, we report a case of a 71-year-old female with advanced epithelial ovarian cancer who developed bilateral total loss of hearing and acute renal failure related with paclitaxel- and carboplatin-based chemotherapy. Acute renal failure accompanied by complete loss of hearing in patients treated with carboplatin and paclitaxel combination has not been previously reported. This uncommon adverse effect of carboplatin and paclitaxel combination was discussed, and all the literature in English related with the toxicity of paclitaxel and carboplatin were reviewed.     

Adenosquamous carcinoma of the uterine cervix--adjuvant chemotherapeutic treatment with paclitaxel and carboplatin; a case report

Adenosquamous carcinoma of the uterine cervix is a rare mixture of malignant glandular and squamous epithelial elements. We present a case of a 56-year-old woman with Stage IV cervical carcinoma treated with paclitaxel and carboplatin chemotherapy after cytoreductive surgery. Solitary liver metastases were treated by ultrasound guided percutaneous sclerotherapy with 95% ethanol. For ten months the patient showed an objective response to the treatment with a good quality of life during that time. A year after the first, the second cytoreductive operation was performed and chemotherapy (paclitaxel, carboplatin, and epirubicin) followed. The patient died 20 months after establishing the diagnosis. Paclitaxel in combination with carboplatin as adjuvant chemotherapeutic treatment could be another promising agent for patients with advanced metastatic cervical adenocarcinoma.     

拓扑替康联合顺铂治疗卵巢上皮性癌的临床研究

目的 探讨拓扑替康联合顺铂（TP）治疗卵巢上皮性癌（卵巢癌）的疗效、毒副反应及预后。方法 将手术后经病理检查确诊为Ⅱ～Ⅳ期卵巢癌的94例患者分为3组：（1）TP组：30例,给予顺铂75mg／m^2,第1天;拓扑替康0．75mg·m^-2·d^-1,第1～5天。（2）紫杉醇＋卡铂（TC）组：31例,卡铂剂量按（血浆浓度-时间）曲线下面积（AUC）=5给予,第1天;紫杉醇135mg／m^2,第1天。（3）环磷酰胺＋顺铂（PC）组：33例,给予顺铂75mg／m^2,第1天;环磷酰胺500mg／m^2,第1天。3组患者均以21～28d为1个化疗周期,6～8个疗程后评价疗效,完全缓解（CR）加部分缓解（PR）为有效。比较3组患者的疗效、毒副反应及预后。结果 （1）化疗反应率：TP组CR为8例,PR为13例,有效率为70％（21／30）;TC组CR为10例,PR为14例,有效率为77％（24／31）;PC组CR为5例,PR为9例,有效率为42％（14／33）。TP组有效率与TC组相比,差异无统计学意义（P〉0．05）;与PC组相比,差异则有统计学意义（P〈0．05）。（2）无瘤生存率：中位随访时间25个月,TP、TC、PC组患者1年无瘤生存率分别为67％、71％、42％;2年无瘤生存率分别为57％、64％、39％。各组间1年及2年无瘤生存率分别比较,差异均无统计学意义（P〉0．05）。（3）总生存率：TP、TC、PC组1年总生存率分别为93％、97％、91％;2年总生存率分别为77％、84％、67％。各组间1年及2年总生存率分别比较,差异均无统计学意义（P〉0．05）。（4）毒副反应：发生Ⅲ～Ⅳ度骨髓抑制的患者,TP组为18例（60％）,TC组为8例（26％）,PC组为10例（30％）,TP组分别与TC、PC组比较,差异均有统计学意义（P〈0．05）;其他毒副反应,3组间比较,差异均无统计学意义（P〉0．05）。结论 作为卵巢癌的一线化疗方案,TP方案虽不能取代TC方案,但可作为临床治疗的一种选择。     

Paclitaxel and carboplatin combination chemotherapy in a hemodialysis patient with advanced ovarian cancer.

BACKGROUND: There are few reports on the pharmacokinetics of paclitaxel combined with carboplatin or on the dose schedule of carboplatin in combination use during hemodialysis in patients with ovarian cancer. CASE: A 40-year-old woman with chronic renal failure on hemodialysis who had FIGO stage III ovarian cancer was treated with debulking surgery and carboplatin/paclitaxel combination chemotherapy. Paclitaxal was administered at 150 mg/m(2) as a 3-h intravenous infusion followed by a 30-min infusion of carboplatin on a nondialysis day. The carboplatin dose was chosen to produce a target area under the concentration/time curve (AUC) of 5.0 microg-min/ml according to the Calvert formula. The pharmacokinetic study showed that the AUCs of free platinum and paclitaxel were 4.43 microg-min/ml and 15.9 microg-h/ml, respectively. Dosing of carboplatin based on the AUC produced an acceptable degree of thrombocytopenia and neutropenia. After the completion of five cycles of the combination chemotherapy, the tumor showed complete response, and the patient remained disease free for 8 months. CONCLUSION: Paclitaxel and carboplatin combination chemotherapy can be given to patients undergoing hemodialysis, with dialysis performed 16 h after the administration and with a dose adjustment of carboplatin to reach a target AUC. In these conditions, tumor response can be obtained.     

TP、PTP及CAP化疗方案治疗上皮性卵巢癌的比较

目的探讨进口紫杉醇(泰素)与铂类联合化疗方案(TP)、国产紫杉醇(紫素)与铂类联合化疗方案(PIP)治疗上皮性卵巢癌的疗效及毒性,并与环磷酰氨、阿霉素及铂类方案(CAP)进行比较。方法对1993年12月至1999年4月采用TP、PIP及CAP化疗方案治疗的卵巢癌患者进行回顾性分析。泰素组(TP组)22例、紫素组(PTP组)18例,CAP组38例。结果泰素组有效率为55.6％,紫素组有效率为71.4％;紫杉醇作为一线用药有效率为88.9％,CAP作为一线用药有效率为55.9％。紫杉醇的毒副作用有造血功能抑制、消化道症状、脱发、外周神经炎、肌肉、关节疼痛,其中2例出现Ⅲ度外周神经损伤。结论TP或PTP作为一线用药疗效高于CAP,国产及进口紫杉醇在疗效及副作用上无明显差异。     

Prognostic impact of adding bevacizumab to carboplatin and paclitaxel for recurrent,persistent, or metastatic cervical cancer

ObjectiveRecent randomized phase III trial has shown significant benefit in overall survival (OS) for patients with advanced cervical cancer by adding bevacizumab to conventional chemotherapy. The aim of this study was to evaluate the prognostic impact for Japanese recurrent, persistent, or metastatic cervical cancer patients where bevacizumab was added to paclitaxel plus carboplatin.Materials and methodsA retrospective analysis was performed on 90 patients with recurrent, persistent, or metastatic cervical cancer mainly treated by paclitaxel plus carboplatin between 2005 and 2019 at our hospital. Data for the following clinicopathological variables were analyzed: (1) bevacizumab use; (2) histology; (3) disease presentation; (4) performance status; (5) prior chemotherapy containing platinum agent; (6) pelvic disease; (7) prior pelvic radiotherapy; (8) location of target lesions. Survival analysis was performed using Kaplan–Meier curves, log-rank tests, Wilcoxon tests, and Cox proportional hazards models combined with propensity score matching.ResultsAdding bevacizumab to paclitaxel plus carboplatin showed significantly increased complete response to compared with that of non-users. In a Cox regression hazard model, bevacizumab use tended to show better OS though without statistically significance. After propensity score matching, adding bevacizumab to paclitaxel plus carboplatin showed a significant better OS by univariate analysis using Wilcoxon test, not by log-rank test.ConclusionAdding bevacizumab to paclitaxel plus carboplatin showed a limited prognostic impact for recurrent, persistent or advanced cervical cancer patients in the real world. Further effective second-line treatments are needed to prolong OS of patients with recurrent, persistent or advanced cervical cancer.     

Second-line with paclitaxel and carboplatin for recurrent disease following first paclitaxel and platinum compounds in ovarian carcinoma

OBJECTIVE: The combination of paclitaxel and platinum compounds is considered the best first-line regimen for advanced ovarian carcinoma. The purpose of this study was to evaluate a paclitaxel and carboplatin combination in pretreated patients who recurred within 24 months after a complete clinical response with the same regimen used as first-line chemotherapy. METHODS: 18 patients were included in this study. Second-line chemotherapy consisted of paclitaxel, 175 mg/m2 as a 3-hour infusion, and carboplatin AUC 6 every 21 days. RESULTS: Among 15 evaluable patients, eight (53%) complete and five (34%) partial responses were observed, while two (13%) patients had stable disease (SD). The response rate was 67% among patients with measurable disease and 52% for evaluable disease. The median progression-free interval after second-line chemotherapy was 8.3 months. The median progression-free interval for patients with measurable disease was 8.6 months and for evaluable disease it was 7.9 months. Seven (46%) of 15 patients have developed recurrence after second-line chemotherapy with paclitaxel and carboplatin with a median time to recurrence of 9.8 months. CONCLUSION: Paclitaxel 175 mg/m2 and carboplatin AUC 6 as second-line chemotherapy in this sensitive population is effective in terms of response rate and progression-free interval.     

Paclitaxel/carboplatin versus cyclophosphamide/carboplatin in peritoneal carcinomatosis of the ovary

The preceding platinum-based combination chemotherapy could possibly reduce tumor masses, allowing for adequate surgical debulking in advanced ovarian cancer. In this study, a total of 18 patients with peritoneal carcinomatosis of the ovary were evaluated between 1996 and 2003. All patients underwent open biopsy for the histopathologic confirmation of ovarian tumor. Forty-one percent of the patients (8/18) were administered six cycles of carboplatin/cyclophosphamide (CP) and the rest were administered six cycles of paclitaxel/carboplatin (TP) as a neoadjuvant chemotherapy (10/18). After six cycles of chemotherapy metastases to the peritoneum, Douglas' pouch, diaphragm, and liver serosa were higher in the CP group than the TP group (p < 0.05). All patients also had a better performance status (WHO performance status 0 or 1), but no statistical difference was observed between either group (p > 0.05). Optimal debulking surgery rates were significantly higher in the TP group (p < 0.05). In conclusion, we suggest paclitaxel/carboplatin in peritoneal carcinomatosis of the ovary as a neoadjuvant chemotherapy. However, large prospective, randomized studies should be performed in patients with peritoneal carcinomatosis of the ovary.