Study of Pemetrexed-based Chemotherapy for Patients with Locally Advanced or Metastatic Cancers

Purpose: This study was conducted to observe the efficacy and safety of pemetrexed based chemotherapyin treating patients with locally advanced or metastatic cancers as first-line, second-line or third-line therapy.Materials and Methods: From May 2011 to January 2015, we recruited 29 patients with advanced breast cancer,19 patients with advanced ovary cancer, 17 patients with advanced esophageal cancer,5 patients with advancedgallbladder cancer,5 patients with advanced cervical cancer and 1 patient with advanced tongue cancer inJiangsu Cancer Hospital and Research Institute.All of them were pathologically confirmed and treated withpemetrexed based chemotherapy. After two cycles of treatment,efficacy and safety can be evaluated. Results:For pemetrexed based regimens,including 76 patients with 6 kinds of advanced cancer were considered eligiblefor inclusion. Complete remission represents CR, partial remission represents PR, stable disease represents SD,progressive disease represents PD. Among 29 patients with advanced breast cancer, 4 patients chose pemetrexedbased regimens as second-line treatment,1 of them was PR,the other 3 got SD. The last 25 patients made useof this chemotherapy as third-line treatment, except one patient could not be assessed, 2 of them got PR,6 ofthem got SD,the remaining 16 of them finally were PD.19 patients with advanced ovary cancer,5 patients usedthis regimens as second-line treatment, 3 of them got PD,the remaining patients got SD, respectively. The last14 patients made use of pemetrexed based regimens as third-line treatment,. RR (CR+PR) was 28.5%. Among17 patients with advanced esophageal cancer, 2 patients made use of pemetrexed based regimens as first-linetreatment,both of them got PR.4 of them used this chemotherapy as second-line regimen, except 2 patients couldnot be assessed,the remaining 2 was PD at last. The last 11 patients was third-line users, RR (CR+PR) was 18.2%.Among 5 patients with advanced gallbladder cancer, pemetrexed based regimens was used in 1 patient as firstlinetreatment and 1 patient as second-line treatment. The curative effect was SD and PD, respectively. 3 patientsaccepted pemetrexed based regimens as third-line treatment, 2 of them got PD as results and another was SD.Among 5 patients with advanced cervical cancer, just 1 patient adopted pemetrexed based regimens as first-linetreatment, whose curative effect was PR.2 patients chose this chemotherapy regimens as second-line treatment.Both of them got PD as their consequence. The last 2 patients made use of the regimens as third-line treatment,the effect of them was PD and SD, respectively. The one who with advanced tongue cancer, pemetrexed basedregimens was used as second-line treatment, and the consequence was PD. About 71.1% patients experienced bonemarrow suppression. Among them, 5 patients reached 4 grade. Other toxicity of pemetrexed were neurotoxicity,fatigue, diarrhea, dysphagia and vomiting. No treatment related death occurred with pemetrexed-based treatment.Conclusions: Pemetrexed based chemotherapy has considerable effect in patients with advanced cancers suchas breast cancer,esophageal cancer and ovary cancer. More randomly clinical trials are needed to verify theresults.     

培美曲塞用于转移性或晚期宫颈癌患者三线及以上治疗的疗效及安全性

目的:观察培美曲塞用于转移性或晚期宫颈癌三线及以上治疗的近期疗效及安全性。方法:收集2016年1月至2016年12月在空军军医大学西京医院肿瘤科住院的转移性或晚期宫颈鳞癌患者,接受三线及以上治疗者共11例,选择培美曲塞为基础的化疗方案。每2周期进行疗效及安全性评估,主要指标包括客观缓解率（objective response rate,ORR）、疾病控制率（disease control rate,DCR）、无进展生存期（progression-free survival,PFS）和不良反应。结果:11例中10例患者为三线治疗,1例患者为四线治疗。疗效评估:部分缓解（partial remission,PR）4例（36%）,稳定（stable disease,SD）5例（45%）,病情进展（progressive disease,PD）2例（18%）。ORR为36%（4例）,DCR为82%（9例）,中位PFS 6.3个月（3.0~10.6个月）。安全性评估:3级及以上不良反应包括中性粒细胞减少（3例,27%）、血小板减少（2例,18%）、总胆红素升高（1例,9%）、间接胆红素升高（1例,9%）。结论:培美曲塞用于转移性或晚期宫颈癌三线及以上化疗具有良好的疗效和安全性。     

Advances in the treatment of second-line non-small-cell lung cancer

Treatment with third-generation chemotherapy agents improves survival and quality of life of patients with non-small-cell lung cancer (NSCLC). Despite these favorable outcomes, most patients receiving front-line therapy experience disease progression. The availability of many new novel agents with activity in NSCLC has prompted investigators to explore second-line chemotherapy options. For many years, docetaxel was the only approved agent for the second-line treatment of NSCLC. More recently, the multi-targeted antifolate pemetrexed has demonstrated activity in patients previously treated with chemotherapy with locally advanced or metastatic NSCLC. The findings of a phase III trial comparing pemetrexed to docetaxel led to the regulatory approval of pemetrexed as monotherapy for the second-line treatment of NSCLC. Several other novel therapies, including molecular targeting agents such as erlotinib, are under development in clinical trials in patients with NSCLC. One of these trials has subsequently led to the approval of erlotinib as second- or third-line therapy in advanced NSCLC.     

雷替曲塞联合奥沙利铂二线治疗晚期胃癌的疗效及安全性

目的:观察雷替曲塞联合奥沙利铂二线治疗晚期胃癌的疗效及安全性。方法:选取2010年1月至2015年10月化疗失败后的30 例晚期胃癌患者，随机分成2组（各15例），一组予雷替曲塞联合奥沙利铂治疗（观察组），即雷替曲塞3 mg/m2，d1；奥沙利铂85 mg/m2，d1。另一组予卡培他滨联合奥沙利铂治疗（对照组），即卡培他滨 1 000 mg/m2，bid po，d1~14，奥沙利铂 130 mg/m2，d1。以上两组方案21 d 为1个周期，每2 个周期评价疗效。结果:观察组 vs 对照组疾病控制率（DCR）73.33% vs 66.67%（P=0.69），总有效率（RR）20% vs 13.33%（P=0.62），中位无进展生存时间（mPFS）3.91 个月 vs 3.72个月（P=0.32），中位生存时间（mOS）8.07个月 vs 6.48个月（P=0.64）。恶心、呕吐发生率、白细胞减少、血小板减少、周围神经毒性、口腔黏膜炎、腹泻、转氨酶升高及心脏毒性，两组比较无差异。结论:对于晚期胃癌的二线化疗，雷替曲塞联合奥沙利铂疗效不劣于其他方案，且毒副反应可耐受，可作为晚期胃癌的一种治疗选择。     

甲磺酸阿帕替尼治疗晚期胃癌的疗效及安全性分析

目的:观察甲磺酸阿帕替尼治疗晚期胃癌的临床疗效和毒副反应。方法:回顾性分析2016年01月至2018年01月在我院接受二线或以上的单纯化疗或甲磺酸阿帕替尼单独治疗的晚期胃癌患者,单纯化疗组56例作为对照组,甲磺酸阿帕替尼组34例。收集两组患者的一般临床资料,分析其临床近期疗效、无进展生存期和毒副反应。结果:对照组和甲磺酸阿帕替尼组患者在性别、年龄、ECOG评分、肿瘤位置、分化程度和是否手术治疗方面差异无统计学意义（P＜0.05）。对照组患者近期疗效:达到CR、PR和SD的患者分别为0例、5例和10例,甲磺酸阿帕替尼组患者近期疗效:达到CR、PR和SD的患者分别为1例、7例和9例。对照组ORR（8.9%）与甲磺酸阿帕替尼组ORR（23.5%）相比,差异无统计学意义（P=0.056）;对照组DCR（26.8%）显著低于甲磺酸阿帕替尼组DCR（50.0%）（P=0.026）。对照组患者中位无进展生存期显著低于甲磺酸阿帕替尼组（P=0.020）。对照组出现乏力和骨髓抑制的比例显著高于甲磺酸阿帕替尼组（P=0.009,P=0.000）。结论:甲磺酸阿帕替尼二线治疗晚期胃癌与对照组相比近期疗效较好,无进展生存期较长,毒副反应较少,具有较好的疗效和安全性。     

培美曲塞联合奥沙利铂方案和紫杉醇脂质体联合替吉奥方案二线治疗晚期胃癌的临床研究

目的:观察培美曲塞联合奥沙利铂方案和紫杉醇脂质体联合替吉奥方案在晚期胃癌二线治疗中的近期疗效和安全性。方法:经病理组织学或细胞学确诊的60例晚期胃癌患者随机分为两组,A组28例(培美曲塞500mg/m2 iv d1,奥沙利铂85mg/m2 iv d1),B组32例(紫杉醇脂质体135mg/m2 iv d1,替吉奥40mg/m2 bid d1~14),21天为1周期,2周期后评价疗效及不良反应发生情况。结果:60例患者均可评价疗效,Ａ组和Ｂ组有效率分别是14.29％和18.75％(P＞0.05),疾病控制率分别是46.43％和56.25％(P＞0.05),中位TTP分别为5.8个月和6.2个月(P＞0.05)。化疗不良反应总体上均可耐受,A组乏力、皮疹和脱发发生率为78.57%、35.71%和25.0%(P＜0.05),B组白细胞减少、血小板减少发生率分别为68.75%和62.50%(P＜0.05)。结论:培美曲塞联合奥沙利铂方案和紫杉醇脂质体联合替吉奥方案二线治疗晚期胃癌的近期疗效相当,不良反应可耐受,可以作为晚期胃癌的有效姑息治疗方案。     

Efficacy of third-line pemetrexed monotherapy versus pemetrexed combination with bevacizumab in patients with advanced EGFR mutation-positive lung adenocarcinoma

Objective

The purposes of this study were to observe the effects of different treatment strategies, including third-line pemetrexed alone versus its combination with bevacizumab, in patients with advanced epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma, and to analyze the effects of the different medication orders of first- and second-line drugs on third-line efficacy.

Patients and methods

One hundred and sixteen cases of patients with EGFR-positive lung adenocarcinoma who had received third-line pemetrexed alone or in combination with bevacizumab between March 2010 and March 2014 at Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. Additionally, all the patients were treated with first-line gemcitabine and cisplatin (GP) chemotherapy and second-line EGFR tyrosine kinase inhibitor (TKI) or with first-line EGFR-TKI and second-line GP chemotherapy.

Results

The median survival of 61 cases with third-line pemetrexed monotherapy was 36.22 months, the median survival time of 55 cases with third-line pemetrexed plus bevacizumab was 38.76 months, and there was a significant difference in survival time between the two groups (P=0.04). Subgroup analysis revealed that among the 55 cases with third-line bevacizumab plus pemetrexed treatment, the median survival of 29 patients with first-line GP and second-line EGFR-TKI was 42.80 months, while the median survival of 26 patients with first-line EGFR-TKI and second-line GP was only 34.46 months; additionally, there was a significant difference in the survival time between the two subgroups (P=0.001). Among 61 cases with third-line pemetrexed treatment, the median survival of 34 patients with first-line GP and second-line EGFR-TKI was 38.72 months, while the median survival of 27 patients with first-line EGFR-TKI and second-line GP was only 32.94 months; the survival time of the two subgroups was significantly different (P=0.001).

Conclusions

Regardless of the order of the first- and second-line chemotherapy and TKI therapy, the pemetrexed plus bevacizumab regimen was superior to the pemetrexed monotherapy as the third-line therapy in patients with advanced EGFR-positive lung adenocarcinoma. However, this strategy is worth further investigation in prospective studies.     

选择性动脉插管灌注化疗栓塞治疗中晚期胃癌的疗效观察

目的　评价选择性动脉插管灌注化疗栓塞对中晚期胃癌的临床疗效及价值。方法　对 49例不能手术或手术后复发转移的中晚期胃癌患者行胃动脉内灌注化疗和栓塞化疗合计 1 2 7次。化疗方案FAM(5 氟脲嘧啶、丝裂霉素、阿霉素或表阿霉素 )或FPM(5 氟脲嘧啶、丝裂霉素、顺铂或卡铂 ) ,栓塞剂选用超液化碘油或超液化碘油加明胶海绵。近期疗效以上消化道造影、CT、B超、胃镜检查结果作为评价标准。结果　肿瘤原发灶有效率 54 .5 % ,局部淋巴结有效率 46 .4 % ,远处转移有效率 32 .1 %。本组 1、3、5年生存率分别为 51 .1 % ,1 3 .3 % ,4.4 %。全组未发生严重副作用及并发症。结论　选择性动脉插管灌注化疗栓塞对于中晚期胃癌是一种有效的治疗方法 ,值得临床上进一步研究     

Third-line therapy for advanced non-small-cell lung cancer patients: feasible drugs for feasible patients

The proven benefit of third-line treatment in advanced non-small cell lung cancer (NSCLC) is still unclear. We retrospectively evaluated the outcome of advanced NSCLC patients treated with third-line therapies in our institution, especially focusing on efficacy and toxicity between mono-therapy and doublets chemotherapy, aiming to assess the value of third-line treatment and evaluate the efficacy of different regimens in third-line treatment. Three hundred and seventeen patients received a second-line treatment among 620 advanced NSCLC after failure of first-line chemotherapy. One hundred and twenty-six patients from this group were offered third-line or further-line treatments. Survival analysis was conducted based on Kaplan-Meier method, and Chi-square was used to compare data between second-line and third-line group. There were significant differences in overall survival between second-line and third-line treatments (17.70 months vs. 24.03 months, P < 0.0001). Twenty-four patients received single chemotherapy, epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) were used to treat thirty-three patients and sixty-nine patients received doublet chemotherapy in third-line treatment. The progression-free survival (PFS) after third-line therapy was 2.37 months in all patients and 2.30 months, 2.80 months, 2.97 months, in the doublet chemotherapy, single-agent chemotherapy, and EGFR-TKIs arms, respectively (P = 0.033). Cancer-related symptom relief improvement was confirmed in 78.9% patients (60/78). Forty-eight patients had no symptoms as confirmed by imaging examination. Patients with advanced NSCLC could get benefits from third-line treatments. Those patients could obtain a moderate progression-free survival and conspicuous improvement in the cancer-related symptom. Mono-therapy was recommended in third-line treatment.     

培美曲塞联合顺铂一线治疗晚期非鳞状非小细胞肺癌的疗效观察

目的观察培美曲塞联合顺铂一线治疗晚期非鳞状非小细胞肺癌的疗效及不良反应。方法36例经组织学或细胞学确诊为非鳞状非小细胞肺癌而且未经化疗的晚期肺癌患者纳入本研究。化疗方案为：培美曲塞 500 mg/m2,静脉滴注,第一天;顺铂75 mg/m2,静脉滴注,第一天或分为第一至第三天。每21天为一周期,至少接受2周期化疗,但最多不超过6周期。所有患者进行疗效及不良反应评估。结果36例患者共化疗151周期,平均化疗周期数4.1。其中完全缓解（CR）0例,部分缓解（PR）17例,疾病稳定（SD）9例,疾病进展（PD）10例,有效率（CR+PR）为47.2%,疾病控制率（CR+PR+SD）为72.2%。中位无疾病进展生存时间为6.6月。主要不良反应为Ⅰ～Ⅱ度骨髓抑制,没有治疗相关性死亡。结论培美曲塞联合顺铂一线治疗晚期非鳞状非小细胞肺癌疗效较好而且不良反应轻。     

Phase II Study on Safety and Efficacy of Yadanzi® (Javanica oilemulsion injection) Combined with Chemotherapy for Patientswith Gastric Cancer

Objective: To investigate the efficacy and safety of Yadanzi® (Javanica oil emulsion injection) combined withchemotherapy for treatment of patients with advanced gastric cancer. Methods: From January 2011 to December2012, we recruited 75 patients with advanced gastric cancer, who received javanica oil emulsion injectiontogether with chemotherapy. After two cycles of treatment, efficacy and safety of the combined therapies wereevaluated. Results: Overall response rate of 75 patients after treatment was 85.3% (CR+PR+SD). Treatmentrelated side effects were recorded. No treatment related death occurred. Conclusions: Javanica oil emulsioninjection combined with chemotherapy could be considered as a safe and effective regimen in treating patientswith advanced gastric cancer. Further randomized clinical trials should be conducted to confirm whether theaddition of Yadanzi® to chemotheraphy could be associated with reduced toxicity, enhanced tolerability andimproved quality of life for patients with advanced gastric cancer.     

顺铂腹腔热灌注联合全身化疗治疗进展期胃肠道癌

目的 :观察顺铂腹腔热灌注 (Intraperitonealperfusionhyperthermicchemotherapy ,CHIP)联合全身化疗治疗进展期胃肠道癌的疗效及其不良反应。方法 :5 1例进展期胃肠道癌患者分成两组 :单纯化疗组 2 6例 ,其中胃癌 11例 ,采用ELF方案 ;大肠癌 15例 ,采用LF方案。CHIP联合化疗组 2 5例 ,其中胃癌 14例 ,大肠癌 11例 ,在ELF或LF方案基础上加用顺铂腹腔热灌注。结果 :单纯化疗组CR 1例 ,PR 6例 ,NC 10例 ,PD 9例 ,有效率 2 6 9% (7/ 2 6 ) ;CHIP联合化疗组CR 1例 ,PR 13例 ,NC 6例 ,PD 5例 ,有效率 5 6 0 % (14 / 2 5 ) ,高于单纯化疗组 (P <0 0 5 )。治疗后主要不良反应为消化系统毒性。结论 :顺铂腹腔热灌注联合全身化疗治疗进展期胃肠道癌较单纯化疗近期疗效显著 ,值得继续研究。     

Second-Line Treatment of Advanced Non-small Cell Lung Cancer

After failure of first-line chemotherapy for advanced non-small cell lung cancer, many patients remain candidates to receive further antitumor treatment. To guide clinical management of these patients and to suggest priorities for clinical research, an International Panel of Experts met in Naples (Italy) in April 2007. Results and evidence-based conclusions are presented in this article. Single-agent chemotherapy with docetaxel or pemetrexed is the recommended option for unselected patients with performance status 0 to 2 who are candidates for second-line chemotherapy for advanced non-small cell lung cancer. Docetaxel has demonstrated superiority compared with best supportive care. Pemetrexed has been shown to be noninferior to docetaxel, with a more favorable toxicity profile. Erlotinib is effective in pretreated patients, and can be given second-line in patients not suitable or intolerant to chemotherapy, and in all patients as third-line treatment after failure of second-line chemotherapy. Gefitinib failed to show superiority to placebo as second- or third-line treatment, but it has been shown to be noninferior to docetaxel. In selected patients such as lifetime nonsmokers or those of East-Asian ethnicity, erlotinib, or gefitinib (where licensed) may be considered as second-line treatment even if they are fit for chemotherapy. Best supportive care in addition to active treatment remains important for all patients, but may be the exclusive option for patients unsuitable for more aggressive therapy. Further research is mandatory, to find better treatments, and to identify clinical and molecular predictive markers of efficacy, both for chemotherapy and for novel biologic agents.     

A case responding to weekly paclitaxel therapy as second-line chemotherapy for gastric cancer previously treated with TS-1

A 58-year-old male patient with the recurrence of para-aortic lymphnodes after TS-1 treatment was treated by a weekly infusion of paclitaxel as second-line chemotherapy. Paclitaxel was administered at a weekly dose of 70 mg/m2/day for three weeks followed by a one week interval. After 2 courses, the tumor was reduced, and the reduction was judged as PR. Moreover, after 5 courses, the tumor was more remarkably reduced and the reduction was judged as CR. The grade 2 leukopenia, neutropenia, and grade 1 alopecia were observed as adverse events. Recently, we treated 11 patients of advanced or recurrent gastric cancers with measurable lesions, using the weekly paclitaxel therapy after TS-1 treatment. The response rate was 36.4%. The median duration of PR was 130 days. Therefore, a weekly paclitaxel regimen was considered to be one of the promising regimens for advanced or recurrent gastric cancer as the second-line chemotherapy after TS-1 treatment.     

培美曲塞单药与培美曲塞联合顺铂二线治疗晚期胃癌的疗效对比

目的:观察培美曲塞联合顺铂作为二线方案治疗晚期胃癌与单纯使用培美曲塞的临床疗效。方法:选取晚期胃癌患者193例,随机分为两组。对照组96例,单纯使用培美曲塞治疗;观察组97例,使用培美曲塞联合顺铂进行治疗。于治疗3个疗程后对两组患者治疗效果进行评价,治疗6个月后对患者生存率进行随访。记录两组患者治疗期间不良反应发生情况。结果:经过3个疗程治疗,对照组患者PR、SD、PD以及RR分别为39.58%、28.13%、32.29%和39.58%;观察组分别为44.33%、27.84%、27.84%和44.33%,两组比较差异没有统计学意义。随访半年,对照组患者生存率为43.75%,观察组为72.16%,明显高于对照组,两组比较差异有统计学意义（P<0.05）。对照组患者血液学毒性、消化道反应、肝功能异常、肾功能异常、脱发以及神经毒性的发生率分别为63.54%、56.25%、12.50%、12.50%、67.71%和60.42%,观察组分别为68.04%、55.67%、15.46%、12.37%、68.04%和59.79%,两组相比无统计学意义。经过治疗,观察组患者日常生活、社会生活、抑郁、焦虑以及总分方面均较对照组明显高,两组比较差异有统计学意义（P<0.05）。结论:与培美曲塞单药治疗相比,培美曲塞联合顺铂二线治疗晚期胃癌可以有效延长患者的生存期,且不会增加患者的不良反应,是一种有效而安全的化疗方案。     

OXA-LV/5-FU方案灌注化疗栓塞治疗晚期胃癌的疗效观察

目的 评价奥沙利铂（草酸铂）联合5-氟尿嘧啶和亚叶酸钙（OXA-LV/5-FU）方案灌注化疗栓塞治疗晚期胃癌的疗效。方法 对42例不能手术的晚期胃癌患者行胃动脉内灌注化疗栓塞治疗。化疗方案为奥沙利铂（OXA）、5-氟尿嘧啶（5-Fu）、亚叶酸钙（LV）,栓塞剂选用碘化油或碘化油加明胶海绵。每次治疗间隔1个半月,每例共行3次。近期疗效按WHO推荐的实体瘤疗效评价标准。结果 42例中完全缓解（CR）4例（9.5%）,部分缓解（PR）30例（71.5%）,稳定（SD）3例（7.1%）,恶化（PD）5例（11.9%）,总有效率（ORR）为80.9%,不良反应：Ⅲ～Ⅳ度者8例,其中恶心呕吐6例（14.3%）,白细胞减少2例（4.8%）。结论 采用OXA-LV-5FU方案胃动脉插管灌注化疗栓塞是治疗晚期胃癌的有效方法 ,不良反应轻而且安全。     

Pemetrexed is Mildly Active with Good Tolerability in Treating Patients with Gastric Cancer

Background: This systemic analysis was conducted to evaluate the efficacy and safety of pemetrexed based chemotherapy in treating patients with metastatic gastric cancer (MGC) as a salvage chemotherapy. Methods: Clinical studies evaluating the efficacy and safety of pemetrexed based regimens on response and safety for patients with gastric cancer were identified by using a predefined search strategy. Pooled response rates (RRs) of treatment were calculated. Results: In pemetrexed based regimens, 4 clinical studies including 171 patientswith advanced gastric cancer were considered eligible for inclusion. Systemic analysis suggested that, in all patients, pooled RR was 25.1% (43/171) in pemetrexed based regimens. Major adverse effects were neutropenia, anorexia, fatigue, and anemia. No treatment related death occurred in pemetrexed based treatment. Conclusion: This systemic analysis suggests that pemetrexed based regimens are associated with mild activity with good tolerability in treating patients with MGC.     

晚期骨肉瘤的二线化疗疗效观察

目的:观察培美曲塞联合顺铂治疗晚期复发转移性骨肉瘤的有效性和安全性。方法:收集 2009年 1 月至 2014年 12 月期间我们观察的30例一线化疗失败的出现转移的晚期骨肉瘤患者,行培美曲塞500 mg/m2,静脉滴注d1;顺铂75~100 mg/m2静脉滴注d1~d3,21天为1周期;化疗2个周期后按照RECIST标准评价客观疗效;如达到PR及SD的患者继续行原方案化疗2周期。结果:30例患者均完成化疗,可评价疗效。完全缓解0例(CR）,部分缓解(PR）5例,疾病稳定(SD)11例,疾病进展(PD)14例;有效率(RR)为16.7%,病控制率(DCR)为53.3%,中位无进展生存时间为8.0个月,中位生存时间为15.8个月,主要不良反应为限制性骨髓抑制,无患者出现肝肾功能不全和过敏反应,2例出现4级中性粒细胞及血小板减少。结论:培美曲塞联合顺铂方案二线治疗晚期复发转移性骨肉瘤疗效肯定,毒副反应可以接受。     

培美曲塞联合顺铂二线治疗进展期胃癌的疗效分析

目的 观察培美曲塞联合顺铂方案二线治疗进展期胃癌的临床疗效、不良反应及HER-2基因表达情况对其疗效的影响.方法 回顾性分析44例采用二线方案化疗的晚期胃癌患者的临床资料:培美曲塞500 mg/m2dl、顺铂75 mg/m2 dl,每21天重复1次,≥2周期.分析HER-2表达与其近期疗效、无进展生存时间(PFS)和总生存时间(OS)的关系.结果 全组共接受化疗146周期(中位4周期),其中完全缓解0例,部分缓解4例(9.1％),病情稳定22例(50.0％),病情进展18例(40.9％),总有效率(ORR)为10.0％,疾病控制率(DCR)为59.0％.中位PFS为3.6月,中位OS为7.4月.HER-2阳性与阴性表达患者的近期疗效间差异无统计学意义(P＞0.05).不良反应中最常见的为血液学毒性,Ⅲ～Ⅳ级血红蛋白减少、中性粒细胞减少、血小板减少发生率分别为11.4％、20.5％、2.3％;非血液学毒性反应较轻,Ⅰ～Ⅱ级恶心、呕吐发生率为52.3％,Ⅰ～Ⅱ级脱发、皮疹发生率为43.2％.结论 培美曲塞联合顺铂治疗晚期胃癌有明确疗效,且不良反应较小,患者可耐受.HER-2表达情况对其近期疗效无确切影响.     

Second-line chemotherapy for patients with advanced gastric cancer

The first choice for treating patients with metastatic gastric cancer is chemotherapy, and combination therapy with fluorouracil, platinum, and trastuzumab has been established as the standard first-line chemotherapy. For further improvement of treatment outcomes, it is important to develop second- and third-line chemotherapy. In the first decade of this century, irinotecan and taxanes, cytotoxic agents, and various molecular targeted agents began to be developed as second-line therapy. Treatment with paclitaxcel weekly in combination with ramucirumab targeting vascular endothelial growth factor receptor 2 has become the first choice for second-line therapy. Immune checkpoint inhibitors are now being developed, and the current treatment strategies for advanced gastric cancer may undergo major changes in the future. This review summarizes the transitions and future prospects of clinical developments for second-line therapy in patients with advanced gastric cancer.