卡培他滨联合奥沙利铂治疗14例晚期结直肠癌

对于晚期、复发转移的结直肠癌患者需要采取以化疗为主的综合治疗 ,我科于 2 0 0 1年 11月～ 2 0 0 2年 11月应用卡培他滨 (希罗达 )与奥沙利铂治疗晚期结直肠癌 14例 ,取得较好疗效。材料和方法一　研究对象　 2 0 0 1年 11月～ 2 0 0 2年 11月收治的晚期结直肠癌患者 14例。其中男 11例 ,女 3例 ;年龄 33～ 78岁 ,中位年龄 6 2岁 ;KPS积分均大于 6 0 ,预计生存期大于 3个月 ;结肠癌 4例 ,直肠癌 10例 ;经过手术治疗者 10例 ,病理确诊管状腺癌 /腺癌 ;未经化疗的初治患者 12例 ,有化疗史的复治患者 2例 ;肺转移 4例 ,肝转移 6例 ,腹腔转…     

吉西他滨联合卡培他滨治疗紫杉类化疗失败的晚期乳腺癌的临床观察

目的探讨吉西他滨联合卡培他滨治疗紫杉类治疗失败的晚期乳腺癌的临床疗效及不良反应。方法对2008年3月至2010年2月住院治疗的69例紫衫类及葸环类治疗失败的晚期乳腺癌患者给予吉西他滨（1000mg／m2）和卡培他滨（1500mg／m2）治疗，3周为1个疗程，至少经过2个疗程的治疗。结果完全缓解3例（4．3％），部分缓解27例（39．1％），稳定22例（31．9％），进展17例（24．6％），总有效率为43．5％，临床获益率为75．4％，中位无进展生存时间为8．2个月，中位生存时间为13．4个月。骨转移患者总有效率为100％，明显高于多发转移、肺部转移和肝脏转移等患者，差异有统计学意义（P〈0．05）。绝经前患者临床获益率明显高于绝经后患者，两组比较差异有统计学意义（P〈0．05）。不良反应以手足综合征和血小板减少为主，均为可逆性，无治疗相关死亡发生。结论吉西他滨联合卡培他滨治疗紫杉类化疗失败的晚期乳腺癌临床效果显著，对于骨转移患者和绝经前患者的治疗效果更佳。     

奥沙利铂联合吉西他滨治疗晚期胆道系统肿瘤的临床观察

目的 观察奥沙利铂联合吉西他滨治疗晚期胆道系统肿瘤的疗效及不良反应。方法 收集2008年1月至2011年3月均经影像和病理组织学确诊的晚期胆道系统肿瘤38例,具体用药方案：奥沙利铂85mg/m²静滴2h,d₁;吉西他滨835 mg/m2静滴30min,d_¹、d₈,21天为1周期。化疗2个周期评价疗效,并记录不良反应。结果 38例均可评价疗效,获CR 1例,PR 7例,有效率（RR）为21.1%(8/38)。主要不良反应包括骨髓抑制、外周神经毒性及恶心呕吐,均未出现重度不良反应。结论 奥沙利铂联合吉西他滨治疗晚期胆道系统肿瘤患者的近期疗效较好,不良反应可以耐受,值得深入研究。     

如何优化吉西他滨在晚期胆系肿瘤中的应用

胆系肿瘤（BTC）主要包括胆囊癌、肝内胆管癌和肝外胆管癌,其中前两种近年来发病率不断攀升,仅有约10％的患者有根治性切除的机会。对于晚期胆系肿瘤,吉西他滨联合顺铂是目前一线治疗的“金标准”,但越来越多的临床实践发现以吉西他滨为主的其他联合方式或许疗效更优。如何优化吉西他滨的疗效已经成为胆系肿瘤一线治疗的热点和焦点,本文拟对该领域作一综述。     

吉西他滨联合卡培他滨治疗胰腺肿瘤1例

胰腺癌是消化系统常见的恶性肿瘤之一,因其病程短,进展快,治疗效果差,5年生存率仅为5%～10%。绝大多数胰腺癌在诊断时已是晚期或已有远处转移,因此,姑息性的全身化疗有助于可以改善患者的生活质量并延长生存时间。现将我科收治的1例应用吉西他滨联合卡培他滨治疗老年胰腺癌患者的诊疗情况报告如下。     

吉西他滨联合奥沙利铂治疗晚期复发上皮性卵巢癌

卵巢癌的发病率上升，死亡率居妇科恶性肿瘤之首位，诊断时70％病例已属中晚期，主要治疗方法为肿瘤细胞减灭术后给予化学治疗。尽管含铂类为主的方案治疗卵巢癌取得一定近期疗效，但大多数患者最终仍复发。针对晚期复发性卵巢癌，经过正确的手术、放疗、化疗等综合手段治疗可达到姑息性治疗的目的，提高患者的生活质量，其中化疗方案的选择是整个治疗中一个重要的环节。近年来，紫杉醇已被应用于卵巢癌的治疗，在国外紫杉醇加铂类方案已成为一线方案。但在我国由于经济原因大部分地区尚不能普及。     

国产吉西他滨联合奥沙利铂治疗晚期乳腺癌30例

[目的]观察国产吉西他滨（GEM）联合奥沙利铂（L-OHP）治疗晚期乳腺癌的疗效及毒副作用。[方法]采用GEM联合L-OHP治疗复发性乳腺癌患者30例。GEM 1000mg／m^2,d。静滴;L-OHP 130mg／m^2,d1静滴：21d为1个周期,至少治疗2个周期。[结果]CR1例．PR7例．SD10例,PD12例,总有效率（CR＋PR）26．66％。毒副反应主要为骨髓抑制、恶心／呕吐、手足综合征等。白细胞及血小板减少发生率分别为70．00％和63.33％、恶心,呕吐发生率为60．00％,手足综合征发生率为56．67％。[结论]GEM联合L-OHP治疗晚期乳腺癌疗效好．毒副作用可耐受．有较好的临床应用价值。     

奥沙利铂联合卡培他滨治疗晚期胃癌的临床分析

目的:研究奥沙利铂(LOHP)联合卡培他滨(CAPE)治疗进展及转移性胃癌的疗效和毒性作用。方法:LOHP85mg/m2,静滴2小时,第1、8天,CAPE2500mg/m2,第1～14天,每3周重复,行2周期后判断疗效。结果:19例病人中完全有效3例(15.8%),部分有效7例(36.8%),稳定5例(26.3%),进展4例(21.1%),总有效率52.6%,中位生存期11月,毒性反应以手足综合症、神经毒性反应、骨髓抑制为主,无化疗相关死亡。结论:奥沙利铂联合卡培他滨治疗晚期胃癌疗效肯定,毒性反应可耐受。     

吉西他滨联合卡培他滨二线治疗晚期乳腺癌

背景与目的：含蒽环类或紫杉类药物的化疗方案是治疗晚期乳腺癌较佳的方案,但临床有20%～30%的患者疗效不佳,对这部分患者二线化疗目前无统一标准方案.本研究探讨既往接受过蒽环类和紫杉类药物治疗失败的晚期乳腺癌患者,使用吉西他滨联合卡培他滨方案治疗的疗效和毒性.方法：吉西他滨1 000 mg/m2,静脉滴注,第1、8天;卡培他滨950 mg/m2口服,每日2次,第1～14天;每3周为一周期,至少应用2疗程,评价临床疗效和毒性,并进行随访.结果：30例女性患者入本研究,疗效均可评价,CR 2例（6.7%）,PR 12例（40.0%）,SD 13例（43.3%）,PD 3例（10.0%）,总有效率（CR﹢PR）46.7%, 中位无进展生存期9个月,中位生存期12.5个月.主要毒性是骨髓抑制和手足综合征.结论：吉西他滨联合卡培他滨化疗方案二线治疗晚期乳腺癌有较好疗效,毒性可耐受.     

吉西他滨联合卡培他滨治疗晚期三阴性乳腺癌的临床观察

目的观察吉西他滨联合卡培他滨治疗ER、PR、HER-2均阴性（三阴性）晚期转移性乳腺癌的疗效与安全性。方法 2004年7月至2009年6月共14例经免疫组化证实ER、PR、HER-2均阴性的晚期转移性乳腺癌复治患者参与研究。患者接受吉西他滨联合卡培他滨方案治疗：吉西他滨800mg/m2,静脉滴注30min,d1、d8、d15;卡培他滨2500mg/m2口服,d1～14。28d重复。结果全组14例共完成58个周期的治疗,中位数4个周期,范围2～6个周期,均可评价疗效。完全缓解0例,部分缓解4例（28.6%）,病情稳定6例（42.9%）,病情进展4例（28.6%）,客观有效率为28.6%;中位疾病进展时间（mTTP）6个月（95%CI：2～10个月）,中位生存期（OS）16个月（95%CI：6～32个月）,1年生存率为64.4%,3年生存率为14.3%。毒副反应主要为Ⅰ～Ⅲ度骨髓抑制、胃肠道反应、手足综合征、末梢神经毒性、流感样症状、轻度肝功能损伤等。结论吉西他滨联合卡培他滨治疗晚期三阴性乳腺癌患者,初步观察有一定的疗效,其毒副作用患者可以耐受。     

A phase II study of gemcitabine in combination with oxaliplatin as first-line chemotherapy in patients with inoperable biliary tract cancer

Purpose   The aim of this study is to investigate the efficacy and safety of gemcitabine and oxaliplatin combination chemotherapy as first-line therapy in patients with inoperable biliary tract cancer (BTC). Methods   The treatment of this non-randomized phase II study consisted of gemcitabine 1,000 mg/m² intravenously (i.v.) on day 1 and oxaliplatin 85 mg/m² i.v. on day 2 every 2 weeks until disease progression, unaccep toxicity or patients’ refusal. Results   From Sept 2006 to Oct 2007, 40 patients were enrolled. In the ITT analysis, the objective response rate was 15.0% and the disease control rate was 52.5%. The median overall survival (95% CI) was 8.5 months (6.4–10.7) and the time to progression was 4.2 months (0.5–7.9). For the 305 cycles, observed grade 3/4 toxicity was uncommon. Conclusions  Gemcitabine and dose adjusted oxaliplatin combination chemotherapy had moderate anti-tumor activity and was well tolerated as a first-line treatment for patients with inoperable BTC.     

Gemcitabine and oxaliplatin in advanced biliary tract carcinoma: a phase II study

Advanced biliary tract carcinomas (BTCs) are often diagnosed at an advanced/metastatic stage and have a poor prognosis. The combination of gemcitabine and oxaliplatin (GEMOX) has shown promising activity in this setting. This international phase II study evaluated the efficacy and safety of GEMOX as first-line therapy in patients with advanced BTCs. Eligible patients with previously untreated locally advanced or metastatic BTC received gemcitabine 1000 mg m⁻² (day 1) and oxaliplatin 100 mg m⁻² (day 2), every 2 weeks. Seventy patients were enroled; 72.9% had metastatic disease. Sixty-seven patients were treated. There were 10 confirmed partial responses (14.9%; 95% confidence interval (CI), 7.4–25.7%) in the treated population (RECIST). Twenty-four patients (35.8 %) had stable disease. The objective response rate was 20.5% in patients with non-gallbladder cancers (9/44 patients) and 4.3% in patients with gallbladder cancers (1/23). Median overall survival for the intent-to-treat population was 8.8 months (95% CI, 6.9–11.1%) and progression-free survival was 3.4 months (95% CI, 2.5–4.6%). Grade 3/4 toxicities included thrombocytopenia (14.9% of patients), alanine aminotransferase elevation (13.4%), anaemia (10.4%), neutropenia (11.9%) and pain (11.9%). In this study, GEMOX demonstrated activity in non-gallbladder carcinoma, but poor activity in gallbladder carcinoma. GEMOX is well tolerated in advanced BTCs.     

Cetuximab,gemcitabine and capecitabine in patients with inoperable biliary tract cancer: A phase 2 study

PurposeBiliary tract cancer is rare and has dismal prognosis. Chemotherapy has its role in inoperable disease but the role of targeted agents like cetuximab remains to be defined. On the basis of high epidermal growth factor receptor expression of biliary tract cancers this study aims to investigate the efficacy of cetuximab, gemcitabine and capecitabine in an exploratory phase 2 trial.Patients and methodsInoperable biliary tract cancer patients were treated with the combination of gemcitabine (1000 mg/m² on day 1 and 8), capecitabine (1300 mg/m²/d on day 1–14) and weekly cetuximab (400 mg/m² loading and 250 mg/m² maintenance dose) in 21-d cycles until progression or the appearance of intolerable side-effects.ResultsOut of 34 patients (mean age 59.7 years) accrued in this study 16 had intrahepatic, eight extrahepatic cholangiocarcinoma and 10 gall bladder cancer. The best overall response rate was 17.6% (two complete responses and four partial responses) and the clinical benefit rate was 76.5%. After a median of 15.4 months follow-up the median progression free survival was 34.3 weeks and the median overall survival was 62.8 weeks. The performance status and chemotherapy efficacy were independent and significant markers of survival. Only moderate side-effects were registered in this study. KRAS mutation was evaluable in 24 tumours, all of these were of wild type.ConclusionThe efficacy of cetuximab, gemcitabine and capecitabine combination is encouraging and a well tolerated treatment of inoperable biliary tract cancers.     

卡培他滨联合奥沙利铂治疗晚期大肠癌的临床观察

目的观察卡培他滨联合奥沙利铂组成的XELOX方案治疗晚期大肠癌的近期疗效与安全性。方法采用XELOX方案治疗晚期大肠癌62例。卡培他滨2000mg/m^2,d1～14,分早晚口服;奥沙利铂130mg/m^2,d1,静点。每21天为1周期,至少2周期。结果近期疗效CR1例,PR26例,SD20例,PD15例,有效率43.5%。初治组有效率55.6%,显著高于复治组的26.9%（P〈0.05）。毒副反应主要为可耐受的骨髓抑制、恶心呕吐、外周神经毒性。结论XELOX方案治疗晚期大肠癌疗效较好,毒副反应轻,是晚期大肠癌,特别是初治者的有效治疗方案。     

A phase I trial of Capecitabine+Gemcitabine with radical radiation for locally advanced pancreatic cancer

Standard chemoradiotherapy with infusional 5FU for locally advanced pancreatic cancer (LAPC) has limited efficacy in this disease. The combination of Capecitabine (Cap) and Gemcitabine (Gem) are synergistic and are potent radiosensitisers. The aim of this phase I trial was thus to determine the highest administered dose of the Cap plus Gem combination with radical radiotherapy (RT) for LAPC. Patients had LAPC, adequate organ function, ECOG PS 0–1. During RT, Gem was escalated from 20–50 mg m⁻² day⁻¹ (twice per week), and Cap 800–2000 mg m⁻² day⁻¹ (b.i.d, days 1–5 of each week). Radiotherapy 50.4 Gy/28 fractions/5.5 weeks, using 3D-conformal techniques. Three patients were entered to each dose level (DL). Dose-limiting toxicity(s) (DLTs) were based on treatment-related toxicities. Twenty patients were accrued. Dose level (DL) 1: Cap/Gem; 800/20 mg m⁻² day⁻¹ (3 patients), DL2: 1000/20 (12 patients), DL3: 1300/30 (5 patients). Dose-limiting toxicities were observed in DL3; grade 3 dehydration (1 patient) and grade 3 diarrhoea and dehydration (1 patient). Dose level 2 was the recommend phase 2 dose. Disease control rate was 75%: PR=15%, SD=60%. Median overall survival was 11.2 months. The addition of Cap and Gem to radical RT was feasible and active and achieved at relatively low doses.     

Multivariate prognostic factors analysis for second-line chemotherapy in advanced biliary tract cancer

Background:

The role of second-line chemotherapy (CT) is not established in advanced biliary tract cancer (aBTC). We investigated the outcome of aBTC patients treated with second-line CT and devised a prognostic model.

Methods:

Baseline clinical and laboratory data of 300 consecutive aBTC patients were collected and association with overall survival (OS) was investigated by multivariable Cox models.

Results:

The following parameters resulted independently associated with longer OS: Eastern Cooperative Oncology Group performance status of 0 (P<0.001; hazard ratio (HR), 0.348; 95% confidence interval (CI) 0.215–0.562), CA19.9 lower than median (P=0.013; HR, 0.574; 95% CI 0.370–0.891), progression-free survival after first-line CT ⩾6 months (P=0.027; HR, 0.633; 95% CI 0.422–0.949) and previous surgery on primary tumour (P=0.027; HR, 0.609; 95% CI 0.392–0.945). We grouped the 249 patients with complete data available into three categories according to the number of fulfilled risk factors: median OS times for good-risk (zero to one factors), intermediate-risk (two factors) and poor-risk (three to four factors) groups were 13.1, 6.6 and 3.7 months, respectively (P<0.001).

Conclusions:

Easily available clinical and laboratory factors predict prognosis of aBTC patients undergoing second-line CT. This model allows individual patient-risk stratification and may help in treatment decision and trial design.     

奥沙利铂联合替吉奥治疗晚期胆道肿瘤的临床观察

目的:观察奥沙利铂联合替吉奥治疗晚期胆道肿瘤的疗效、疾病进展时间及不良反应。方法:31例患者采用奥沙利铂联合替吉奥治疗,每3周重复1次,治疗2个周期后评价疗效。结果:31例患者均完成6个周期的化疗,其中完全缓解0例,部分缓解13例,稳定14例,进展4例,控制率87.09%。主要不良反应为骨髓抑制、胃肠道反应及外周神经毒性。结论:奥沙利铂联合替吉奥治疗晚期胆道肿瘤有较好的疗效,不良反应可耐受,值得临床推广应用。     

奥沙利铂联合卡培他滨二线治疗晚期胃癌的临床观察

目的 探讨奥沙利铂联合卡培他滨二线治疗晚期胃癌的客观疗效和安全性。方法对既往曾经应用不同方案多次化疗的24例晚期胃癌患者,采用LX方案,即奥沙利铂85mg,／m^2,iv,dl、d15;卡培他滨1250mg／m^2,分2次口服,dl～14;28d为1个化疗周期,连用2个周期以上。按照WHO实体肿瘤近期客观疗效评定标准进行评价。结果 全组24例均可评价疗效。每例进行2～6个周期的治疗,共完成92个周期。其中完全缓解2例,部分缓解5例,稳定10例,进展7例,客观有效率为29.2％。疾病进展时间2～18个月,中位疾病进展时间5个月。缓解期4～14个月,中位缓解期8个月。毒性反应主要是骨髓抑制和恶心呕吐,均为可逆性。结论奥沙利铂联合卡培他滨二线治疗晚期胃癌疗效肯定,安全性较好,值得积极推广。