来曲唑联合唑来膦酸治疗绝经后乳腺癌骨转移疗效观察

目的:观察来曲唑联合唑来膦酸治疗绝经后乳腺癌骨转移的临床效果及不良反应.方法:42例绝经后乳腺癌骨转移患者给予来曲唑片口服 2.5mg/d,唑来膦酸4mg加入生理盐水100ml静滴,每4周1周期,两药连用3个周期后评价疗效.结果:治疗后止痛、体力状况的改善及骨转移病灶的有效率分别为85.71%、69.05%、45.24%,主要不良反应为发热.结论:来曲唑联合唑来膦酸治疗绝经后乳腺癌骨转移有较好的疗效,不良反应少,患者容易接受.     

来曲唑治疗绝经后乳腺癌骨转移

目的 研究来曲唑解救治疗绝经后乳腺癌骨转移的疗效和副作用。方法：36例绝经后乳腺癌骨转移患者给予来曲唑2．5mg，每日1次，口服至少2月。结果：36例可评价疗效和毒副作用患者中，完全缓解(CR)2例，部分缓解(PR)8例，总有效率占27．7％。稳定(SD)20例占55．5％，其中病情稳定≥6月者ll例，临床获益患者(CR PR SD)≥6月21例占58．3％，病情进展6例占16．6％。治疗中无严重不良反应。结论：来曲唑治疗绝经后乳腺癌骨转移有一定疗效，药物不良反应轻，患者容易耐受。     

来曲唑及去势联合来曲唑综合治疗晚期乳腺癌46例分析

目的观察来曲唑组及去势联合来曲唑治疗组间治疗晚期乳腺癌的疗效及不良反应。方法来曲唑组36例绝经后晚期乳腺癌患者接受来曲唑2.5mg口服,每日1次;去势联合来曲唑治疗组10例绝经前晚期乳腺癌接受去势治疗和来曲唑治疗,部分患者加用局部放疗。结果来曲唑组及去势联合来曲唑组治疗晚期乳腺癌均有较好效果。但来曲唑组较去势联合来曲唑组在平均生存时间(37.1个月对26.1个月)以及两年生存率(94.0%对60.0%)均有优势。结论来曲唑治疗晚期乳腺癌效果较好,药物不良反应轻。绝经前女性通过去势联合来曲唑也可以取得满意效果。     

唑来膦酸或帕米膦酸二钠联合阿那曲唑治疗绝经后乳腺癌骨转移的疗效观察

目的 比较唑来膦酸和帕米膦酸二钠分别联合阿那曲唑治疗绝经后乳腺癌骨转移的临床疗效及不良反应。方法 收集2010年1月至2014年6月我院肿瘤科收治的绝经后乳腺癌骨转移患者51例,以随机数字表法分为对照组（n=27）和治疗组（n=24）。治疗组口服阿那曲唑（1 mg/d）联合唑来膦酸4 mg静滴;对照组口服阿那曲唑（1 mg/d）联合帕米膦酸二钠60 mg静滴,28 d为1个周期。观察两组骨痛缓解情况、骨转移灶清退情况、无骨相关事件（skeletal related evend,SRE）生存时间、总生存时间及不良反应。结果 治疗14　d后对照组和治疗组疼痛控制总有效率分别为66.7%和87.5%,差异有统计学意义（P＜0.05）;治疗56 d后对照组疼痛控制总有效率为77.8%,治疗组为91.7%,差异无统计学意义（P＞0.05）。治疗组的骨转移灶清退情况显著优于对照组,差异有统计学意义（P＜0.05）。对照组与治疗组中位无SRE生存时间为17.4个月和22.4个月,中位总生存时间为25.8个月和35.1个月,差异均有统计学意义（P＜0.05）。不良反应主要为发热、肌肉及骨酸痛等,给予对症治疗后缓解。结论 唑来膦酸联合阿那曲唑治疗绝经后乳腺癌骨转移疗效较好,不良反应可耐受,安全性良好,值得临床推广应用。     

唑来膦酸治疗绝经后乳腺癌患者骨质疏松的临床疗效和安全性

目的 采用唑来膦酸治疗绝经后乳腺癌患者骨质疏松,分析其疗效及安全性.方法 选择绝经后乳腺癌患者作为研究对象,实验组采用唑来膦酸联合来曲唑,对照组仅用来曲唑,测量2组患者治疗前后骨密度,进行VAS疼痛评分,观察并比较2组患者的并发症发生率.结果 治疗后实验组患者LI-L4、Ward's三角、股骨颈的骨密度高于对照组,差异有统计学意义(P＜0.05);治疗后2组患者静息痛、前屈后伸痛、翻身痛的VAS评分较治疗前降低,且实验组低于对照组,差异有统计学意义(P＜0.05);实验组患者发生发热2例,骨痛1例,总发生率15％,对照组发生率为10％,2组无明显差异,且均经对症治疗后缓解,无不良影响.结论 绝经后乳腺癌患者出现骨质疏松,采用唑来膦酸治疗,能够提高骨密度,缓解关节疼痛程度,且不良反应轻微,安全有效.     

唑来磷酸联合化疗治疗恶性肿瘤骨转移疗效观察

目的观察唑来磷酸联合化疗治疗恶性肿瘤骨转移疼痛、生活质量及疗效的影响。方法全组100例恶性肿瘤骨转移患者分为治疗组（48例）和对照组（52例）。治疗组在化疗前或后应用唑来磷酸注射液,对照组为单纯化疗。化疗2周期及应用唑来磷酸2次后观察骨痛、生活质量的变化、疗效及不良反应。结果治疗组恶性肿瘤骨转移引起的疼痛起效迅速,总有效率83.3%,对照组总有效率42.3%,两组比较差异有统计学意义（P〈0.05）,治疗组治疗后活动能力改善情况明显优于对照组。两组肿瘤疗效的变化差异无统计学意义。两组不良反应均不明显。结论唑来磷酸能有效缓解恶性肿瘤所致的转移性骨痛,用量少、用药方便、安全性好、输注时间短,能明显改善患者的生活质量,与化疗联合不增加化疗的不良反应,并有一定的协同作用。     

平消胶囊联合来曲唑治疗晚期绝经后乳腺癌临床观察

目的:观察平消胶囊联合来曲唑治疗晚期绝经后乳腺癌的疗效.方法:85例晚期绝经后乳腺癌患者采用随机对照方法分为实验组44例和对照组4l例.实验组口服来曲唑2.5毫克一日一次,平消胶囊6-8粒一日三次,对照组口服来曲唑2.5毫克一日一次.评价疗效、生活质量、疾病进展时间、生存期、不良反应情况.结果:实验组生活质量改善率高于对照组,两组差异有统计学意义(P＜0.05),实验组疾病进展时间较对照组明显延长,两组差异有统计学意义(P＜0.05).实验组临床获益率、中位生存期高于对照组,但差异无统计学意义(P＞0.05),二组不良反应均轻微.结论:平消胶囊联合来曲唑可提高晚期绝经后乳腺癌患者生活质量、延长疾病进展时间,耐受性好,值得临床推广.     

唑来膦酸联合放疗治疗骨转移癌的临床疗效观察

目的 探讨唑来膦酸联合局部放疗治疗恶性肿瘤局限件骨转移的临床疗效.方法 45例局限性骨转移患者随机分为2组,联合治疗组23例,采用唑来膦酸静脉滴注加局部放疗;单纯放疗组22例,只采用局部放疗.结果 联合治疗组和单纯放疗组的疼痛缓解率分别为91.3%和86.4%.差异无统计学意义(P>0.05);联合治疗组和单纯放疗组的溶骨病灶再钙化的有效率分别为52.2%和22.7%,差异有统计学意义(P<0.01);联合治疗组和单纯放疗组出现新的骨转移病灶的患者比例分别为13.0%和40.9%,联合治疗组显著低于单纯化疗组(P<0.05).联合治疗组的不良反应主要为短暂低热和恶心.结论 唑来膦酸联合放疗治疗恶性肿瘤局限性骨转移疗效确切,其控制骨痛作用强,可高效修复溶骨病灶,并能降低新的骨转移灶发生率.     

唑来膦酸联合甲地孕酮治疗乳腺癌骨转移的疗效观察

乳腺癌是妇女较常见的恶性肿瘤之一.经常规的手术及放化疗后,易出现复发和转移,其中骨转移较为多见,且半数以上出现骨痛,严重影响患者的生活质量.因乳腺癌的骨转移X线上多表现为骨破坏和骨增生,为此我科自2003年11月起应用唑来膦酸(苏奇)联合甲地孕酮治疗晚期乳腺癌骨转移患者,现将结果报告如下.     

唑来膦酸钠对绝经后乳腺癌患者骨代谢影响结果分析

目的:通过观察唑来膦酸钠对绝经后乳腺癌患者骨代谢影响,探讨唑来膦酸钠在早期预防乳腺癌患者发生骨代谢障碍及抑制骨转移中的作用。方法:85例绝经后乳腺癌患者均手术治疗,且术后常规行6个疗程的化疗,无骨转移病例。对照组:28例化疗后接受中药治疗;来曲唑组:30例化疗后继续服用来曲唑2.5mg/d;来曲唑+唑来膦酸钠组:27例患者化疗后除服用来曲唑2.5mg/d外,使用唑来膦酸钠注射液4mg+生理盐水100ml,静脉滴注15min,每4周为1个疗程。6个月后应用双能X线骨密度仪对三组乳癌患者腰椎、股骨近端骨密度(BMD)进行测定,用SPETCT行全身核素骨显像检查,使用全自动生化仪器测定血清碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)等生化指标,用免疫组化方法测定雌激素(E2),对三组患者治疗前后各项指标分析比较。结果:治疗后来曲唑组与对照组病人的BMD、E2、血清Ca、P指标比较,均明显降低(P<0.05)、ALP明显上高(P<0.05);来曲唑+唑来膦酸钠组与来曲唑组比较,BMD、血清Ca、P指标明显升高(P<0.05),ALP降低(P<0.05)、E2未见明显变化(P>0.05);来曲唑+唑来膦酸钠与对照组比较,ALP、E2指标明显降低(P<0.05),BMD明显升高(P<0.05),血清Ca、P未见明显变化(P>0.05)。与对照组比较唑来膦酸钠组的骨转移发生率明显降低(P<0.05)。结论:唑来膦酸钠对接受来曲唑治疗引起的骨代谢障碍早期防治疗效明显,且对骨转移发生有明显抑制作用。     

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.