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1.
目的:对西妥昔单抗联合卡培他滨和顺铂一线治疗晚期胃癌的有效性和安全性以及疗效相关生物标志进行研究。方法:对符合入组标准的52例晚期胃癌患者予以西妥昔单抗联合化疗,具体用法:西妥昔单抗起始剂量400mg/m2,静滴,第1天,随后每周250mg/m2;顺铂80mg/m,静滴,第1天;卡培他滨2 000mg/(m·d),分早、晚口服,第1~14天,21天为1个周期。采用RECIST标准评价疗效。同时对EGFR基因拷贝数与表达、血清TGF-α与EGF表达、K-ras突变等生物标志进行检测分析,并对临床疗效和不良反应进行相关性分析。结果:52例患者中,47例可评价疗效,有效率为53.2%,疾病控制率85.1%,中位疾病进展时间(TTP)5.23个月。出现0~1级与2~3级皮疹患者有效率分别为40.0%和76.5%(P=0.016),其TTP分别为3.6个月和6.5个月(P=0006)。4例EGFR基因扩增者中3例PR,1例SD。PR+CR组患者血清TGF-α明显高于SD+PD组(36.6ng/Lvs.26.0ng/L,P=0.048),TGF-α高表达患者TTP较低表达长(6.1个月vs.2.7个月,P=0.044)。EGF高表达患者TTP较低表达长(5.9个月vs.2.9个月,P=0.050)。EGFR高表达与重度皮疹相关(P=0.001)。检测49例患者均未发现K-ras突变。结论:西妥昔单抗联合卡培他滨和顺铂方案一线治疗晚期胃癌疗效及耐受性良好;EGFR基因拷贝数、血清EGF及TGF-α可能是预测本方案治疗获益的生物标志。  相似文献   

2.
目的:观察西妥昔单抗联合含伊立替康或奥沙利铂化疗方案治疗转移性结直肠癌的近期疗效及毒副反应。方法:10例经病理组织学确诊的转移性结直肠癌患者,给予西妥苷单抗联合FOLFIRI方案或FOLFOX方案治疗,西妥昔单抗首次给予负荷剂量400mg/m,每周给予维持剂量为250mg/m。结果:全组10例患者中,完全缓解(CR)1例,部分缓解(PR)4例,稳定(SD)2例,进展(PD)3例,有效率为50%,疾病控制率为70%,中位肿瘤进展时间(TTP)为6.4个月。主要毒副反应为痤疮样皮疹和腹泻。结论:西妥昔单抗联合FOLFIRI方案或FOLFOX方案治疗转移性结直肠癌疗效较好,毒副反应可耐受。  相似文献   

3.
目的 18氟脱氧葡萄糖正电子发射成像/电子计算机断层扫描(18F-FDG-PET/CT)不仅可提供肿瘤大小等解剖学信息,而且可从细胞分子水平反映人体生化和代谢变化,本研究旨在对18F-FDG-PET/CT早期预测复发转移性乳腺癌治疗缓解率的价值进行初步研究.方法 选择2010-01-01-2014-12-31复发转移的乳腺癌患者18例,所有患者均于治疗前(PET/CT1)和治疗1个周期后(PET/CT2)分别显像1次.根据近期疗效分为客观缓解(OR)组(n=10)和非客观缓解(non-OR)组(n=8),分析OR组和non-OR组之间PET/CT1 SUVmax、PET/CT2 SUVmax、△SUVmax和SUVmax变化率的差异.SUVmax变化率以20.00%为界值,≥20%为代谢反应组(n=12),<20.00%为无代谢组(n=6),分析代谢反应组与无代谢反应组患者OR、DCR的差异.结果 OR组患者的△SUVmax为2.609±0.299,显著高于non-OR组的0.975±0.395,t=3.368,P=0.003 9;OR组SUVmax变化率为(37.250±3.102)%,明显高于non-OR组(16.300±4.111)%,t=4.148,P=0.000 8;代谢反应组缓解率为83.33%,明显优于无代谢反应组,差异均有统计学意义,x2=13.92,P<0.001.结论 18F-FDG-PET/CT对复发转移性乳腺癌治疗缓解率具有重要的早期临床预测价值.  相似文献   

4.
 目的 比较西妥昔单抗250 mg/m2单周方案和500 mg/m2双周方案分别联合化疗治疗晚期大肠癌的近期疗效及安全性。方法 56例晚期大肠癌患者,ECOG行为状态评分0~2分,均有可评价病灶(RECIST 2000标准)。西妥昔单抗单周方案联合化疗组30例,给药方法为400 mg/m2第1周,以后250 mg/m2每周重复应用;双周方案联合化疗组26例,给药方法为500 mg/m2第1周,以后每两周重复应用。两组均以完成8周治疗或出现疾病进展为治疗终点。结果 西妥昔单抗单周方案联合化疗组28例可评价疗效:完全缓解(CR)1例,部分缓解(PR)7例,疾病稳定(SD)11例,疾病进展(PD)9例,有效率28.6 %,疾病控制率67.9 %;双周方案联合化疗组26例可评价疗效:CR 0例,PR 8例,SD 9例,PD 9例,有效率30.8 %,疾病控制率65.4 %,两组比较差异无统计学意义(P>0.05)。两组Ⅲ~Ⅳ度不良反应主要表现为皮疹、恶心、中性粒细胞减少及白细胞减少,两组比较差异也无统计学意义(P>0.05)。结论 西妥昔单抗单周和双周方案分别联合化疗治疗晚期大肠癌疗效相近,不良反应均可耐受。  相似文献   

5.

Objectives

The influence of age (<70?years and ≥70?years) was retrospectively studied on the quality of life (QoL), incidence of side effects (including skin reactions) and efficacy of chemotherapy plus cetuximab in patients with KRAS wild type (WT) metastatic colorectal cancer (mCRC).

Methods

225 patients of the Observed study (PS 0-1) were retrieved based on age (< 70 and ≥70?years) and evaluated through EORTC QLQ-C30 and DLQI questionnaires.

Results

The two patient groups (141?<?70 and 84?≥?70?years, respectively) were balanced with no differences in any of the clinical and pathological characteristics considered. Both groups underwent similar type of first-line chemotherapy plus cetuximab, treatment duration and compliance. Cetuximab therapy caused similar incidence of side effects and impact on QoL in older and younger patients. No difference was observed in progression free survival (PFS) and in disease control rates between the two patient populations. Median overall survival (OS) was higher in patients <70 (27?months, 95% CI: 22.7–31.27) than in patients ≥70 (19?months, 95% CI: 14.65–23.35) (p?=?0.002), which is likely due to higher proportions of metastatic resection (27.0% vs 8.3%; p?=?0.001) and utilization of second-line therapy in younger group (58.9% vs 42.9%; p?=?0.028).

Conclusion

The current data suggest that fit older patients with mCRC can be safely treated with a cetuximab-based therapy, as QoL and safety profile do not seem to be affected by age. In addition, age did not impact the choice of chemotherapy to be associated to cetuximab and treatment compliance.  相似文献   

6.
目的 观察西妥昔单抗联合FOLFOX 4方案一线治疗转移性结直肠癌的临床疗效和毒副反应。方法 回顾性分析2008年4月至2011年10月经组织病理学证实的转移性结直肠癌患者36例,其中治疗组(n=18)采用西妥昔单抗(500mg/m2 静滴120min,每周1次,使用6~12次)联合FOLFOX 4方案(奥沙利铂85mg/m2静滴2h,d1;左亚叶酸钙200mg/m2静滴2h,d1、d2;氟尿嘧啶400mg/m2静滴,d1、d2;氟尿嘧啶600mg/m2持续静脉泵入22h,d1、d2。14天为1周期,化疗不超过12个周期。)治疗。对照组(n=18)仅用FOLFOX 4方案化疗,同治疗组。结果 治疗组与对照组的客观缓解率分别为66.7%和22.2%(P<0.05),疾病控制率分别为94.4%和67.7%(P>0.05)。治疗组和对照组痤疮样皮疹发生率分别为389%和0,其他不良反应包括骨髓抑制、恶心呕吐、神经毒性、肝脏损害及脱发等,差异均无统计学意义(P>0.05)。结论 西妥昔单抗联合FOLFOX 4方案治疗转移性结直肠癌的近期疗效显著,毒副反应可耐受。  相似文献   

7.
The aim of this study was to evaluate the association of sensitivity to previous irinotecan-based chemotherapy with efficacy of cetuximab plus irinotecan therapy in metastatic colorectal cancer (MCRC) patients with wild-type KRAS. We analysed a pooled data set consisting of data from 87 MCRC patients from two previous phase II studies (n = 60) and a group given off-protocol treatment (n = 27) following irinotecan-, oxaliplatin-, and fluoropyrimidine-based chemotherapy. Overall objective response rate to cetuximab plus irinotecan was 28.7%, median progression-free survival (PFS) was 5.3 months, and median overall survival was 12.2 months. Objective response rate did not significantly differ between patients with a favourable response to previous irinotecan (n = 23), stable disease (n = 38), or progressive disease (n = 26), with observed rates of 29.2%, 31.6%, and 23.1%, respectively. Additionally, the non-parametric Spearman rank correlation coefficients (ρ) between the PFS of previous irinotecan-based chemotherapy and that of cetuximab plus irinotecan were quite low (ρ = 0.067 and 0.057 in patients with previous irinotecan as first- and second-line therapies, respectively). Although exploratory nature and small sample size may be limitations of this study, these findings indicate that the efficacy of irinotecan plus cetuximab in MCRC patients with wild-type KRAS did not differ by previous sensitivity to irinotecan.  相似文献   

8.
目的 观察西妥昔单抗联合化疗治疗K-Ras野生型转移性结直肠癌的疗效及安全性,探讨可能影响疗效及预后的因素。方法 收集2007年5月至2012年5月解放军总医院收治的K Ras野生型转移性结直肠癌患者共90例,采用西妥昔单抗(400mg/m2,静滴,第1周,维持剂量每周250mg/m2或每2周500mg/m2)联合化疗方案,主要为含伊立替康为基础方案(FOLFIRI或XELIRI或单药CPT-11)、含奥沙利铂为基础方案(FOLFOX或XELOX)、5 FU/LV方案或单药卡培他滨。回顾性评估西妥昔单抗联合化疗在治疗中的疗效和安全性,分析患者临床病理特征,并探讨影响疗效的因素以及此类患者预后相关的因素。结果 西妥昔单抗中位治疗时间为16周(6~44周),客观缓解率(ORR)为45.6%,疾病控制率(DCR)为87.8%。其中一线治疗ORR为51.6%,二线治疗ORR为40.0%,三线治疗ORR为18.2%。单因素分析显示,年龄、原发灶部位、西妥昔单抗治疗时间与疗效有关,差异具有统计学意义(P<0.05)。90例患者中位随访时间为20.2个月,82例(91.1%)复发转移,60例(66.7%)死亡。患者中位无疾病进展时间(PFS)为7.8个月,中位总生存时间(OS)为22.5个月。其中一线中位PFS为9.1个月,中位OS为27.6个月;二线中位PFS为7.7个月,中位OS为14.5个月;三线中位PFS为2.9个月,中位OS为6.7个月。单因素分析显示:原发灶部位、早期肿瘤缓解者以及西妥昔单抗治疗时间与PFS有关;原发灶部位、早期肿瘤缓解者、西妥昔单抗治疗时间以及转移侵及范围与OS有关。Cox多因素生存分析显示:原发肿瘤病灶部位、早期肿瘤缓解是PFS的独立预后因素,转移侵及范围是OS的独立预后因素。西妥昔单抗相关治疗最常见的不良反应是痤疮样皮疹(78.0%),化疗相关的不良反应主要为腹泻、恶心呕吐、骨髓抑制,经对症处理后,患者均可耐受。结论 西妥昔单抗联合多种方案化疗治疗晚期转移性结直肠癌患者,各线治疗均能取得较好的疗效,不良反应可耐受;原发灶部位可能是西妥昔单抗联合化疗的疗效预测因素,其与患者预后生存可能相关;早期肿瘤缓解可作为判断患者预后相关指标。  相似文献   

9.
10.

Purpose

We performed a retrospective study to evaluate the efficacy of cetuximab plus chemotherapy in metastatic gastric cancer (MGC) patients previously treated with chemotherapy and to investigate potential predictors of treatment efficacy in those patients.

Methods

Thirty-two patients with MGC were included in this study. Cetuximab was delivered, often combined with irinotecan-based chemotherapy. Thirty patients were analyzed for K-ras mutations via direct sequencing of the tumor DNA.

Results

Patients were heavily pretreated with a median number of three previous lines of palliative chemotherapy (56% of the patients were refractory to all of the following drugs: fluoropyrimidines, cisplatin, irinotecan, oxaliplatin, and docetaxel) and 53% of the patients displayed poor performance status. Of 28 response-assessable patients, the overall response rate to cetuximab plus chemotherapy was 3.6% [95% confidence interval (CI) 0–10.5%] and the disease control rate was 28.6%. The median progression-free survival (PFS) was 1.7 months (95% CI 1.3–2.1 months), and the median overall survival (OS) was 3.2 months (95% CI 1.4–5.0 months). Multivariate analyses revealed that skin rash and performance status were significantly associated with PFS and OS. The presence of a K-ras mutation (13.3%) was not associated with either PFS or OS.

Conclusion

Our study suggests that MGC patients with good performance status and skin rash benefit most from salvage cetuximab combined with chemotherapy, even in heavily pretreated status.  相似文献   

11.
背景与目的:PET/CT在非小细胞肺癌(non-small cell lung cancer,NSCLC)的预后判断中有重要价值,但单独针对Ⅲ期且接受靶向治疗患者的研究较少。本研究旨在探讨在这些患者中18F氟代脱氧葡萄糖(18F-fluorodeoxyghcose,18F-FDG)PET/CT基线标准摄取值(standard uptake value,SUV)与预后的相关性。方法:前瞻性分析复旦大学附属肿瘤医院放疗科2009年9月-2012年7月入组的17例接受西妥昔单抗(cetuximab,C225)联合顺铂+长春瑞宾(NP方案)诱导化疗及同期放化疗的患者,入组前两周内完成PET/CT检查。采用Cox回归风险比例模型对SUV-T、SUV-N、SUV-TOTAL、性别、年龄、组织学类型、TNM分期、功能状态评分(performance status,PS)、吸烟状态与患者生存时间进行单因素生存分析,差异有统计学意义者进行多因素生存分析。Log-rank检验及Kaplan-Meier法分别评估以SUV-T、SUV-N、SUV-TOTAL界值分组患者间生存期的差异并绘制生存曲线。结果:单因素预后分析提示,上述SUVmax、PS评分、吸烟状态与预后相关,其中SUV-T及SUV-N的界值是11、SUV-TOTAL为20。多因素分析结果显示,SUV-TOTAL(P=0.012)、SUV-T(P=0.025)、SUVN(P=0.033)是影响本组患者生存的独立预后因素,其中SUV-TOTAL>20组患者的相对危险度(hazard ratio,HR)为14.7。结论:对于C225联合同步放化疗的患者,PET/CT局部区域、原发灶及纵隔淋巴结SUV值与预后有一定相关性,值得进一步大样本研究。将3者结合起来,可指导该治疗的合理应用。  相似文献   

12.
目的 评价紫杉醇联合奥沙利铂和卡培他滨(POX方案)治疗晚期胃癌的疗效和不良反应。方法 21例晚期胃癌患者均采用POX方案治疗:紫杉醇85mg/m,第1、8天,静脉滴注;奥沙利铂130mg/m2,第1天,静脉滴注;卡培他滨1000mg/m分2次口服,第1~14天,21天为1周期。2周期评价疗效。结果 全组21例均可评价疗效,其中PR13例,SD6例,PD2例,客观有效率为61.9%;中位肿瘤进展时间为5.7个月,中位总生存期为11个月。不良反应主要为骨髓抑制、恶心呕吐和外周神经毒性。结论 紫杉醇联合奥沙利铂和卡培他滨治疗晚期胃癌疗效较好,不良反应可耐受,值得临床进一步研究。  相似文献   

13.
表皮生长因子受体(epidermal growth factor receptor,EGFR)单克隆抗体西妥昔单抗联合化疗是RAS野生型转移性结直肠癌(metastatic colorectal cancer,mCRC)患者一线治疗的标准方案,并在后续治疗中也可能有效。一线西妥昔单抗联合化疗后患者病情缓解或稳定,西妥昔单抗继续维持治疗存在很大争议。而当肿瘤对治疗产生耐药性时,就会发生疾病进展。而对于化疗和靶向治疗后疾病进展并不意味着患者对这两类药物同时产生耐药性。多项研究表明,患者可能对化疗药物而不是西妥昔单抗产生耐药性,同时对西妥昔单抗产生耐药性的患者也可能通过化疗转换作用复敏,目前对一线西妥昔单抗联合化疗后进展的RAS野生型患者通过后续使用西妥昔单抗跨线治疗或二线化疗后再挑战治疗能否获益尚无定论。多项研究试图筛选适合于上述治疗策略的优势人群,以期延长这些患者的治疗获益时间,有助于建立其全程治疗策略。就近年来RAS野生型mCRC西妥昔单抗维持、跨线和再挑战治疗方面的研究进展进行综述。  相似文献   

14.
目的:探讨NPR-A在胃腺癌中的表达及与胃癌患者临床病理资料的相关性。方法:应用免疫组化SP方法检测NPR-A在40例胃腺癌组织中的表达,并分析其表达与临床病理资料的相关性。结果:NPR-A在胃癌中主要表达在细胞浆和细胞膜,偶见细胞核着色。在40例胃癌组织中,共有25例组织高表达,阳性率为62.5%,明显高于癌旁组织。NPR-A的表达与胃癌分级、分期及淋巴结转移相关(P<0.05),而与其他临床病理指标之间未见明显相关(P>0.05)。结论:NPR-A在胃腺癌组织中高表达,其表达量与胃癌分级、分期及淋巴结转移相关,提示NPR-A的表达可能参与到胃癌的发展、转移过程中,有望为胃癌的诊断与治疗提供新的途径。  相似文献   

15.
目的目前,国内外关于性别与贲门腺癌(gastric cardia adenocarcinoma,GCA)患者术后预后的研究鲜有报道。本研究探讨性别是否与GCA患者的预后有关。为GCA患者的治疗提供最优方案,延长其生存期。方法回顾性分析郑州大学第一附属医院省部共建食管癌防治国家重点实验室500×10~3例食管癌和贲门癌临床信息数据库中行贲门癌根治术的5968例GCA患者临床资料,采用Kaplan-Meier法计算患者的累积生存率,并绘制生存曲线,组间比较用Log-rank检验。多因素Cox比例风险回归模型方法分析预后主要影响因素。结果本研究5968例患者中男性中位总生存期(median overall survival,mOS)为3.871年,女性为4.274年,差异有统计学意义,χ^2=21.396,P<0.001。单因素分析显示,年龄(χ^2=47.863,P<0.001)、分化程度(χ^2=59.517,P<0.001)、切缘状况(χ^2=12.198,P<0.001)、TNM分期(χ^2=470.929,P<0.001)均是GCA患者预后的影响因素,结果显示在年龄(<55岁,χ^2=5.749,P=0.016;≥55岁,χ^2=15.462,P=0.001)、高低发区(低发区,χ^2=8.218,P=0.004;高发区,χ^2=13.462,P=0.001)、分化程度(低分化,χ^2=8.144,P=0.004;中分化,χ^2=7.060,P=0.008;高分化,χ^2=5.422,P=0.020)、切缘状况(净,χ^2=16.010,P=0.001;不净,χ^2=7.193,P=0.007)、TNM分期(Ⅱ期,χ^2=11.760,P<0.001;Ⅲ期,χ^2=13.331,P<0.001)上女性生存均优于男性。多因素分析显示,性别(OR=1.209,95%CI为1.120~1.304)、年龄(OR=1.349,95%CI为1.240~1.469)、分化程度(中分化,OR=1.174,95%CI为1.046~1.317;低分化,OR=1.093,95%CI为0.976~1.224)、切缘状况(OR=1.167,95%CI为1.048~1.299)、TNM分期(Ⅱ期,OR=1.823,95%CI为1.423~2.337;Ⅲ期,OR=3.518,95%CI为2.752~4.497)是影响GCA患者预后的独立影响因素。调整混杂因素后进一步多因素分层分析提示,年龄(OR=1.312,95%CI为1.191~1.445)、中分化(OR=1.155,95%CI为1.010~1.322)、切缘状况(OR=1.241,95%CI为1.100~1.400)、TNM分期(Ⅱ期,OR=1.832,95%CI为1.398~2.401;Ⅲ期,OR=3.535,95%CI为2.707~4.617)是男性GCA患者预后的独立影响因素;年龄(OR=1.470,95%CI为1.231~1.754)、TNM分期(Ⅲ期OR=3.692,95%CI为1.970~6.918)是女性GCA患者预后的独立影响因素。结论性别为GCA患者预后的独立影响因素,女性患者的生存期明显优于男性患者。且不同性别GCA患者预后的独立影响因素不同。  相似文献   

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目的:探讨肿瘤干细胞标记前列腺干细胞抗原(prostate stem cell antigen,PSCA)在胃腺癌中的诊断价值。方法:采用免疫组化方法(EnVision法)检测353例胃腺癌根治标本和100例其它胃部常见病变标本的PSCA表达情况,并分析PSCA与胃腺癌临床病理特征的关系。结果:PSCA在胃腺癌组织中表达阳性率为82.2%,明显高于高级别上皮内瘤变(60%)、低级别上皮内瘤变(25%)、腺瘤(20%)、慢性溃疡(10%)、慢性胃炎(0%),差异具有统计学意义(P<0.05)。PSCA与胃腺癌分化程度、浸润深度、淋巴结转移情况均具有相关性(P<0.05)。PSCA与远处转移情况、患者年龄、性别均无明显相关性(P>0.05)。结论:PSCA与胃腺癌临床病理特征关系密切,可以作为胃腺癌诊断的重要标志物。  相似文献   

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BACKGROUND: This nonrandomized open label phase II study evaluated the efficacy and safety of FOLFOXIRI in metastatic or recurrent gastric cancer patients. PATIENTS AND METHODS: Patients with histologically proven, metastatic gastric adenocarcinoma, aged 18-70 years, performance status zero to two, no prior chemotherapy, and with signed written informed consent were eligible. Treatment consisted of irinotecan 150 mg/m2 day 1, oxaliplatin 85 mg/m2 day 1, leucovorin 100 mg/m2 day 1, and 5-fluorouracil 2000 mg/m2 as a 48-h continuous infusion starting on day 1, which was repeated every 2 weeks. RESULTS: From August 2004 to August 2005, 48 patients were prospectively enrolled. The median age was 54 years (24-69). In total, 386 cycles were administered with a median of nine cycles per patient (range 1-12 cycles) and 45 of 48 patients were assessable for treatment response. An independent review of tumor responses resulted in overall response rate of 66.7% (95% confidence interval=53.4% to 80.0%) by intent-to-treat analysis with one complete response and 31 partial responses. The median survival of all patients was 14.8 months and the median time to progression was 9.6 months. Most common grade 3/4 toxic effects were neutropenia (12% of all cycles) and emesis (8% of all cycles). Grade 2 peripheral neuropathy occurred in five patients. One (2%) patient had severe tumor bleeding and five (10%) patients experienced grade 3 diarrhea. CONCLUSIONS: The modified FOLFOXIRI combination chemotherapy showed a very promising preliminary antitumor activity and was generally well tolerated as a first-line treatment of patients with metastatic gastric cancer.  相似文献   

18.
十全大补汤配合腹腔化疗对进展期胃癌术后的影响   总被引:1,自引:0,他引:1  
目的:探讨腹腔化疗配合中药十全大补汤在进展期胃癌术后的临床价值。方法:观察进展期胃癌根治性手术后患者78例,随机分成两组,即全身化疗+腹腔内化疗+十全大补组(治疗组)和全身化疗组(对照组),观察两组患者术后的1年、2年、3年复发率和生存率。结果:治疗组的3年复发率为21.75%,对照组为41.33%(P<0.05);治疗组3年生存率为58.38%,而对照组为39.6%(P<0.05)。结论:全身静脉化疗结合腹腔内化疗并配合十全大补汤治疗进展期胃癌手术后患者的疗效优于单纯全身静脉化疗。  相似文献   

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含替吉奥联合化疗方案治疗进展期胃癌研究的进展   总被引:8,自引:1,他引:7       下载免费PDF全文
替吉奥胶囊(S-1)是替加氟及优福定的升级换代产品,使用替吉奥联合化疗方案治疗晚期胃癌在不同的临床研究中取得了初步肯定的治疗效果,毒副作用小,疗效确切,给药方便。本文就含替吉奥联合化疗方案治疗进展期胃癌的研究进展作一综述。  相似文献   

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