重组人血管内皮抑制素在晚期非小细胞肺癌化疗患者中的应用效果

目的 探讨重组人血管内皮抑制素在晚期非小细胞肺癌(NSCLC)化疗患者中的应用效果.方法 依据随机数字表法将120例晚期NSCLC患者分为观察组和对照组,每组60例.对照组患者予以顺铂注射液治疗,观察组患者在对照组的基础上联合重组人血管内皮抑制素注射液治疗.比较治疗前后两组患者的肿瘤标志物[细胞角质蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原50(CA50)]水平、肺功能指标[用力肺活量占预计值百分比(FVC％)、第一秒用力呼气量(FEV1)以及最大通气量(MVV)]、外周血血管内皮生长因子(VEGF)和低氧诱导因子-1α(HIF-1α)水平、生活质量及免疫功能指标(CD3+、CD4+、CD8+水平及CD4+/CD8+).结果 治疗后,观察组患者的CYFRA21-1、CEA、CA50水平均低于对照组,FVC％、FEV1、MVV均高于对照组,外周血VEGF和HIF-1α水平均低于对照组,功能情况、情感情况、社会/家庭情况、生理状态评分均低于对照组,差异均有统计学意义(P﹤0.05).观察组患者的不良反应总发生率为5.00％,低于对照组的16.67％,差异有统计学意义(P﹤0.05).结论 重组人血管内皮抑制素有利于降低晚期NSCLC化疗患者的肿瘤标志物及外周血VEGF和HIF-1α水平,改善肺功能,提高生活质量,增强免疫功能,降低不良反应发生率.     

替吉奥治疗晚期非小细胞肺癌的有效性及安全性

目的探讨替吉奥联合顺铂治疗晚期非小细胞肺癌的有效性及安全性。方法将90例晚期非小细胞肺癌患者按治疗方法的不同分为观察组(n=39)和对照组(n=51),对照组采用吉西他滨联合顺铂疗法,观察组采用替吉奥联合顺铂疗法,比较两组患者近期疾病控制率、治疗前后卡氏功能状态(KPS)评分、治疗前后血清肿瘤标志物[癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)及鳞状上皮细胞癌抗原(SCCA)]水平变化及不良反应发生情况。结果观察组患者的近期疾病控制率为76.92%,明显高于对照组的52.94%,差异有统计学意义(P﹤0.01)。治疗前,两组患者KPS评分比较,差异无统计学意义(P﹥0.05);治疗后,两组患者KPS评分均升高(P﹤0.05),且观察组患者KPS评分明显高于对照组(P﹤0.01)。治疗前,两组患者CEA、CYFRA21-1及SCCA水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者CEA、CYFRA21-1及SCCA水平均降低(P﹤0.05),且观察组各指标水平均明显低于对照组(P﹤0.01)。观察组患者白细胞减少、血小板减少、胃肠道反应发生率均明显低于对照组,差异均有统计学意义(P﹤0.01)。结论替吉奥治疗晚期非小细胞肺癌疾病控制率高,能显著改善患者生活质量,且不良反应发生率低于临床常规用药。     

重组人血管内皮抑制素注射液联合奈达铂胸腔热灌注对非小细胞肺癌胸腔积液患者的治疗疗效观察

目的 探究重组人血管内皮抑制素注射液联合奈达铂胸腔热灌注对非小细胞肺癌合并胸腔积液患者治疗疗效的影响.方法 选取非小细胞肺癌合并胸腔积液患者98例,根据治疗方案不同将患者分为治疗组与对照组,每组各49例.治疗组患者接受重组人血管内皮抑制素注射液联合奈达铂胸腔热灌注治疗,对照组患者接受单纯顺铂胸腔热灌注治疗.观察比较两组患者治疗前后的血清学指标、胸腔积液变化及不良反应发生情况.结果 治疗后2周,治疗组患者的癌胚抗原、丙氨酸转移酶水平均低于对照组(P﹤0.05);治疗后2周,治疗组患者的胸腔积液改善情况优于对照组(P﹤0.05);治疗过程中,治疗组患者的恶心呕吐及腹痛腹泻发生率低于对照组(P﹤0.05).结论 重组人血管内皮抑制素注射液联合奈达铂胸腔热灌注相对于仅采用顺铂进行胸腔热灌注可降低患者化疗的不良反应发生率,并且还能有效预防胸腔积液的复发.     

肿瘤标志物及T淋巴细胞亚群在肺癌化疗患者中的变化及临床意义

目的 探讨肿瘤标志物及T淋巴细胞亚群在肺癌化疗患者中的变化及临床意义.方法 选取135例肺癌患者,检测化疗前后血清细胞角质蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)水平和T淋巴细胞(CD4+、CD8+、CD4+/CD8+)水平,依据实体瘤疗效评价标准(RECIST)1.1版评估所有患者的化疗疗效,将完全缓解和部分缓解患者纳入有效组,疾病稳定+疾病进展患者纳入无效组.结果 135例患者完成一线化疗方案后完全缓解28例,部分缓解66例,疾病稳定34例,疾病进展7例,依据RECIST分为有效组94例,无效组41例.化疗6、12周,有效组患者CYFRA21-1、CEA水平均明显低于本组化疗前和无效组(P﹤0.01).化疗6周,有效组患者CD8+水平低于无效组,CD4+/CD8+高于无效组(P﹤0.05);化疗12周,有效组患者CD4+水平及CD4+/CD8+均高于无效组,CD8+水平低于无效组(P﹤0.05).94例化疗有效组患者中,小细胞肺癌(SCLC)患者18例,非小细胞肺癌(NSCLC)患者76例,分别作为SCLC组和NSCLC组.化疗12周,SCLC组和NSCLC组患者CYFRA21-1、CEA水平均低于本组化疗前(P﹤0.05),且SCLC组患者CYFRA21-1、CEA水平均低于NSCLC组(P﹤0.05);SCLC组患者CD4+水平及CD4+/CD8+均高于本组化疗前(P﹤0.05),且SCLC组患者血清CD4+水平及CD4+/CD8+均高于NSCLC组(P﹤0.05).化疗期间,135例患者不良反应总发生率为20.00％(27/135),未发生严重不良反应.结论 有效化疗可以降低肺癌患者血清肿瘤标志物水平,改善患者机体免疫功能,有助于促进患者康复,且有效化疗对SCLC患者的影响更大.     

培美曲塞联合顺铂与吉西他滨联合顺铂治疗ⅢB、Ⅳ期非小细胞肺癌的疗效比较

目的 比较培美曲塞联合顺铂与吉西他滨联合顺铂治疗ⅢB、Ⅳ期非小细胞肺癌(NSCLC)的临床疗效.方法 根据治疗方法的不同将68例NSCLC患者分为观察组和对照组,每组34例.对照组患者采用吉西他滨联合顺铂治疗,观察组患者采用培美曲塞联合顺铂治疗,均治疗6周.比较两组患者的近期疗效、肿瘤标志物[癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平、肿瘤血管生成指标[基质金属蛋白酶2(MMP2)和基质金属蛋白酶9(MMP9)]、免疫功能指标(CD3+、CD4+、CD8+水平及CD4+/CD8+)及治疗期间的不良反应发生情况.结果 治疗后,观察组患者的客观缓解率(ORR)高于对照组,差异有统计学意义(P﹤0.05).治疗后,观察组患者的CEA、CYFRA21-1、MMP2和MMP9水平均低于对照组,CD3+、CD4+水平及CD4+/CD8+均高于对照组,CD8+水平低于对照组,差异均有统计学意义(P﹤0.05).治疗期间,观察组患者白细胞减少及血小板减少的发生率均低于对照组,差异均有统计学意义(P﹤0.05).结论 与吉西他滨联合顺铂相比,培美曲塞联合顺铂治疗ⅢB、Ⅳ期NSCLC患者的近期疗效较佳,可有效降低肿瘤标志物水平,抑制肿瘤血管生成,调节免疫应答且血液学毒性较小.     

参芪扶正注射液联合培美曲塞钠+顺铂化疗方案治疗晚期非小细胞肺癌的疗效研究

目的 探讨参芪扶正注射液联合培美曲塞钠+顺铂化疗方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效.方法 将150例晚期NSCLC患者根据用药方案不同分为参芪扶正注射液联合培美曲塞钠+顺铂化疗方案治疗的观察组(72例)和单用培美曲塞钠+顺铂化疗方案治疗的对照组(78例).观察两组患者的近期临床疗效、外周血T淋巴细胞亚群水平、不良反应以及卡氏功能状态(KPS)评分变化.结果 观察组患者的疾病控制率为79.17％,高于对照组的64.10％(P<0.05).治疗后,对照组患者CD3+、CD4+和CD4+/CD8+水平均较治疗前降低(P<0.05),观察组患者CD3+、CD4+和CD4+/CD8+水平均明显高于对照组(P<0.01).观察组患者白细胞减少、血小板减少、肝肾功能不全、胃肠道反应发生率均低于对照组(P<0.05).观察组患者KPS评分有效率为84.72％,高于对照组的67.95％(P<0.05).结论 参芪扶正注射液联合培美曲塞钠+顺铂化疗方案治疗晚期NSCLC能够提高疾病控制率,有效减轻培美曲塞钠+顺铂化疗方案引起的免疫抑制及不良反应,改善患者生活质量.     

康莱特注射液联合多西他赛+奈达铂化疗治疗中晚期非小细胞肺癌患者的疗效

目的 分析观察康莱特注射液联合多西他赛+奈达铂化疗治疗中晚期非小细胞肺癌(NSCLC)患者的疗效.方法 将80例中晚期NSCLC患者按随机数字表法等比例分为对照组与观察组,每组40例.对照组予以多西他赛+奈达铂化疗治疗,观察组予以康莱特注射液联合多西他赛+奈达铂化疗治疗,比较两组患者的近期疗效、肿瘤相关细胞因子表达水平、卡氏功能状态(KPS)评分、不良反应发生情况以及无进展生存期(PFS).结果 治疗后,观察组患者总有效率、临床受益率均高于对照组(P﹤0.05);两组患者细胞角质蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原19-9(CA19-9)蛋白水平和血黏蛋白1(MUC1)mRNA表达水平均降低(P﹤0.05),磷酸酶张力蛋白同源物(PTEN)mRNA表达水平均升高(P﹤0.05),且观察组患者上述指标变化幅度更大(P﹤0.05).治疗1、2个疗程后,两组患者KPS评分均升高(P﹤0.05),且观察组均高于对照组(P﹤0.05).观察组患者骨髓抑制、胃肠道不良反应发生率均低于对照组,差异均有统计学意义(P﹤0.05).观察组患者PFS为5.72个月(95％CI:5.13～6.34),长于对照组的4.01个月(95％CI:3.79～5.26),差异有统计学意义(P﹤0.05).结论 康莱特注射液联合多西他赛+奈达铂化疗治疗中晚期NSCLC患者,可明显提高近期疗效,调节肿瘤相关细胞因子表达水平,改善患者生活质量,降低不良反应发生率,控制疾病进展.     

重组人血管内皮抑制素联合顺铂腔内化疗治疗非小细胞肺癌合并恶性胸腔积液临床观察

目的 观察重组人血管内皮抑制素联合顺铂(DDP)腔内化疗治疗非小细胞肺癌(NSCLC)合并恶性胸腔积液的疗效和安全性.方法 将60例NSCLC合并恶性胸腔积液患者随机分为2组,每组30例,排尽胸腔积液后,分别给予DDP 60 mg联合重组人血管内皮抑制素60 mg(治疗组)及单独DDP 60 mg(对照组)腔内化疗.结果 治疗组有效率为53.33%,对照组为26.67%,比较差异有统计学意义(P<0.05).治疗组生活质量改善率为73.33%,对照组改善率为56.67%,比较差异有统计学意义(P<0.05).治疗组毒副反应与对照组相近,未明显增加.结论 重组人血管内皮抑制素联合DDP腔内化疗治疗NSCLC合并恶性胸腔积液安全有效.     

紫杉醇脂质体联合铂类化疗同步放疗治疗宫颈癌患者的临床疗效

目的 探讨紫杉醇脂质体联合铂类化疗同步放疗治疗宫颈癌患者的临床疗效。方法 根据治疗方法的不同将80例宫颈癌患者分为对照组(n=41,紫杉醇联合铂类化疗同步放疗)和观察组(n=39,紫杉醇脂质体联合铂类化疗同步放疗)。比较两组患者的临床疗效、肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCCA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]、肝肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、血尿酸(BUA)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、免疫功能指标(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)及不良反应发生情况。结果 观察组患者的总有效率高于对照组(P﹤0.05)。治疗后,两组患者CEA、SCCA、CA125、CA19-9水平均低于本组治疗前,观察组患者CEA、SCCA、CA125、CA19-9水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者Scr、BUN、BUA、AST、ALT水平均高于本组治疗前,观...     

红参发酵产物联合长春瑞滨及顺铂化疗方案治疗晚期非小细胞肺癌患者的疗效

目的探讨红参发酵产物联合长春瑞滨及顺铂化疗方案治疗晚期非小细胞肺癌患者的疗效。方法将104例晚期非小细胞肺癌患者随机分为治疗组及对照组,每组52例。对照组患者给予单纯长春瑞滨^+顺铂化疗方案,治疗组患者在对照组基础上联合应用红参发酵产物。分别在治疗前后采用疲劳症状量表(FSI)、肺癌治疗功能评价量表(FACT-L)评价两组患者疲劳症状及生活质量,并比较治疗前后两组患者血清肿瘤标志物水平、免疫功能指标水平、药物不良反应及生存情况。结果治疗前,两组患者FSI各维度评分及总分,FACT-L各维度评分及总分,细胞角质蛋白19片段抗原21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、自然杀伤(NK)细胞、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平比较,差异均无统计学意义(P﹥0.05)。治疗后,对照组患者FSI各维度评分及总分均高于治疗前及治疗组;治疗组患者生理状态、情绪状态、对疾病关注度评分及总分均高于治疗前,且生理状态、社会家庭状态、情绪状态、功能状态、对疾病关注度评分及总分均高于对照组;两组患者CEA、CYFRA21-1及NSE水平均较治疗前下降,且治疗组患者均低于对照组患者;治疗组患者NK细胞、CD3^+、CD4^+及CD4^+/CD8^+水平均较治疗前上升,且均高于对照组患者,差异均有统计学意义(P﹤0.05)。治疗组患者血液学不良反应发生例数少于对照组,差异有统计学意义(P﹤0.05)。结论红参发酵产物联合长春瑞滨及顺铂化疗方案能够有效提高晚期非小细胞肺癌患者的免疫功能及生活质量,降低血清肿瘤标志物水平,并减轻血液学不良反应。     

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.