紫杉醇、顺铂及卡培他滨联合放疗治疗晚期鼻咽癌的疗效观察

目的 探讨紫杉醇、顺铂及卡培他滨方案 （TPX）联合放疗治疗晚期鼻咽癌的疗效及安全性。方法 2002年2月至2007年9月收治57例Ⅲ、ⅣA期鼻咽癌患者,先予直线加速器常规放疗,鼻咽原发灶2Gy／f,每周5次,DT 70Gy,7周完成。放疗后2周,29例给予TPX方案化疗（紫杉醇175mg／m²静滴,d₁;顺铂 25mg／m²静滴,d₁～d₃;卡培他滨1.5g／m²口服,d₁～d₁₄,3周为1周期）;另28例给予TP方案化疗（紫杉醇175mg／m² 静滴,d₁;顺铂25mg／m²静滴,d₁～d₃,3周为1周期）。两组均化疗4周期。化疗完成后对两组的近期疗效和总生存期进行比较。结果 TPX组和TP组的总有效率（RR）分别为96.5％和92.9％（P＞0.05）;3年生存率分别为82.8％和57.1％（P＜0.05）;3年远处转移率分别为 24.1％和50.0％ （P＜0.05）;PTX组骨髓抑制、胃肠道反应、神经毒性及肝肾功损害等毒副反应与TP组相近（P＞0.05）,手足综合征高于TP组（P＜0.05）。结论 TPX方案较TP方案联合放疗能提高晚期鼻咽癌的生存率,减少远处转移,且化疗毒副反应可以耐受。     

恶性肿瘤患者体表面积计算方法的比较

目的 探讨不同体重指数（BMI）的恶性肿瘤患者体表面积的计算方法。方法 对227例恶性肿瘤患者在住院当天、第2天和化疗前各测量1次空腹时的身高和实际体重,计算其平均值。按照不同BMI值（≤18.6kg／m²、18.6～23.9kg／m²、24～27.9kg／m²和≥28kg／m²）将患者分为消瘦组（17例）、正常体重组（107例）、超重组（82例）和肥胖组（21例）;计算各组患者的实际和理想体表面积,比较两者间差异。结果 正常体重组患者的实际和理想体表面积分别为1.590m²和1.584m²,差异无统计学意义（P＞0.05）;消瘦组患者的实际和理想体表面积分别为1.523m²和1.641m²（P＜0.05）;超重组患者的实际和理想体表面积分别为1.724m²和1.590m²（P＜0.05）;肥胖组患者的实际和理想体表面积分别为1.813m²和1.570m²（P＜0.05）。结论 不同BMI值患者的实际和理想体表面积有一定的差异,对于超重和肥胖的恶性肿瘤患者实施化疗建议根据理想体表面积计算化疗药物剂量,避免不必要的治疗风险。     

改良FOLFOX方案时辰化疗治疗晚期胃肠癌的临床观察

目的探讨奥沙利铂（L-OHP）联合亚叶酸钙（LV）、5-氟尿嘧啶(5-Fu)的改良FOLFOX时辰化疗方案与L-OHP联合LV、5-Fu的标准FOLFOX4常规化疗方案治疗晚期胃肠癌的近期疗效及不良反应。方法183例晚期胃肠癌患者随机分为时辰化疗组和常规化疗组, 时辰化疗组92例予改良FOLFOX方案时辰化疗, L-OHP 85～100mg/m2,第1天,14∶00～18∶00,正弦曲线式输液泵静脉持续滴注,给药峰值在16∶00;LV 200mg/m2,第1,2天, 22∶00～10∶00;5-Fu 1 000mg/m²　第1,2天,22∶00～10∶00,LV和5-Fu也均用上述正弦曲线式输液泵静脉持续滴注,凌晨04∶00达给药高峰。常规化疗组给予标准的FOLFOX4方案化疗（L-OHP 85～100mg/m²,第1天静滴2小时;LV 200mg/m2,第1,2天静滴2小时;5-Fu 400mg/m²,第1,2天静推,5-Fu600mg/m²第1,2天持续静滴22小时。L-OHP于上午正常工作时间给药,LV于L-OHP给药结束后给药,5-Fu于LV结束后给药;两组病例化疗均每2周重复,每30天为1周期,至少2周期后对两组的近期疗效和不良反应进行统计、比较。结果时辰化疗组的有效率为65.2%, KPS评分平均升高分值为18.7,均明显高于常规化疗组(P<0.05)。时辰化疗组的各种不良反应均明显低于常规组(P<0.05)。结论改良时辰化疗方案与常规化疗方案相比有效率明显增高, 不良反应发生率明显降低, 并具有更好的可耐受性, 值得临床推广。     

洛铂或顺铂联合依托泊苷治疗广泛期小细胞肺癌的临床观察

目的 探讨依托泊苷联合洛铂化疗方案治疗小细胞肺癌（SCLC）的近期疗效、远期生存及毒副反应。方法 回顾性分析未经抗肿瘤治疗的广泛期SCLC患者85例,根据治疗方案分为两组,即依托泊苷+洛铂（EL）组42例和依托泊苷+顺铂（EP）组43例。EL组给予依托泊苷80 mg／m²,d₁～d₅,洛铂30 mg／m²,d₁;EP组给予依托泊苷80 mg／m²,d₁～d₅,顺铂25 mg／m²,d₁～d₃,21天为1周期。至少完成2个周期化疗以后评估疗效和毒副反应。 结果 EL组和EP组的有效率（RR）分别为59.5％和53.5％（P＞0.05）,疾病控制率（DCR）分别为80.9％和76.7％（P＞0.05）,但EL组的中位无进展生存时间（PFS）为6.5个月,高于EP组的4.5个月（P＜0.05）。EL组血小板减少的发生率高于EP组,恶心呕吐及肝肾功能损害的发生率均低于EP组（P＜0.05）。结论 同EP方案相比,EL方案可延长中位PFS,且消化道不良反应较轻,基本无肝肾毒性。     

TAC与TP方案治疗三阴性乳腺癌的临床观察

目的 比较新辅助化疗TAC与TP方案治疗三阴性乳腺癌（TNBC）的疗效和安全性。方法 102例三阴性乳腺癌患者均经病理组织学确诊,分为TAC组（52例）和TP组（50例）。TAC组：多西他赛75mg／m²或紫杉醇（紫杉醇脂质体）135mg／m² iv,d₁;吡柔比星40mg／m²或表柔比星75mg／m² iv,d₂;环磷酰胺600mg／m² iv,d₁。TP组：多西他赛75mg／m²或紫杉醇（紫杉醇脂质体）135mg／m² iv,d₁;顺铂30mg／m² iv,d₂～d₄。21天为1周期,化疗2～4个周期后行手术治疗。评价两组近期疗效和毒副反应。结果 TAC组获pCR 5例（9.6％）,PR 35例（67.3％）,SD 9例（17.3％）,RR为76.9％;TP组获pCR 4例（8.0％）,PR 32例（640％）,SD 5例（100％）,RR为72.0％,两组pCR率和RR差异均无统计学意义（P＞0.05）。102例患者中12例经2个周期化疗后肿瘤进展,其中TAC组3例,TP组9例。TAC组有2例发生房性前期收缩,TP组3例发生2级肾功能损伤。TAC组3～4级血液学毒性和脱发的发生率明显高于TP组,但TP组的3～4级胃肠道反应发生率高于TAC组。结论 TAC方案与TP方案在三阴性乳腺癌新辅助化疗中均具有一定疗效,不良反应尚可耐受。     

康艾注射液联合化疗治疗晚期胃癌

目的观察康艾注射液联合TX方案化疗治疗晚期胃癌患者的疗效、毒性反应及对生活质量的影响。方法62例晚期胃癌患者随机分为康艾联合化疗组（治疗组）及单纯化疗组（对照组）,其中治疗组32例,对照组30例。评价两组患者近期疗效、毒性反应及生活质量。结果治疗组与对照组近期疗效分别为46.9％和43.3％（P>0.05）;治疗组血液及非血液毒性均低于对照组(P<0.05);治疗组生活质量明显改善(P<0.05)。结论康艾注射液联合化疗治疗晚期胃癌,能减轻化疗毒性及改善生活质量。     

吉西他滨与紫杉醇分别联合顺铂治疗非小细胞肺癌的对比研究

目的对比吉西他滨与紫杉醇分别联合顺铂化疗初治非小细胞肺癌的疗效和不良反应。方法81例患者随机分为两组,吉西他滨组（GP）：吉西他滨1 000 mg／m² ,d₁,d₈,静脉滴注,顺铂30 mg／m² ,d₂～d₄,静脉滴注,28天为1周期。紫杉醇组（TP）：紫杉醇175mg/ m²,d₁,顺铂30 mg／m² ,d₂～d₄,静脉滴注,28天为1周期。结果GP组总有效率（CR+PR）45.0％（18/40）,TP组43.2％（16/37）,两组近期疗效差异无统计学意义（χ²=0.527,P=0.957）。GP组中位生存期为11月,1年生存率37.7%,而TP组为11月,31.7%,两组生存差异无统计学意义（χ2=0.140,P=0.708）。两组主要不良反应不同,GP组血小板减少症显著高于TP组,而TP组外周神经炎、恶心呕吐和肌痛显著高于GP组。结论吉西他滨与紫杉醇联合分次顺铂治疗非小细胞肺癌疗效相当,但吉西他滨的治疗相关不良反应较轻,可作为初治晚期非小细胞肺癌的一线方案。     

晚期胃癌一线化疗失败后不同解救化疗方案的疗效比较

目的　回顾性分析不同化疗方案对一线化疗失败的晚期胃癌患者进行解救治疗的疗效和安全性,探讨晚期胃癌二线治疗适宜的化疗方案。方法　８８例一线化疗失败的晚期胃癌患者,分为紫杉类组（３２例）：多西紫杉醇６０～７５ｍｇ／ｍ^２或紫杉醇１３５～１７５ｍｇ／ｍ^２,分ｄ_１、ｄ_８;５-ＦＵ５００ｍｇ／ｍ^２ｄ_１～ｄ_５或顺铂２０ｍｇｄ_１～ｄ_５,２１天为１周期。奥沙利铂组（３１例）：奥沙利铂８５ｍｇ／ｍ^２ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。伊立替康组（２５例）：伊立替康１５０～１８０ｍｇ／ｍ^２,ｄ_１;５-ＦＵ４００ｍｇ／ｍ^２ｉｖｄ_１、ｄ_２,５-ＦＵ６００ｍｇ／ｍ^２,ｃｉｖ２２ｈ,ｄ_１、ｄ_２;ＣＦ２００ｍｇ／ｍ^２ｄ_１、ｄ_２,１４天为１周期。结果　８８例均可评价不良反应,８２例可评价客观疗效。紫杉类组、奥沙利铂组以及伊立替康组总有效率分别为３.２％、１４.３％和１７.４％,疾病控制率分别为４８.４％、６０.７％和６５.２％;中位ＰＦＳ分别为２个月（１.３９～２.６１个月）、３个月（２.１６～３.８４个月）和３个月（２.４６～３.５４个月）,差异无统计学意义（Ｐ＝０.１９５）;中位ＯＳ为６个月（４.２１～７.７９个月）、７个月（６.１２～７.８８个月）和７个月（５.０８～８.９２个月）,差异无统计学意义（Ｐ＝０.３９３）。３组不良反应易耐受,主要为１～２级血液学毒性。伊立替康组腹泻发生率较高,为４８％,但３级以上发生率较低,仅为８％。奥沙利铂组外周神经毒性为４８％。结论　晚期胃癌一线治疗失败后采用目前常用的化疗方案解救治疗有一定的客观缓解率和临床受益率,但疗效有限,需要进一步积极探索有效的治疗方案。     

同步放化疗治疗局部晚期非小细胞肺癌的Ⅲ期临床研究

目的：探讨周剂量长春瑞滨、顺铂同步放射治疗局部晚期非小细胞肺癌的近期疗效和毒性反应。方法：８７例局部晚期非小细胞肺癌患者,ＫＰＳ评分≥７０,中位年龄５７岁（３５～７０岁）,随机分为同步组（２８例）、序贯组（３０例）和放疗组（２９例）。放射治疗采用６～８ＭＶ加速器,常规分割,总剂量６０～６４Ｇｙ;化疗采用长春瑞滨与顺铂联合;同步组化疗为长春瑞滨１２.５ｍｇ／ｍ^２,顺铂２０～４０ｍｇ／ｍ²,每周一给药１次,共６～７次;序贯组化疗为长春瑞滨２０ｍｇ／ｍ^２,ｄ_１、ｄ_８,顺铂８０～１００ｍｇ／ｍ²,ｄ_１或分为ｄ_１～ｄ_３。每３周为１周期,共３～４周期。３组用药前均给予预处理。治疗后按ＷＨＯ标准评价疗效和毒性。结果：８７例中有１例死亡,８６例完成治疗并可评价疗效和毒性。３组有效率分别为７５.００％、５８.６２％和４４.８２％（Ｐ＜０.０５）。平均生存时间分别为１５.７个月、１３.５个月及８.６个月。１年生存率分别为７１.４３％、６０.８８％和３５.９８％（Ｐ＝０.０１３７）。ⅢＡ期患者１年生存率分别为７５.００％、５７.１４％和４４.４４％（Ｐ＝０.３３９４）。ⅢＢ期患者１年生存率分别为７０.００％、６３.６４％和３５.００％（Ｐ＝０.０３３６）。３组毒副反应主要为骨髓抑制,未见明显肺及食道毒性。治疗后ＫＰＳ评分及体重同步组和序贯组均得到改善。结论：同步放化疗治疗局部晚期非小细胞肺癌疗效明显优于序贯放化疗及单纯放疗,患者的生存质量提高而未明显增加肺、食道的毒性。     

多西紫杉醇与多西紫杉醇联合卡铂治疗老年晚期非小细胞肺癌的疗效观察

目的比较单药多西紫杉醇（Docetaxel,TXT）和TXT联合卡铂（Carboplatin,CBP）即TC方案治疗老年晚期非小细胞肺癌(Non-small cell lung cancer,NSCLC)的疗效及不良反应的差异。方法46例晚期NSCLC老年患者,随机分为两组: TXT组给予TXT 50mg/m²,第1天,每2周重复;TC组给予TXT 40mg/m²,第1天, CBP 300mg/m²,第1天,每2周重复。结果两组有效率(36.4% vs 41.7%, P=0.77)和中位生存期(9.2月 vs 7.9月,P=0.13)差异均无统计学意义。TXT组患者生活质量改善优于TC组（77.3% vs 45.8%,P=0.03）,且Ⅲ+Ⅳ度白细胞减少发生率明显低于TC组（18.2% vs 54.2%, P=0.02）。两组非血液学毒性较温和,耐受性良好。结论与TC方案相比,TXT单药2周方案治疗老年NSCLC疗效相当,耐受性及生活质量更好,值得临床进一步观察研究。     

CO2对宫颈癌HeLa细胞抗失巢凋亡特性的影响

 目的 观察CO₂对宫颈癌HeLa细胞系抗失巢凋亡能力的影响。方法 以宫颈癌HeLa细胞系为研究对象,实验组给予CO₂持续通气4小时,压力为8mmHg,对照组HeLa细胞不进行CO₂通气,两组细胞同时设贴壁培养组和悬浮培养组进行培养24h、72h、120h。利用软琼脂集落形成实验、Poly HEMA悬浮培养、流式细胞技术、观察体外培养过程中CO₂对宫颈癌HeLa细胞系增殖和抗失巢凋亡的影响。结果 实验组与对照组均具有凋亡能力和抗失巢凋亡能力,实验组的增殖能力和集落形成明显优于对照组 （P＜0.01 ),但实验组抗失巢凋亡能力明显低于对照组。结论 CO₂能够促进宫颈癌HeLa细胞集落形成,具有较强的失巢凋亡能力,但不能增强抗失巢凋亡能力。     

Mutagenesis and lethality following S phase irradiation of xeroderma pigmentosum and normal human diploid fibroblasts with ultraviolet light

The mutagenic and lethal effects of u.v. light exposure in theDNA synthetic phase of the cell cycle were determined in xerodermapigmentosum complementation group A (XP-A), hereditary adenomatosisof the colon and rectum (ACR), and a normal, foreskin derivedcell strain (AG1522). For AG1522, an increased sensitivity tothe cytotoxic effects of u.v. light (survival curve D₀ = 3.2J/m²) was observed as compared to previous findings for confluent,non-proliferating cultures (D₀ = 4.2 J/m²). XP-A fibroblastswere markedly hypersensitive (D₀ = 0.5 J/m²) and ACR fibroblastsexhibited an intermediate response (D₀ = 2.0 J/m²). The mutagenicresponse of ACR fibroblasts, however, was similar to normalfibroblasts. A threshold of 1.5–2 J/m² was observed foru.v. induced mutagenesis in normal and ACR fibroblasts. XP fibroblasts,on the other hand, were strikingly hypermutable and demonstratedlittle or no threshold. When S phase mutagenesis was consideredas a function of survival level rather than u.v. light dose,XP fibroblasts remained significantly hypermutable as comparedwith normal fibroblasts at all survival levels. Previous mutagenesisresults with confluent, nonproliferating cultures of XP andnormal fibroblasts were reanalyzed as a function of cytotoxicity;XP hypermutability at all survival levels was also observed.     

Notch1基因在淋巴细胞肿瘤中的表达变化及其意义

目的 了解Notch1基因在淋巴细胞肿瘤中的表达特点。方法 采用SYBR GreenⅠ荧光定量PCR和相对定量分析法检测43例淋巴细胞肿瘤患者(T细胞急性淋巴细胞白血病7例、T细胞非霍奇金淋巴瘤6例、B细胞急性淋巴细胞白血病9例、B细胞慢性淋巴细胞白血病5例和B细胞非霍奇金淋巴瘤16例)和20例健康人外周血单个核细胞的Notch1基因表达水平,以β2微球蛋白基因（β₂M）作为内参,采用公式2^-ΔCt×100%计算Notch1基因表达水平。结果 T细胞肿瘤组（中位数0.897%）与B细胞肿瘤组（中位数0.726%）患者外周血单个核细胞Notch1基因表达均比健康对照组（中位数0.288％）明显上升（P<0. 01,P<0. 01）。T细胞肿瘤组Notch1基因表达水平与B细胞肿瘤组的差异无统计学意义（P>0.05）。但五种类型淋巴细胞肿瘤Notch1基因表达水平有所不同,其中以B细胞慢性淋巴细胞白血病组最高,其次是T细胞非霍奇金淋巴瘤组,而B细胞非霍奇金淋巴瘤组的Notch1基因表达水平最低。结论 异常高表达的Notch1基因可能与参与淋巴细胞肿瘤的发生发展过程,研究结果为靶向抑制Notch1的基因治疗提供初步依据。     

L-精氨酸预防大剂量顺铂所致急性肾毒性的临床研究

目的 :观察L 精氨酸预防大剂量顺铂急性肾毒性的临床疗效。方法 :对适合用大剂量顺铂( 10 0mg/m2 )化疗的患者随机分为研究组 (顺铂加精氨酸周期 )和对照组 (单用顺铂周期 ) ,两组形成自身对照 (即 1例患者的 2个周期进行自身对照 )。L 精氨酸的用法为 10g/ (m2 ·d) ,在用顺铂的当天给予 ,比较研究组与对照组化疗后 2 4h尿 β2 微球蛋白 ( β2 MG)的变化。结果 :38例对可评价疗效的患者中 ,显效 2 3例对 ( 60 5% ) ,有效 12例对 ,总有效率 92 1% ( 35/ 38)。加L 精氨酸周期化疗后的尿β2 MG值( x±s)明显低于不加精氨酸周期的尿 β2 MG值 ( x±s) ,两者相比 ,,差异具有非常显著性P <0 0 0 5。30例非小细胞肺癌患者化疗后CR 3例 ,PR 12例 ,总有效率 50 % ,疗效较好。结论 :L 精氨酸可显著预防大剂量顺铂的急性肾毒性 ,而不影响顺铂的抗癌活性     

顺铂时辰给药合并羟基喜树碱治疗晚期非小细胞肺癌的临床观察

 目的 探索顺铂（DDP）时辰给药与常规给药合并羟基喜树碱（HCPrr）治疗晚期非小细胞肺癌的疗效和副作用。方法 59例Ⅲb～Ⅳ期非小细胞肺癌患者随机分为两组，顺铂时辰给药合并羟基喜树碱组(时辰化疗组）和顺铂、羟基喜树碱常规给药组（常规化疗组），两组顺铂和羟基喜树碱的剂量相同。顺铂14mg／（m²·d）。羟基喜树碱6mg／（m²·d），两药连用5天，21天为1周期，时辰化疗组顺铂在18：00用药。其他用药时间相同。每例连用两周期以上评价疗效。结果 时辰化疗组PR13例，SD13例，PD4例，有效率（CR＋PR）43．3％，常规化疗组PR9例，SD17例，PD3例，有效率31．0％，两组比较P=0．051。时辰化疗组中位生存期6．62个月，12个月生存率30．4％（9／30例），18个月生存率13．3％（4／30）。常规化疗组中位生存期5．06个月，12个月生存率24．1％（7／29），18个月生存率3．4％（1／29）；时辰化疗组的有效率和生存期较常规组有优势。血液学毒性和消化系统等副作用两组相仿。结论 顺铂时辰给药合并羟基喜树碱治疗晚期非小细胞肺癌有临床应用价值。     

Preventive effect of prostaglandin E1 on cisplatin-induced nephrotoxicity

In order to prevent the nephrotoxicity induced by cisplatin (CDDP), prostaglandin E1 (PGE1) was administered intravenously after anticancer chemotherapy to six patients with lung cancer. All patients underwent two courses of multi-drug chemotherapy with the same regimen including a single administration of 80 mg/m2 CDDP. From the 7th day of the 2nd course of chemotherapy, 120 micrograms PGE1 had been administered for five days. During the two courses of chemotherapy, serum creatinine, blood urea nitrogen, creatinine clearance (Ccr), 24-h excretions of beta 2-microglobulin (beta 2-MG) and N-acetylglucosaminidase (NAG) in urine were measured every week in all patients. The mean value of Ccr was higher in the 2nd course than in the control course (65 ml/min vs. 74 ml/min). The 24-h excretions of beta 2-MG and NAG were also reduced in the 2nd course. Out of six patients, only one was complicated by mild phlebitis at the PGE1 infusion site. From these results it was suggested that PGE1 was effective for prevention of CDDP nephrotoxicity.     

Comparison of dose-effect relationships of carcinogens following low-dose chronic exposure and high-dose single injection: an analysis by the median-effect principle

Experimental dose-effect relationships of carcinogens followingeither acute (single dose) or chronic (time to tumor) exposureappears to conform with the median-effect principle (Chou, J.Theor. Biol. 59, 253–276, 1976) of the mass-action law:f_a/ (1 – f_a) = (D/D_m)^m, where D is dose or cumulativedose, D_m is the D required for the median-effect, m is the Hill-typecoefficient, and f_a is the fraction that is affected by D. Theparameters m and D_m are the basic characteristics for each carcinogenat specified experimental conditions. A plot of y = log [(f_a)-1-^–1]–1]^–1vs x = log (D) gives the slope, m, and the intercept, log D_m,at y = 0. Using previously reported data, it is shown that dose-effectrelationships of carcinogens obtained from various experimentaldesigns (e.g., mode of exposure, route of administration, ageat beginning of exposure to carcinogen, type of tumor produced,and strain and sex of animal used) can be normalized and compareddirectly on the same gauge and thus their consistency with themass-law principle can be clearly demonstrated. The analysissuggests that chemical carcinogens, like non-carcinogenic chemicals,exert their effects according to the principle of the mass-actionlaw. It also suggests that the interaction of the ultimate carcinogensand the probable targets is a multi-event or a slow-transitionprocess (i.e., m>1). The analytical procedure described byf_a = [1 + (D_m/D)^m]^–1 provides a simplified general methodfor assessment of low-dose risk of carcinogens.     

Clinical pharmacology of high-dose cisplatin

Summary Although nephrotoxicity has frequently limited conventional treatment with cisplatin to doses of 100–120 mg/m² per cycle, vigorous chloruresis can permit the administration of high-dose cisplatin (200 mg/m² per cycle) with minimal nephrotoxicity. Systemic toxicities are worsened, but therapeutic response seems to be enhanced. The pharmacokinetics of cisplatin in plasma and urine were examined to assess the causes of these effects. Plasma disappearance of ultrafiltrable platinum was well-described by a single exponential for each patient. The mean t_1/2 was 50% longer for patients receiving high-dose cisplatin than for patients receiving conventional doses. The total systemic exposure was three times greater in the high-dose group, which tends to explain the systemic toxicity and improved tumor efficacy, but not the lack of nephrotoxicity. It is suggested that the kidneys of patients in the high-dose group were relatively protected by dilution of active Pt species in the urine in the tubule lumen as well as by high chloride ion concentrations in the urine.     

Comparative effectiveness study of single high-dose cisplatin with fractionated doses cisplatin in first-line therapy for treatment-naive Chinese patients with advanced non–small-cell lung cancer

BackgroundCisplatin is one of the most effective chemotherapeutic drugs for patients with advanced non–small-cell lung cancer (NSCLC). Single high-dose cisplatin is a commonly used chemotherapy regimen in the world. At present, fractionated doses cisplatin is used in most hospitals in China. Although many doctors have begun to try a single dose of cisplatin, there are still few studies on the comparison of the 2 regimens. This study describes the efficacy and side effects of cisplatin single-dose administration and fractionated doses regimen in the treatment of advanced NSCLC.MethodsA retrospective study was conducted on 219 patients with advanced NSCLC who received chemotherapy with DDP were divided into 2 groups according to the single dose of cisplatin from January 2014 to December 2017. For experimental group, 108 patients were enrolled and received DDP at a dose of 75 mg/m² on day 1. A total of 111 patients were enrolled in the control group, and DDP was administrated at 25 mg/m² on days 1-3. The efficacy, toxicity, and progression-free survival of the 2 groups were observed and analyzed.ResultsIn the experimental group, the numbers of patients who received PR, SD, and PD were 66, 34, and 8 respectively. In the control group, the numbers of patients who received PR, SD, and PD were 18, 77, and 16 respectively. The percentages of patients with a objective response rate response in the experimental group were significantly higher than that in the control group (61.11% vs 16.22%, P < 0.0001). The incidence of III-IV vomiting in the experimental group was lower than that in the control group (11.11% vs 26.13%). The incidence of I-II hiccups in the experimental group was higher than that in the control group (15.74% vs 10.81%). None of the patients had III-IV degree nephrotoxicity. Myelosuppression mainly manifested as leukopenia. In the experimental group, the incidence of I-II degree of leukopenia was 71.30%, and the III-IV degree was 7.41%, which was 74.77% and 11.71 respectively in the control group. A small number of patients have a decrease in mild platelets and hemoglobin.ConclusionFor patients with advanced NSCLC who require chemotherapy with DDP regimen, the short-term effect of single-dose administration of DDP is better than that of fractional small-dose administration. Toxicity can be tolerated and it is worth promoting clinically.