托瑞米芬联合长春瑞滨和顺铂二线治疗中晚期非小细胞肺癌的疗效

目的:前瞻性研究托瑞米芬(toremifene, TOR)联合NP方案(顺铂加长春瑞滨)二线治疗含铂联合化疗方案一线治疗失败的中晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效和安全性.方法:2004年1月-2006年2月,44例接受含铂联合化疗方案一线治疗失败的ⅡB～Ⅳ期NSCLC患者接受了TOR联合NP方案的二线治疗.化疗2个周期后评价疗效和不良反应,并分析生存情况.结果:44例患者的中位化疗周期数为1.8个(范围:1～3个),其中可评价疗效者为37例(既往曾经接受NP方案化疗者21名,接受其他含铂联合化疗方案者16例).37例患者接受二线治疗后,4例获得部分缓解,19例为疾病稳定,14例为疾病进展,无完全缓解者,总有效(完全缓解+部分缓解)率为10.8%(4/37),疾病控制(完全缓解+部分缓解+疾病稳定)率为62.2%(23/37).其中,肺鳞癌患者的有效率和疾病控制率分别为27.3%(3/11)和72.7%(8/11),高于肺腺癌患者的0%(0/18)和44.4%(8/18)(P<0.05).44例患者的中位生存期为8.2个月,中位疾病稳定时间为4.0个月(1.0～10.2个月),总的1年生存率为24.4%.其中,肺鳞癌患者的中位生存期和1年生存率分别为9.2个月和33.3%,肺腺癌患者的中位生存期和1年生存率分别为7.1个月和27.7%,两者比较差异均无统计学意义(P>0.05).男性与女性患者的生存差异也无统计学意义.化疗中,1例患者因肝功能损害(高胆红素血症)中止治疗.化疗不良反应主要包括胃肠反应、骨髓抑制和肝功能损害等,无严重不良反应发生.结论:TOR联合NP方案二线治疗NSCLC患者的疗效与目前的一线含铂联合化疗方案相似,尤其对于肺鳞癌患者而言,且不良反应未见明显增加.     

PI3K／Akt相关基因多态性与胃癌含铂化疗方案疗效的关系分析

目的 探讨PI3K／Akt信号通路中第10号染色体同源丢失性磷酸酶张力蛋白基因（PTEN）和磷脂酰肌醇激酶-3催化亚单位α（PIK3CA）的单核苷酸多态性（SNPs）与晚期胃癌含铂化疗方案疗效的关系。方法 采用Haploview 软件从国际人类基因组单体型图计划（Hap Map）公布的北京汉族人群基因型数据库中筛选出PTEN基因的4个标签SNPs（rs532678、rs926091、rs11202609、rs17431184）及PIK3CA基因的3个标签SNPs（rs2459693、rs3729679、rs12494623）。收集2012年1月至2015年12月158例晚期胃癌患者外周血标本并采用Sequenom MassArray质谱阵列技术对待检样本的以上7个SNPs进行基因分型;采用RECIST 11版标准评价以上患者接受含铂化疗方案2个周期的近期疗效,以CR+PR为敏感组、SD+PD为不敏感组,分析化疗敏感情况与以上SNPs位点基因型、等位基因的关系。结果 158例晚期胃癌患者PTEN及PIK3CA基因7个SNPs的基因型及等位基因分布均符合Hardy-Weinberg平衡。158例患者经2个周期化疗后共有化疗敏感者83例（CR 3例、PR 80例）和不敏感者75例（SD 42例、PD 33例）。PIK3CA rs3729679、rs12494623 SNPs与晚期胃癌含铂化疗方案的敏感性有关,其中携带突变等位基因者（rs3729679 G,rs12494623 T）的化疗敏感率较低,且化疗不敏感的风险显著升高,差异均有统计学意义（P＜0.05）;其余PIK3CA SNPs和PTEN SNPs位点基因分布与化疗敏感率及不敏感风险均无关（P＞0.05）。结论 PIK3CA rs3729679、rs12494623 SNPs与晚期胃癌含铂方案化疗敏感性有关,且携带rs3729679 G或rs12494623 T等位基因者的化疗不敏感风险较高,对于预测晚期胃癌含铂化疗方案的疗效有一定价值。     

Survival benefit with erlotinib maintenance therapy in patients with advanced non-small-cell lung cancer (NSCLC) according to response to first-line chemotherapy

BackgroundIn the placebo-controlled phase III SATURN study, maintenance erlotinib after first-line chemotherapy demonstrated significantly prolonged progression-free survival (PFS) and overall survival (OS) in the overall study population of patients with advanced non-small-cell lung cancer (NSCLC).MethodsAfter four cycles of platinum-based doublet chemotherapy, patients without progressive disease (PD) were randomised to erlotinib (150 mg/day) or placebo until PD or unacceptable toxicity. In this pre-planned analysis, data are assessed according to response to first-line chemotherapy (complete/partial response [CR/PR] or stable disease [SD]).ResultsFollowing first-line chemotherapy, 889 non-PD patients were included in the intention-to-treat population (55% SD; 44% CR/PR; <1% unknown response). Erlotinib maintenance therapy significantly prolonged PFS in both the SD (hazard ratio [HR] = 0.68; P < 0.0001) and CR/PR (HR = 0.74; P = 0.0059) groups, while OS was significantly prolonged in the SD group only (HR = 0.72; P = 0.0019). The erlotinib-related OS benefit in the SD group remained significant across subgroups, irrespective of tumour histology and/or EGFR mutation status. The incidence of adverse events was similar in the SD group and the overall population, and erlotinib treatment did not negatively impact quality of life.ConclusionsPatients with advanced NSCLC and SD following first-line platinum-based doublet chemotherapy derive a significant OS benefit from maintenance erlotinib therapy.     

Carboplatin and etoposide chemotherapy regimen for recurrent malignant glioma: a phase II study.

PURPOSE: A phase II study that used combination chemotherapy with carboplatin (CBDCA) and etoposide (VP 16) (CE) was performed on patients with recurrent malignant glioma to investigate tumor control and toxicity. PATIENTS AND METHODS: Thirty-eight patients were treated with CBDCA 300 mg/m2 on days 1 to 3 and VP 16 100 mg/m2 on days 1 to 5. A minimum of three courses were required unless the patient had a rapid progression of disease (PD). Courses were repeated every 4 weeks. RESULTS: We observed partial responses (PRs) in eight of 38 patients (21%), stable disease (SD) in 12 of 38 (32%), whereas 18 of 38 (47%) patients had PD. The median time to tumor progression (TTP) for PR and SD patients was 42.5 weeks, whereas the median survival time (MST) for PR and SD patients was 47.5 weeks. Three groups of toxicities were observed: hematologic, gastrointestinal, and hepatic. No grade 4 Eastern Cooperative Oncology Group toxicity was observed. CONCLUSIONS: This regimen has shown at least comparable results with other series that used platinum-based agents. Further studies that use these agents in various-dose schedules and drug combinations are warranted.     

Chronological Changes in Neutrophil/lymphocyte Ratio in Advanced Gastric Cancer Patients Treated with Nivolumab: a Report of Nine Cases

Background: Nivolumab has been approved for use in advanced gastric cancer (GC) after third-line chemotherapy in Japan. However, it remains difficult to predict favorable nivolumab response before treatment. Methods: We evaluated the clinical course with a focus on the chronological changes in neutrophil/lymphocyte ratio (NLR) throughout the chemotherapy and assessed the relationship between nivolumab response and chronological changes in NLR before nivolumab administration. Results: We experienced nine cases who received nivolumab monotherapy for unresectable advanced or postoperative recurrent GC. Nivolumab was used as third-line chemotherapy in all patients, and partial response (PR) and stable disease (SD) were observed in two patients each. Nivolumab treatment resulted in progressive disease (PD) in five patients. In patients with PR or SD, changes in the NLR tended to correspond to the response of target metastatic lymph nodes to first- and second-line chemotherapy. In the four cases with PR or SD following nivolumab, ∆NLRresponses that was the difference in the degree of decline during the most effective pretreatment chemotherapy were 1.39, 0.73, 1.62, and 1.22. However, the patients with PD showed lower ∆NLRresponses, at 0.66, 0.66, 0.25, 0.13, and -0.05 in the five cases. Mean ∆NLRresponses in the patients with PR or SD and patients with PD were 1.17 and 0.33, respectively (P = 0.0008). Conclusions: We experienced nine GC cases treated with nivolumab and assessed the association between chronological NLR changes throughout chemotherapy and tumor response to nivolumab. Changes in NLR during pretreatment chemotherapy might predict tumor response to nivolumab monotherapy in patients with advanced GC.     

吉西他滨联合卡培他滨治疗耐药转移性乳腺癌的临床观察

目的探讨吉西他滨和卡培他滨联合化疗治疗蒽环类和(或)紫杉类耐药的转移性乳腺癌的近期疗效和不良反应。方法 2008年3月至2011年3月应用吉西他滨联合卡培他滨治疗转移性乳腺癌38例,每3周为1个周期,所有患者均评估毒性,对至少用过2个周期化疗的患者评估疗效。结果 CR 3例,PR 13例,SD 14例,PD 8例,有效率(CR+PR)为42.1%(16/38),临床获益率(CR+PR+SD)为78.9%(30/38)。主要不良反应为骨髓抑制、手足综合征、胃肠道反应。Ⅲ～Ⅳ度的骨髓抑制发生率低,手足综合征及消化道反应以Ⅰ～Ⅱ度为主。结论吉西他滨联合卡培他滨对蒽环类和(或)紫杉类耐药的转移性乳腺癌有较好的治疗效果,且不良反应可以耐受。     

Study of Pemetrexed-based Chemotherapy for Patients with Locally Advanced or Metastatic Cancers

Purpose: This study was conducted to observe the efficacy and safety of pemetrexed based chemotherapyin treating patients with locally advanced or metastatic cancers as first-line, second-line or third-line therapy.Materials and Methods: From May 2011 to January 2015, we recruited 29 patients with advanced breast cancer,19 patients with advanced ovary cancer, 17 patients with advanced esophageal cancer,5 patients with advancedgallbladder cancer,5 patients with advanced cervical cancer and 1 patient with advanced tongue cancer inJiangsu Cancer Hospital and Research Institute.All of them were pathologically confirmed and treated withpemetrexed based chemotherapy. After two cycles of treatment,efficacy and safety can be evaluated. Results:For pemetrexed based regimens,including 76 patients with 6 kinds of advanced cancer were considered eligiblefor inclusion. Complete remission represents CR, partial remission represents PR, stable disease represents SD,progressive disease represents PD. Among 29 patients with advanced breast cancer, 4 patients chose pemetrexedbased regimens as second-line treatment,1 of them was PR,the other 3 got SD. The last 25 patients made useof this chemotherapy as third-line treatment, except one patient could not be assessed, 2 of them got PR,6 ofthem got SD,the remaining 16 of them finally were PD.19 patients with advanced ovary cancer,5 patients usedthis regimens as second-line treatment, 3 of them got PD,the remaining patients got SD, respectively. The last14 patients made use of pemetrexed based regimens as third-line treatment,. RR (CR+PR) was 28.5%. Among17 patients with advanced esophageal cancer, 2 patients made use of pemetrexed based regimens as first-linetreatment,both of them got PR.4 of them used this chemotherapy as second-line regimen, except 2 patients couldnot be assessed,the remaining 2 was PD at last. The last 11 patients was third-line users, RR (CR+PR) was 18.2%.Among 5 patients with advanced gallbladder cancer, pemetrexed based regimens was used in 1 patient as firstlinetreatment and 1 patient as second-line treatment. The curative effect was SD and PD, respectively. 3 patientsaccepted pemetrexed based regimens as third-line treatment, 2 of them got PD as results and another was SD.Among 5 patients with advanced cervical cancer, just 1 patient adopted pemetrexed based regimens as first-linetreatment, whose curative effect was PR.2 patients chose this chemotherapy regimens as second-line treatment.Both of them got PD as their consequence. The last 2 patients made use of the regimens as third-line treatment,the effect of them was PD and SD, respectively. The one who with advanced tongue cancer, pemetrexed basedregimens was used as second-line treatment, and the consequence was PD. About 71.1% patients experienced bonemarrow suppression. Among them, 5 patients reached 4 grade. Other toxicity of pemetrexed were neurotoxicity,fatigue, diarrhea, dysphagia and vomiting. No treatment related death occurred with pemetrexed-based treatment.Conclusions: Pemetrexed based chemotherapy has considerable effect in patients with advanced cancers suchas breast cancer,esophageal cancer and ovary cancer. More randomly clinical trials are needed to verify theresults.     

晚期NSCLC一线化疗疾病控制与生存关系的分析

目的回顾性分析一线化疗疾病控制（DCR）与进展（PD）患者之间生存的差别,探讨DCR可否预测生存。方法本文回顾性分析本院一线含铂联合化疗86例ⅢB期/Ⅳ期非小细胞肺癌（NSCLC）患者,化疗的疗效按WHO标准分为CR,PR,SD,PD。结果一线化疗后DCR共64例（74.4%）[其中CR 0例,PR 30例（34.9%）,SD 34例（39.5%）],PD 22例（25.6%）。DCR和PD患者中位生存期（MST）有统计学意义,为14.2月和5.1月（P〈0.001）。CR＋PR和SD患者MST有统计学意义,为15.0月和11.0月（P=0.030）。COX多因素回归分析显示一线化疗疾病控制（P=0.017）,ECOG评分（P=0.046）是总生存的独立预后因素。结论本研究提示晚期NSCLC患者一线化疗疾病控制患者其生存较进展患者好,疾病控制比化疗有效似乎更能反映化疗疗效,预测生存期。     

Weekly therapy with folinic acid (FA) and high-dose 5-fluorouracil (5-FU) 24-hour infusion in pretreated patients with metastatic colorectal carcinoma: A multicenter study by the Association of Medical Oncology of the German Cancer Society (AIO)

BACKGROUND: No effective salvage therapy is known for patients with metastaticcolorectal carcinoma progressive after chemotherapy with 5-fluorouracil(5-FU)/folinic acid (FA) or 5-FU/alpha interferon (IFN) combinations.The aim of the study was to test whether weekly FA/high-dose5-FU is an effective therapy in pretreated patients with progressivemetastatic colorectal carcinoma. PATIENTS AND METHODS: Between January and December 1992, 57 patients with metastaticcolorectal carcinoma were treated with weekly infusions of high-dose5-fluorouracil (5-FU) (2600 mg/m² as 24-hour infusion) and folinicacid (FA) (500 mg/m² as 1-hour infusion prior to 5-FU). Allpatients were pretreated with chemotherapy, most of them withregimens containing 5-FU i.v. bolus/FA or 5-FU/alfa interferon(IFN), and all had documented progressive disease at the timeof entering the study. In patients with partial remission (PR)or stable disease (SD) with improvement of their clinical condition,therapy was continued until progressive disease (PD) was documented.In all other patients therapy was stopped after one course (6infusions). RESULTS: 5/57 patients (9%) achieved PR, 32/57 (56%) SD, in 19/57 (33%)disease was progressive and one toxic death occured. 26/32 patients(81%) with SD or PR after the first chemotherapy again obtainedSD or PR on high-dose 5-FU/FA but only 8/18 (44%) of those withPD after first chemotherapy did so. The median duration of SD/PRwas 3 months and the median survival for all patients 8 months(range 3–17+). Apart from one toxic death, toxicity consistingfor the most part of mucositis (n = 24), nausea (n = 23), diarrhoea(n – 18) and hand-foot syndrome (n = 12) was moderate. CONCLUSION: Pretreated patients with metastatic colorectal carcinoma, notablythose with a primary PR or SD, can probably benefit from weeklyhigh-dose 5-FU/FA. metastatic colorectal carcinoma, high-dose 5-FU/FA     

CEA and CA19.9 as early predictors of progression in advanced/metastatic colorectal cancer patients receiving oxaliplatin-based chemotherapy and bevacizumab

We evaluated the changes of the tumor markers CEA and CA19.9 as early predictors of progression in metastatic colorectal cancer (mCRC) patients participating in a clinical study and receiving chemotherapy and bevacizumab (Bev). Seventy-two patients had high baseline CEA or CA19.9 serum levels. By ROC analyses, the areas under the curves were 0.83 for variable CEA cutoff values for distinguishing progressive disease (PD) versus stable disease (SD)/partial remission (PR)/complete remission (CR), and 0.80 for variable CA19.9 cutoff values for distinguishing PD versus SD/PR/CR. Rises in CEA and CA19.9 may early signal the occurrence of progression in mCRC patients receiving chemotherapy and Bev.     

DNA损伤修复基因XRCC1和XPD遗传多态与晚期非小细胞肺癌对铂类药物的敏感性

目的 探讨DNA损伤修复基因XRCC1和XPD的遗传多态与晚期非小细胞肺癌（NSCLC）对以铂类为主化疗药物敏感性的关系。方法 以聚合酶链反应（PCR）结合限制性片段长度多态性（RFLP）,检测200例以顺铂（DDP）或卡铂（CBP）为主要化疗方案的NSCLC患者XRCC1 Arg194Trp和XPD Lys751Gln多态基因型,并比较不同基因型与化疗敏感性的关系。结果 化疗总有效（CR＋PR）率为36．0％,其中CR1例,PR71例,SD94例,PD34例。携带XRCC1第194位密码子Arg／Trp或Trp／Trp基因型的个体化疗敏感性是XRCC1第194位密码子Arg／Arg基因型携带者的2．48倍（95％CI为1．36～4．51,P=0．003）;未发现XPD Lys751Gln多态与化疗敏感性的相关性。联合分析这两个遗传多态发现,XRCC1 Arg194Trp和XPD Lys751Gln多态在NSCLC对铂类药物敏感性中存在一定的联合作用（趋势检验,P=0．004）。结论XRCC1 Arg194Trp和XPDLys751Gin遗传多态可能与NSCLC铂类药物敏感性有关。     

血清CA125、CEA、IL-10水平检测对晚期非小细胞肺癌患者预后价值分析

目的 探讨晚期非小细胞肺癌患者血清CA125、CEA、IL-10水平在预后中的价值.方法 采用ELISA法检测不同分期NSCLC患者治疗前后CA125、CEA、IL-10的水平;观察对比化疗前后不同分期的NSCLC患者CA125、CEA、IL-10的表达水平;评价化疗后NSCLC患者的疗效及生存期.结果 化疗前Ⅳ期患者CA125、CEA、IL-10水平高于Ⅲ期患者;PR患者血清CA125、CEA、IL-10水平治疗后明显降低,SD患者CA125、CEA、IL-10水平治疗前后无显著变化,PD患者CA125、CEA、IL-10水平治疗后均显著升高;PR患者平均生存期显著长于SD患者,SD患者平均生存期显著长于PD患者.结论 血清CA125、CEA、IL-10是评估晚期非小细胞肺癌患者预后有价值的指标.     

Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer

PURPOSE: Selective internal radiation therapy (SIRT) with SIR-Spheres(R) is a new technique for selectively targeting high doses of radiation to tumours within the liver. The primary objectives of this randomised trial were to compare the response rate, time to progressive disease (PD), and toxicity of a regimen of systemic fluorouracil/leucovorin chemotherapy versus the same chemotherapy plus a single administration of SIR-Spheres in patients with advanced colorectal liver metastases. The trial was designed to presage a larger trial that would have survival as the primary outcome. PATIENTS AND METHODS: Twenty-one patients with previously untreated advanced colorectal liver metastases, with or without extrahepatic metastases, were randomised into the study. RESULTS: Using RECIST criteria, the response rate for 11 patients receiving the combination treatment was significantly greater than for 10 patients receiving chemotherapy alone (First Integrated Response; 10 PR, 1 SD vs. 0 PR, 6 SD, 4 PD, P < 0.001 and Best Confirmed Response; 8 PR, 3 SD vs. 0 PR, 6 SD, 4 PD P < 0.001). The time to PD was greater for patients receiving the combination treatment (18.6 months vs. 3.6 months, P < 0.0005). Median survival was significantly longer for patients receiving the combination treatment (29.4 months vs. 12.8 months, P = 0.02). One patient in the combination arm died from chemotherapy induced neutropenic sepsis after the fourth chemotherapy cycle. There were more Grade 3 and 4 toxicity events in patients receiving the combination treatment. There was no difference in quality-of-life over a 3 month period between the two treatments when rated by patients (P = 0.96) or physicians (P = 0.98). CONCLUSIONS: This small phase 2 randomised trial demonstrated that the addition of a single administration of SIR-Spheres to a regimen of systemic fluorouracil/leucovorin chemotherapy significantly increased both treatment related response, time to PD, and survival with acceptable toxicity. The combination of SIR-Spheres plus systemic chemotherapy is now the subject of ongoing trials to further define patient benefit.     

CGS 16949A, a new aromatase inhibitor in the treatment of breast cancer--a phase I study

Forty-six postmenopausal women with either locally advanced or metastatic breast cancer were treated with the aromatase inhibitor CGS 16949A in three different daily doses (0.3 mg, 0.6 mg and 0.9 mg total daily dose). 41 patients (89%) were pretreated by endocrine treatment for metastatic disease; 30 of these 41 were also pretreated with chemotherapy. Of the remaining 5 patients (11%) 3 were previously treated with chemotherapy alone and 2 were not pretreated. Evaluable sites of disease were: skin and soft tissue (including local recurrence) in 34, bone in 31, lung in 14 and viscera in 13 instances, respectively. 1 PR (3%) and 9 stable diseases (24%) were observed in the 37 patients assessable for response. All but two of these results were observed in the 0.9 mg group. Time to progression was 14 months for the patient showing a PR, and the median time to progression for those with stable disease was 6 months (range 6 to 23 months). Plasma estradiol and estrone levels were measured in patients receiving the daily dose of 0.6 mg (n = 4) and 0.9 mg (n = 15). The estrone levels decreased from a mean of 23.1 pg/mL (SD 17.1) to 10.5 pg/mL (SD 6.6) in the 0.6 mg-group and from 21.2 pg/mL (SD 18.9) to 9.1 pg/mL (SD 5.5) in the 0.9 mg-group within 4 days of drug administration (p less than 0.0001 from baseline in both groups, with no significant difference between doses).(ABSTRACT TRUNCATED AT 250 WORDS)     

重组人血管内皮抑制素联合化疗治疗晚期胃癌的临床观察*

目的：观察国产抗肿瘤血管生成剂重组人血管内皮抑制素（恩度）与化疗药物联合治疗晚期胃癌的有效性和安全性。方法：２００７年１月～２００９年１月,９例晚期胃癌患者接受恩度联合常规化疗药物治疗。恩度７.５ｍｇ／ｍ２（１５ｍｇ／ｄ）,加入生理盐水５００ｍｌ内静滴,连用１４天为１疗程。同时,有４例患者采用ＦＯＬＦＯＸ４方案,４例患者采用喜树碱类为主的方案,１例患者采用紫杉醇为主的方案化疗。分别按照ＲＥＣＩＳＴ标准和ＮＣＩ-ＣＴＣ３.０评价疗效和毒性。结果：９例中８例可评价疗效。获３例ＰＲ,４例ＳＤ,１例ＰＤ。总有效率３７.５％,疾病控制率８７.５％。４例一线治疗者获ＰＲ、ＳＤ各２例;２例二线治疗者获ＰＲ、ＳＤ各１例;２例四线治疗者获ＳＤ、ＰＤ各１例。疾病进展时间（ＴＴＰ）为２～１４个月。９例患者均可评价毒性,主要毒副反应为粒细胞减少、恶心呕吐、乏力和虚弱,考虑主要与化疗相关;未见明显心血管系统毒性和出血情况。结论：初步观察恩度联合化疗药物治疗晚期胃癌疗效明显,不增加化疗毒性,安全性高,值得进一步积累病例和积极开展多中心临床协作研究。     

A Phase II Study of Advanced Colorectal Cancer Patients Treated with Combination 5-Fluorouracil Plus Leucovorin and Subcutaneous Interleukin-2 Plus Alpha Interferon

Summary

Twenty-one patients with advanced, pretreated colorectal cancer in disease progression were entered in a phase II study to investigate the use of 5-fluorouracil (5FU) + leucovorin with subcutaneous Interleukin-2 + alpha interferon (α-IFN). Eighteen of these patients were evaluable for response to treatment: 1 partial response (PR) (duration 8 months), 9 stable disease (SD) (median duration of 6.5 months, range 2-15) and 8 progressive disease (PD). The PR patient survived for 15 months, the SD patients for a median of 11 months and 8 months for PD patients. Toxicity evaluated in the 21 patients reached grade 4 for mucositis in two cases. Grade 3 toxicity was observed more frequently for fever (52.3%) and diarrhea (33.3%) and was most probably the result of the combined side-effect of chemotherapy and the biological response modifiers (BRMs). Treatment was, for the most part, carried out on an out-patient basis as originally planned.

In 15 patients tests were carried out to verify whether any immuno-activation had taken place. Significant increases were found during the course of therapy regarding cluster of differentiation activation (HLA-DR, CD71, CS25). Different curves were observed during the course of treatment with respect to the CD8 value, which proved higher in SD patients than in PD patients.

Our study would seem to suggest that the addition of BRMs to 5FU + leucovorin could increase survival. The next step, however, must be to determine lower doses of IL-2 for subcutaneous administration in order to reduce toxicity but maintain the same immunostimulation.     

含奈达铂联合方案治疗口腔鳞癌的近期疗效观察

目的：观察含国产奈达铂联合方案治疗口腔鳞癌的近期疗效和毒副反应。方法：20例T3、T4期口腔鳞癌患者随机分成两组接受诱导化疗,其中10例为含奈达铂联合化疗组（VMNP组）,10例为含顺铂联合化疗组（VMPP组）,初步评价奈达铂的临床疗效。结果：VMNP组10例患者中,CR3例,PR5例,MR1例,SD1例,总有效率为80％;VMPP组10例患者中,CR1例,PR5例,MR2例,SD1例,PD1例,总有效率为60％,二者无显著性差异（P〉0．05）;VMNP组临床毒副反应较轻。结论：含奈达铂联合化疗方案治疗口腔鳞癌有较好的近期疗效。     

白蛋白结合型紫杉醇治疗晚期胰腺癌的临床观察

目的探讨白蛋白结合型紫杉醇治疗晚期胰腺癌患者的临床疗效及不良反应。方法选择2010年8月至2014年7月就诊于南京医科大学附属肿瘤医院的35例晚期转移性胰腺癌患者,均以白蛋白结合型紫杉醇为基础药物的联合化疗方案治疗,回顾性分析其治疗效果和安全性。结果 35例患者均可评估疗效。无完全缓解(CR)病例,13例部分缓解(PR),16例疾病稳定(SD),6例疾病进展(PD)。其中,一线治疗中7例PR,5例SD;二线治疗中4例PR,7例SD;二线以上治疗中4例SD。一线治疗的中位无进展生存期(m PFS)为7.1个月,二线治疗的m PFS为4.8个月,二线以上治疗的m PFS为5.3个月。主要不良反应为脱发、血液毒性、肝功能损伤、消化道反应等,经对症处理后均好转。结论白蛋白结合型紫杉醇联合化疗治疗晚期胰腺癌疗效肯定,耐受性良好,值得进一步研究。     

DNA修复率预测晚期胃癌含铂化疗方案疗效的研究

目的 探讨晚期胃癌外周血淋巴细胞（PBLC）的DNA修复率（DRR）与含铂化疗方案疗效的关系。方法 采用单细胞凝胶电泳法检测47例晚期胃癌患者（胃癌组）PBLC的DRR,同时选取20例非肿瘤患者作为对照（对照组）。所有胃癌患者均接受含铂化疗方案治疗并评价疗效。分析两组顺铂暴露前与暴露并经修复后的DRR及胃癌组DRR与临床病理特征和含铂化疗方案疗效的相关性。结果 利用尾长（Z=4.662,P=0.000）和尾相（Z=3.827,P=0.000）检测胃癌组PBLC的DRR均低于对照组。胃癌组PBLC的 DRR与年龄、性别、ECOG评分、组织分化和嗜酒习惯均无关（P＞0.05）。47例患者中43例可评价疗效,其中获CR 1例、PR 12例、SD 13例、PD 17例,疾病控制率为60.5％。以尾长作为评价DRR的指标提示DRR与化疗疗效呈负相关（r=-0.327,P=0.032）,而以尾相作为评价DRR的指标提示DRR与化疗疗效无关（r=0.143,P=0.361）。结论 胃癌患者较非肿瘤人群DNA修复能力降低,DRR可以预测晚期胃癌患者含铂化疗方案的近期疗效。     

Efficacy of First-line Chemotherapy Affects the Second-Line Setting Response in Patients with Advanced Non-Small Cell Lung Cancer

Background: Chemotherapy is the mainstay of treatment for the majority of patients with advanced nonsmall cell lung cancer (NSCLC) without driver mutations and many receive therapies beyond first-line. Secondline chemotherapy has been disappointing both in terms of response rate and survival and we know relatively little about the prognostic factors. Materials and Methods: One thousand and eight patients with advanced NSCLC who received second-line chemotherapy after progression were reviewed in Shanghai PulmonaryHospital, China, from September 2005 to July 2010. We analyzed the effects of potential prognostic factors on the outcomes of second-line chemotherapy (overall response rate, ORR; progression free survival, PFS; overall survival, OS). Results: The response and progression free survival of first-line chemotherapy affects the ORR, PFS and OS of second-line chemotherapy (ORR: CR/PR 15.4%, SD 10.1%, PD2.3%, p<0.001; PFS: CR/PR 3.80 months, SD 2.77 months, PD 2.03 months, p<0.001; OS: CR/PR 11.60 months, SD 10.33 months, PD 6.57 months, p=0.578, p<0.001, p<0.001, respectively). On multivariate analysis, better response to first-line therapy (CR/PR: HR=0.751, p=0.002; SD: HR=0.781, p=0.021) and progression within 3-6 months (HR=0.626, p<0.001), together with adenocarcinoma (HR=0.815, p=0.017), without liver metastasis (HR=0.541, p=0.001), never-smoker(HR=0.772, p=0.001), and ECOG PS 0-1 (HR=0.745, p=0.021) were predictors for good OS following secondline chemotherapy. Conclusions: Patients who responded to first-line chemotherapy had a better outcome after second-line therapy for advanced NSCLC, and the efficacy of first-line chemotherapy, period of progression, histology, liver metastasis, smoking status and ECOG PS were independent prognostic factors for OS.