6种常用抗肿瘤药物致小鼠肝损害程度的比较研究

目的:比较6种常用抗肿瘤药物的致肝损害程度。方法:取小鼠随机分为7组,每组10只,分别尾静脉注射生理盐水及临床常用剂量的顺铂(17mg·kg-1)、卡铂(67mg·kg-1)、紫杉醇(30mg·kg-1)、多西紫杉醇(17mg·kg-1)、吉西他滨(222mg·kg-1)、长春瑞滨(5.6mg·kg-1),给药第3天检测各组小鼠肝功能生化、肝组织氧化和抗氧化指标,光电镜观察肝组织病理学变化。结果:与生理盐水组比较,6个药物组给药第3天均出现肝功能生化指标与病理组织形状改变:天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、丙二醛(MDA)活性均明显升高,还原型谷胱甘肽(GSH)活性均明显降低(P<0.05或P<0.01);镜下显示细胞脂肪变性最严重的是多西紫杉醇,肝细胞坏死和瘀胆最严重的是多西紫杉醇和吉西他滨;综合各指标显示,6种药物均可致肝损害,严重程度排序为:吉西他滨≈多西紫杉醇>长春瑞滨>顺铂≈紫杉醇>卡铂。结论:6种常用抗肿瘤药物在给药第3天均出现不同程度的致肝损害,其中以吉西他滨和多西紫杉醇致肝损害较严重,建议临床使用时及早预防性应用抗氧化剂。     

长春瑞滨和吉西他滨方案初治老年晚期非小细胞肺癌的对比研究

目的:评价顺铂联合长春瑞滨(NP)或吉西他滨(GP)对老年晚期非小细胞肺癌(NSCLC)的初治疗效和毒副反应。方法:64例老年初治晚期NSCLC(Ⅲb期和Ⅳ期)患者,随机分为NP组(33例)、GP组(31例),化疗2周期后,评价疗效。结果:NP组与GP组近期有效率分别为39.39%、38.71%,中位生存时间分别为8.5、8.3个月,2组间差异均无统计学意义(P>0.05)。NP组以白细胞减少、静脉炎、便秘较为常见,GP组以血小板减少、皮疹为主(P<0.05)。结论:NP和GP方案作为一线化疗方案初治老年晚期NSCLC效果确切,耐受性较好。     

盖诺加顺铂治疗中晚期乳腺癌临床疗效观察

目的探讨盖诺加顺铂治疗中晚期乳腺癌的临床疗效。方法选取2010年3月-2011年2月我院收治的中晚期乳腺癌患者46例，采用盖诺联合顺铂治疗。选取2005年2月-2007年3月我院收治的以顺铂治疗的中晚期患者为对照组。对比两组临床疗效和毒副反应。结果46例患者均完成化疗，其中CR7例、PR21例、SD13例、PD5例，RR 60．9％，DCR 89．1％。对照组53例患者仅采用顺铂化疗，其中CR4例、PR16倒、SD19例、PD14例，RR 37．7％，DCR 73．6％。两组患者RR、DCR均有显著差异（P〈0．05）。毒副反应方面以骨髓抑制和恶心、呕吐为主，两组差异无统计学意义。结论长春瑞滨和顺铂治疗中晚期乳腺癌效果显著，值得进一步推广。     

Phase 2 Study of Nimotuzumab in Combination With Concurrent Chemoradiotherapy in Patients With Locally Advanced Non–Small-Cell Lung Cancer

BackgroundWe evaluated the tolerability and efficacy of nimotuzumab, a humanized IgG1 monoclonal anti–epidermal growth factor receptor antibody, with concurrent chemoradiotherapy in patients with unresectable locally advanced non–small-cell lung cancer.Patients and MethodsIn this multicenter, single-arm, open-label, phase 2 trial conducted in Japan (JapicCTI-090825), patients received thoracic radiotherapy (60 Gy, 2 Gy per fraction, 6 weeks) and four 4-week cycles of chemotherapy (day 1, cisplatin 80 mg/m²; days 1 and 8, vinorelbine 20 mg/m²). Nimotuzumab 200 mg was administrated weekly for 16 weeks. The primary endpoint was treatment completion rate, defined as the percentage of patients completing 60 Gy of radiotherapy within 8 weeks, 2 cycles of chemotherapy, and at least 75% of the required nimotuzumab dose during the initial 2-cycle concurrent chemoradiotherapy period.ResultsOf 40 patients enrolled, 39 received the study treatment, which was well tolerated, with a completion rate of 87.2%. Thirty-eight patients completed 60 Gy of radiotherapy within 8 weeks. Infusion reaction, grade 3 or higher rash, grade 3 or higher radiation pneumonitis, or grade 4 or higher nonhematologic toxicity were not observed. The objective response rate was 69.2%. The median progression-free survival (PFS) and 5-year PFS rate were 508 days and 29.0%, respectively. The 5-year PFS rate in patients with non–squamous cell carcinoma (n = 23) was 13.7% and in patients with squamous cell carcinoma (n = 16) was 50.0%. The 5-year overall survival rate was 58.4%.ConclusionAddition of nimotuzumab to the concurrent chemoradiotherapy regimen was well tolerated and showed potential for treating patients with locally advanced non–small-cell lung cancer, particularly squamous cell carcinoma.     

1例盖诺外渗引起皮肤坏死的护理

盖诺是长春碱类抗癌药，此药外渗引起严重的局部皮肤毒性反应。近三年来在我们使用盖诺治疗的患者中有1例因药液外渗发生局部皮肤坏死，经对症处理使皮肤修复良好，足部功能良好，无关节活动障碍。现将此例治疗护理过程报道如下：     

南风Ⅰ号外用防治长春瑞宾所致静脉炎的临床研究

目的观察新型中药复方制剂——南风Ⅰ号防治长春瑞宾所致静脉炎的临床疗效.方法选择以长春瑞宾为主的联合化疗方案第1、8天给药的患者,将自身2次化疗同一注射部位分成预防组和对照组,对预防组患者给予中药南风Ⅰ号涂剂;将已发生静脉炎的患者随机分成治疗组和对照组,治疗组给予南风Ⅰ号外敷治疗,对照组给予硫酸镁外敷对照进行临床观察.结果采用STATA 8.0软件进行统计分析,卡方检验比较预防组和对照组之间以及治疗组和对照之间的差异,均具有显著的统计学意义（P＜0.01）.结论新型中药复方制剂——南风Ⅰ号对防治长春瑞宾所致静脉炎具有一定的疗效.     

NP方案治疗蒽环类耐药乳腺癌的护理

目的探讨盖诺加顺铂治疗蒽环类耐药晚期乳腺癌的临床应用效果和护理配合。方法蒽环类耐药的晚期乳腺癌52例患者,采用盖诺(NVB)25mg/m2ivgtt·d1,8,顺铂(PDD)30mg/m2,ivgtt.d1～3,21天为1周期,2周期评价疗效,全组化疗共175周期,每例平均3个周期(2～5周期)。结果部分缓解率(PR)42.3%(22/52),无完全缓解患者;生活质量有改善,治疗后Karnofsky评分(77.5±16.6)高于治疗前(69.5±21.5),P>0.05。不良反应主要为白细胞降低86.5%,恶心呕吐59.6%和外周静脉炎30.8%等。结论盖诺加顺铂治疗蒽环类耐药的晚期乳腺癌作为二线化疗,护理人员应做好护理,促进患者康复,观察化疗后患者的反应,保证化疗的顺利进行。     

含铂的3种化疗方案对非小细胞肺癌的疗效比较

目的：分析比较含铂的3种化疗方案对非小细胞肺癌的临床疗效。方法：将102例晚期非小细胞肺癌患者随机分为A、B、c组。分别接受GP方案（吉西他滨＋顺铂）、TP方案（紫杉醇＋顺铂）、NP方案（长春瑞滨＋顺铂）化疗,观察疗效及不良反应情况。结果：A组总有效率为35．3％,B组为38．2％,C组为44．1％。不良反应主要有骨髓抑制、脱发、胃肠道反应、恶心呕吐,经对症处理后均得到明显好转。其中C组骨髓抑制发生率明显高于A、B组（P〈0．05）。结论：3种化疗方案对非小细胞肺癌的疗效相近,不良反应可逆,均为有效治疗方案。     

Developments in cytotoxic chemotherapy: advances in treatment utilising vinorelbine

Vinorelbine is a third generation vinca alkaloid which has been in clinical development for 15 years. Recent exploration of its pre-clinical activity has revealed unexpected evidence of potential synergy with taxane compounds and early clinical results support the suggestion of enhanced efficacy particularly in breast cancer. The initial studies establishing the clinical activity of vinorelbine in breast cancer and non-small cell lung cancer have been extended to encompass a thorough evaluation of its contribution to combination chemotherapy for these disorders. In the treatment of breast cancer useful activity has been established for vinorelbine in combination with anthracyclines, anthracenediones, antimetabolites and the taxanes; additive toxicity is not a limiting factor. The activity of vinorelbine in the treatment of non-small cell lung cancer is significantly extended by incorporation into schedules utilising cisplatin and other agents. Vinorelbine has also demonstrated useful activity in the treatment of a wide range of other malignancies including prostatic carcinoma, multiple myeloma, cancer of the ovary, cervix and head and neck and malignant lymphomas.     

随机对照研究IP/NP方案治疗Ⅲ～Ⅳ期非小细胞肺癌

目的：随机对照观察研究IP／NP方案治疗Ⅲ-Ⅳ期NSCLC的疗效。方法：自2000年8月－2001年10月，治疗47例Ⅲ-Ⅳ期NSCLC，采用分层随机分组法，分别以IFO，DDP组成IP方案和以NVB，DDP组成NP方案治疗。结果：总有效率：IP组34．8％（8／23），NP组37．5％（9／24），NP方案近期疗效略高于IP方案，但二组相比较无显著性差异（P＞0．05），结论：IP／NP方案治疗Ⅲ-Ⅳ期NSCLC疗效较为满意，血液学毒性能控制，非血液学毒性不严重，值得临床使用。