卡培他滨联合草酸铂和紫杉醇一线治疗晚期或转移性胃癌

目的 评估卡培他滨联合草酸铂和紫杉醇一线治疗晚期或转移性胃癌的疗效和毒副反应.方法 全组36例患者,采用卡培他滨1250mg/(m2·d),连用14d;紫杉醇90mg/(m2·d)静滴,第1、8d;草酸铂100mg/(m2·d)静滴,第1、8d;21d为1周期,用药2～6个周期后进行评估.结果 全组34例可评价,获得CR 1例,PR 21例,SD 8例,PD 3例,有效率(CR PR)为69.5%,中位TTP为9个月(2～17个月),中位生存时间16个月(2～38个月).主要毒副反应为胃肠反应和骨髓抑制,多为Ⅰ～Ⅱ度毒性反应,Ⅲ～Ⅳ度毒性反应主要为口腔炎、恶心呕吐、白细胞和血小板降低.所有患者均无化疗相关性死亡.结论 卡培他滨联合草酸铂和紫杉醇一线治疗晚期胃癌患者近期疗效较好,不良反应可以耐受,值得临床推广.     

国产紫杉醇联合卡铂治疗晚期非小细胞肺癌23例分析

目的观察国产紫杉醇联合卡铂方案治疗晚期非小细胞肺癌（NSCLC）的疗效和毒副反应。方法选取初治晚期非小细胞肺癌23例，采用紫杉醇、卡铂方案联合化疗，按WHO疗效及毒副反应评价标准，完成2个周期以上治疗的患者进行临床疗效及不良反应评估。结果可评价患者23例，有效率为39.1%，随诊20例中位生存期为8.9个月，1年生存率为40%（8/20）。全组毒性反应主要为血液学毒性，其中Ⅲ-Ⅳ期白细胞降低发生率为39.1%（9/23），血小板下降发生率为8.7%（2/23），血红蛋白下降发生率为4.3%（1/23）。结论紫杉醇联合卡铂治疗晚期非小细胞肺癌较好疗效。不良反应可耐受，安全性高，可在临庆推广应用。     

冠状动脉药物涂层支架治疗急性心肌梗死

20世纪80年代以来的研究表明，在冠状动脉粥样硬化斑块破裂的基础上血栓形成，使冠状动脉急性闭塞，是导致ST段抬高的急性心肌梗死的原因。常用的血运重建方法是溶栓治疗和直接冠脉介入术（percutaneous coroanry intervention，PCI）。溶栓治疗与安慰剂对比可明显降低病死率。直接PCI可使梗死相关血管再通率高，达到心肌梗死溶栓试验（TIMI）3级血流者明显多，再闭塞率低。缺血复发少，且出血（尤其脑出血）的危险性低。Keeley等比较了两种方法的23个随机临床对照试验。直接PCI无论是短期死亡、非致死性心肌梗死、卒中．还是联合终点，都好于溶栓治疗。2004年的美国心脏学会／美国心脏协会在治疗急性心肌梗死指南中建议的对早期急性心肌梗死患者中梗塞相关血管的早期支架植入术已成为标准的治疗方案之一。     

Effects of paclitaxel, docetaxel and their combinations on subcutaneous lymphomas in inbred Sprague–Dawley/Cub rats

We investigated, whether the effects on paclitaxel, docetaxel or their combinations on T-cell lymphomas in Sprague-Dawley/Cub rats were mainly caused by their different efficiency or combination of different mechanism of action, or limited by metabolic inactivation by P450 enzymes or drug efflux caused by P-glycoprotein (P-gp). Docetaxel most effectively prolonged the survival of rats and the time of lymphoma appearance, inhibited their intravital size and weight after sacrifice. Paclitaxel was poorly effective and combined administration had intermediate effects. Blood levels of both drugs were similar. Repeated administration of paclitaxel, but not docetaxel, decreased its area under concentration, but the effect disappeared 6h after dosing and was not sufficient to explain lower effects of paclitaxel. The faster metabolism of docetaxel than paclitaxel in vitro did not limit its higher efficiency and repeated administration of paclitaxel did not induce its metabolism to decrease its blood levels sufficiently. Likewise, undetectable expression of P-gp protein in tumours could not explain lower effects of paclitaxel, which is a better substrate of P-gp. Docetaxel was three-fold more effective than paclitaxel against P388D1 lymphoma cell line, used as a model of the T-cell lymphoma and combined action was dominated by the effects of docetaxel. Thus, docetaxel was effective against T-cell lymphomas and may be a potential anticancer drug in similar indications.     

紫杉醇阿霉素治疗晚期乳腺癌疗效观察

目的 观察紫杉醇联合阿霉素（TA）治疗晚期乳腺癌的疗效和不良反应。方法 对54例晚期乳腺癌患者进行观察。结果 TA总有效率61．1％，主要不良反应有骨髓抑制、胃肠反应、脱发等。结论 紫彬醇联合阿霉素对晚期乳腺癌有较好的疗效和耐受性。     

紫杉醇联合表阿霉素双周方案治疗转移性乳腺癌32例

目的观察紫杉醇联合表阿霉素(TE)双周方案治疗转移性乳腺癌的近期疗效与毒副反应。方法32例转移性乳腺癌患者采用TE方案化疗,表阿霉素40mg/(m2.d)第1、2天静脉滴注,紫杉醇85mg/m2第3天静脉滴注,14天为一周期,完成2～4个周期,评价疗效和毒副反应。结果CR5例,PR19例,NC8例,无PD,有效率(RR)为75.00%,其中初治组有效率为91.67%,复治组为65.00%(P<0.05),差异有统计学意义,初治组有效率高于复治组。主要剂量限制性毒性为骨髓抑制,Ⅲ～Ⅳ度骨髓抑制发生率为40.63%(13/32),所有患者均需要使用G-CSF支持治疗。结论TE双周方案治疗转移性乳腺癌疗效好,毒副反应可耐受,是治疗晚期乳腺癌较好的方案。     

Phase I-II study of biweekly paclitaxel administration with fixed-dose-rate cisplatin in advanced gastric cancer

Background Both paclitaxel (TXL) and cisplatin (CDDP) show efficacy against gastric cancer. The aim of this phase I-II study was to determine the maximum tolerated dose (MTD) and to evaluate the toxicity and efficacy of combination chemotherapy with these two agents. Methods Nineteen patients entered the phase I part of the study, and 21 patients entered the phase II part. TXL infusions were administered on days 1 and 15, with a fixed 3mg/m² dose of CDDP. Results In the phase I part of the study, we determined dose level 5, which represented a TXL dose of 18mg/m², with CDDP 3mg/m², to be the MTD. The recommended dose (RD) was level 4, with a TXL dose of 16mg/m² with CDDP, 3mg/m². In the phase II part of the study, the response rate was 25.0%; five patients had a partial response, seven had stable disease, 6 had progressive disease, and 2 were not evaluable. Grade 3 or 4 neutropenia was the most common adverse event and occurred in 65% of the patients. During treatment, 25% of the patients received granulocyte colony-stimulating factor, but febrile neutropenia was not shown in any of the patients. Major nonhematological toxicities were nausea/vomiting, anorexia, fatigue, alopecia, and sensory neuropathy. Adverse reactions of grade 3 or 4 were shown by two patients, one with anorexia (5%) and the other with sensory neuropathy (5%). Conclusion The RD was determined to be TXL 14mg/m², with CDDP 3mg/m².     

紫杉醇联合顺铂治疗晚期非小细胞肺癌临床观察

目的评价TP方案治疗晚期NSCLC近期疗效和毒副反应。方法TAX 135mg／m^2．d1，DDP 75mg／m^2，分5天应用，21天为1疗程。结果可评价疗效者40例，无CR病例，PR37．5％（15／40），SD47．5％（19／40）．PD15．0％（6／40），临床症状改善率72．5％（29／40）。毒副作用主要为血液毒性95．0％（38／40）和恶心呕吐52．5％（21／40）。结论TP方案对晚期NSCLC有较好疗效，且不良反应可以耐受。     

紫杉醇联合顺铂治疗晚期鼻咽癌临床应用

目的 评价紫杉醇联合顺铂治疗晚期鼻咽癌的临床疗效和毒副反应。方法 28例晚期局部复发或／和远处转移性鼻咽癌患者采用紫杉醇175mg／m^2，静脉滴注持续3h，第1天给药；DDP30mg／m^2，静脉滴注，第2～4天。21d为1周期，2周期后评价疗效。结果 全组均可评价，CR3例，PR15例。有效率（RR）为64．28％，主要毒副反应为骨髓抑制，周围神经炎，消化道反应，肌肉及关节痛，脱发等。结论 紫杉醇联合顺铂治疗晚期局部复发或／和远处转移性鼻咽癌有较高疗效，毒副反应较小，值得临床进一步研究。     

紫杉醇联合草酸铂对比紫杉醇联合顺铂一线方案治疗晚期非小细胞肺癌临床研究

背景与目的 紫杉醇与顺铂联合治疗非小细胞肺癌有明确疗效，但顺铂毒副反应较大。本试验选择毒副反应较小的草酸铂替代顺铂治疗晚期非小细胞肺癌，观察其疗效及不良反应。方法 2002年1月～2004年10月共83例确诊为非小细胞肺癌患者入组，随机分成试验组（紫杉醇175mg／m^2，第1天，草酸铂130mg／m^2，第1天，每21天重复，连用2--周期）和对照组（给予紫杉醇175mg／m^2，第1天，顺铂80mg／m^2，第1天，每21天重复一次，连用2～6周期），比较两组的有效率和不良反应发生率。结果 83例均顺利完成2周期以上化疗，可评价疗效。试验组有效率为34．1％（14／41），对照组为33．3％（14／42），试验组中位无进展生存时间为6．0个月，对照组为5．5个月，试验组中位生存时间为10．7个月，对照组为10．5个月，试验组1年生存率为39．0％（16／41），对照组为40．5％（17／42），均无统计学差异。毒副反应方面，试验组Ⅲ＋Ⅳ白细胞下降率为4．9％，对照组为28．6％，试验组无Ⅲ＋Ⅳ血小板下降者，对照组为14．3％，试验组Ⅲ＋Ⅳ恶心呕吐率为7．3％，对照组为26．2％，均有统计学差异。试验组Ⅲ＋Ⅳ神经损害率为9．8％，对照组为9．5％，试验组无Ⅲ＋Ⅳ肾功能损害者，对照组为7．1％，试验组无Ⅲ＋Ⅳ肌肉关节疼痛者，对照组为2．4％，均无统计学差异。结论 紫杉醇联合草酸铂方案与紫杉醇联合顺铂治疗晚期非小细胞肺癌的疗效相似，但不良反应明显减少。