吉西他滨联合卡铂治疗老年晚期非小细胞肺癌临床疗效观察

目的观察分析吉西他滨联合卡铂治疗老年晚期非小细胞肺癌的临床疗效。方法选择我院2008年1月～2011年1月住院初治及复治的NSCLC患者21例,对初治、复治以及不同类型、不同分期的NSCLC患者的疗效及毒副作用情况进行分析。结果初治患者的疗效明显高于复治的疗效,两组比较差异具有统计学意义（P〈0．05）。不同类型NSCLC的疗效比较差异无统计学意义（P〉0．05）。不同分期NSCLC的疗效比较差异无统计学意义（P〉0．05）。主要不良反应为骨髓抑制、白细胞和血小板的减少。结论吉西他滨联合卡铂治疗老年晚期非小细胞肺癌临床疗效确切、毒副作用少,值得广泛推广和应用。     

What's new in pancreatic cancer treatment?

Pancreatic cancer represents a major challenge to oncologists because of its high chemoresistant nature and dismal outcomes. Conventional therapy for advanced disease relied for a long time on palliative 5-fluorouracil (5-FU)-based chemotherapy, but with unsatisfactory results. The introduction of the novel antimetabolite gemcitabine provides new optimism for patients with advanced pancreatic cancer, as multiple clinical trials have demonstrated the superiority of gemcitabine over 5-FU and other agents for these patients. The benefits of gemcitabine over conventional therapies include improved response rate and enhanced survival, as well as improvement in disease-related symptoms and quality of life in these patients. With these data, gemcitabine is widely accepted worldwide as the therapy of choice by many oncologists for advanced pancreatic cancer. The current review presents an overview of the clinical studies of gemcitabine over the past decade for the treatment of patients with advanced pancreatic cancer. Other investigational regimens or uses (e.g., fixed dose-rate infusion, intraarterial infusion, adjuvant use, chemo-radiation, etc) are also reviewed. Received: October 27, 2001 / Accepted: November 16, 2001     

Phase-II Trial Using Gemcitabine as Monochemotherapy in Patients with Metastasized Pancreatic Carcinoma

Summary BACKGROUND: The aim of this phase-II study was to evaluate the efficacy of gemcitabine monochemotherapy in patients with metastasized pancreatic carcinoma known to have a poor overall tumor response rate to chemotherapy in order to achieve an improvement in the quality of life. METHODS: In 28 patients with metastasized pancreatic carcinoma (mean age, 63.7 years; range, 37 to 77 years; sex ratio, 13 males, 15 females), systemic chemotherapy with gemcitabine (dose, 1000 mg/m²) was administered on day 1, 8 and 15. After one further week (day 29), the cycle was repeated. After each 2nd cycle, extension of tumor growth (restaging) including radiological imaging (ultrasound, computed tomography, plain film of the thorax) and laboratory analysis (tumor marker) was performed. Frequency, severity and spectrum of side effects were assessed according to WHO grading prior to each treatment. Quality of life was evaluated using standardized questionnaires. RESULTS: All in all, 106 chemotherapeutic cycles were administered in 28 patients (range, 1–18 cycles; mean, 3.78). While in no patient complete remission was observed, 2 out of 28 patients showed partial remission (7.2 %). In 11 out of 28 patients, stable tumor disease was detected (39.2 %). Fifteen out of 28 patients (53.6 %) showed progressive tumor growth. Four out of 28 patients lived longer than 1 year (1-year survival rate, 14.3 %). Side effects of the chemotherapy were only moderate. Only in 26 of 106 cycles (26.5 %), side effects were documented. Significant improvement in the quality of life was reported in 25 % of the treated patients. CONCLUSIONS: Chemotherapy using gemcitabine is a well tolerable treatment option with a minimal rate of side effects in the case of metastasized pancreatic carcinoma. However, overall response rate is low. Even considering the acceptable median survival time of 9.1 months most likely caused by second-line chemotherapy, optimization of gemcitabine monotherapy appears to be required using a combination with a further potential cytostatic drug.     

Gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are medically unsuitable for or who have failed cisplatin-based chemotherapy

Objective: To evaluate the efficacy and toxicity of gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are unsuitable for or who have failed cisplatin-containing chemotherapy.Patients and Methods: Thirty-one patients with advanced transitional cell carcinoma (TCC) of the bladder were scheduled to receive gemcitabine and vinorelbine chemotherapy. Twenty-one patients had received no prior chemotherapy and their creatinine clearance was below 50 ml/min (group 1), and the remaining 10 patients did not respond to previous cisplatin-containing chemotherapy (group 2).Results: In group 1, objective response rate was 47.6%, including 2 (9.5%) complete and 8 (38.9%) partial responses. In group 2, partial response was observed in 2 (20%) patients. The median survival time for patients in group 1 and 2 were 15 months (range 3–23) and 7 months (range 3–21), respectively. Grades 3 or 4 leukopenia developed in 16.1% of patients. Overall, 12.9% of the patients suffered from grade 3 nonhematologic toxicity.Conclusion: Our preliminary data indicate that the combination of gemcitabine and vinorelbine is active and well tolerated especially in patients with advanced TCC who are unsuitable for cisplatin-based chemotherapy.     

奈达铂联合吉西他滨治疗转移性三阴性乳腺癌的近期疗效和不良反应

目的探讨奈达铂联合吉西他滨治疗转移性三阴性乳腺癌(TNBC)的近期疗效和不良反应。方法选择2010-09—2014-12间入住的52例TNBC患者作为研究对象。其中首发组患者21例,术后复发组患者31例。化疗方案为:奈达铂80 mg/m2,d1;吉西他滨1 000 mg/m2,d1,8,静滴。每21 d为一个化疗周期。持续两个周期后对疗效进行评价。比较2组患者近期疗效及不良反应发生情况。结果 (1)首发组总缓解率显著高于术后复发组(P0.05)。首发组患者中位无进展生存时间(PFS)为(21.52±3.22)个月,术后复发组患者PFS为(16.73±1.82)个月,首发组患者PFS显著高于术后复发组(P0.05)。(2)本组患者治疗过程中,主要发生的不良反应包括:贫血、中性粒细胞减少、血小板减少、恶心呕吐、腹泻、便秘、脱发、皮疹等,且不良反应毒性分级以1~2级为主。结论奈达铂联合吉西他滨治疗转移性三阴性乳腺癌(TNBC)的近期疗效显著,不良反应主要以1~2级为主。     

多西紫杉醇联合吉西他滨治疗晚期非小细胞肺癌的临床观察

目的:观察非铂类药物多西紫杉醇(艾素)和吉西他滨(泽菲)联合治疗晚期非小细胞肺癌(NSCLC)的临床疗效及不良反应。方法:37例NSCLC给予泽菲1 000mg/m2,第1天和第8天静脉滴注30min,艾素75mg/m2,第8天静脉滴注1h,21d为一个周期,至少治疗2个周期。结果:全组33例可评价疗效,CR 1例,PR 11例,总有效率为39.4%(CR+PR),SD45.5%(15/33),PD18.2%(6/33),中位生存期为11个月,疾病进展时间为6.5个月;1年生存率为48.5%(16/33)。不良反应主要是骨髓抑制,其中Ⅲ~Ⅳ度白细胞下降有31.4%,Ⅲ~Ⅳ度血小板下降有23.5%;非血液学毒性表现为恶心及呕吐,Ⅰ~Ⅱ度有23.1%,无Ⅲ~Ⅳ度恶心及呕吐。结论:多西紫杉醇联合吉西他滨对于晚期NSCLC疗效较理想,不良反应较低,对于提高生活质量有意义,是可以替代铂类药物的有效方案。     

吉西他滨联合顺铂治疗鼻咽癌远处转移的临床研究

目的观察吉西他滨联合顺铂治疗鼻咽癌远处转移的临床疗效和不良反应。方法吉西他滨1000mg/m2,分别于第1天和第8天静脉点滴,顺铂30mg/m2,第1～3天,21天为1个周期,所有病例接受至少2个周期的化疗。结果32例患者入组,完全缓解7例,部分缓解21例,总有效率为87.5%(28/32)。主要不良反应为骨髓抑制、恶心、呕吐、脱发及皮疹,有4例(12.5%,4/32)发生了Ⅲ～Ⅳ度骨髓毒性。结论吉西他滨联合顺铂方案治疗鼻咽癌远处转移有较好的疗效,患者耐受性良好,值得临床进一步研究。     

健择联合卡铂或顺铂治疗晚期非小细胞肺癌

目的 观察健择联合卡铂与健择联合顺铂治疗晚期非小细胞肺癌的疗效和毒副反应。方法 157例均经病理或细胞学确诊为晚期非小细胞肺癌患者,分为GC和GP两组接受治疗。21天为1周期,每例完成2周期后评价疗效。结果 近期疗效C,C组和GP组均无1例完全缓解,部分缓解初冶分别为53．3％、55．8％,复治分别为26．3％、29．2％（P〉0．05）。中位疾病进展时间（MTTP）初治分别为6．4、7．0个月,复治分别为4．8、5．1个月（P〉O．05）,中位生存时间分别为8．9、9．3个月（P〉0．05）。一年生存率分别为29．3％、32．7％（P〉0．05）。临床获益改善率为80．3％、64．5％（P〈0．05）。毒副反应以骨髓抑制为主,白细胞、血小板Ⅲ～Ⅳ度毒性发生率GC组较GP组稍高,但两组比较差异无统计学意义（P〉0．05）,两组均无出血发生。非血液学毒性主要是胃肠道反应,Ⅲ～Ⅳ度反应GP组多于GC组,两组比较差异有统计学意义（P〈0．005）。结论 健择联合卡铂或顺铂治疗晚期NSCLC临床疗效均较高,毒副反应小,安全性高。尤其健择联合卡铂消化道反应轻,临床受益反应好,患者更易接受,对于老年或体力差的晚期NSCLC患者是较理想的治疗方案,临床应用更易推广。     

山甲白花汤联合吉西他滨抗胰腺癌耐药机制研究

目的：探讨山甲白花汤联合吉西他滨抗胰腺癌耐药的作用机制。方法：将30只小鼠按随机数表法分为模型组、吉西他滨组和联合组,构建皮下移植瘤小鼠模型,分别使用山甲白花汤、吉西他滨及联合处理小鼠,观察肿瘤的体积、重量变化和类固醇受体辅激活因子/分化抑制蛋白1（Src/Id1）信号通路蛋白。将人胰腺癌细胞系1（PANC-1）细胞分为对照组、吉西他滨处理组、联合处理组、联合+微小核糖核酸-124-3p抑制剂（miR-124-3p inhibitor）组和联合+过表达信号转导蛋白2样1（oe-SDF2L1）组,比较各组细胞增殖与迁移能力、微核糖核酸-124-3p（miR-124-3p）、信号转导蛋白2样1（SDF2L1）及信使核糖核酸（mRNA）水平。结果：与吉西他滨组比较,联合组中肿瘤体积与重量降低、Id1和磷酸化非受体酪氨酸激酶/非受体酪氨酸激酶（p-Src/Src）、SDF2L1水平降低。与对照组比较,吉西他滨处理组细胞增殖与迁移率明显降低,微小核糖核酸-124-3p（miR-124-3p）水平升高且SDF2L1水平明显降低,与吉西他滨处理组比较,联合处理组细胞增殖与迁移率明显降低,miR-124-3p水平升高且SDF2L1水平明显降低,与联合处理组比较,联合+miR-124-3p inhibitor组和联合+oe-SDF2L1组细胞增殖与迁移率均明显升高,SDF2L1水平均明显升高。结论：山甲白花汤联合吉西他滨通过上调miR-124-3p抑制SDF2L1发挥抗胰腺癌耐药作用。