奥沙利铂及羟基喜树碱分别联合卡培他滨治疗晚期大肠癌

目的：比较奥沙利铂及羟基喜树碱分别联合卡培他滨治疗晚期大肠癌的临床疗效与安全性。方法：吉林大学中日联谊医院2002年1月—2008年2月收治的转移性或复发性晚期大肠癌患者41例,23例采用＂奥沙利铂＋卡培他滨＂方案化疗（A组）,18例采用＂羟基喜树碱＋卡培他滨＂方案化疗（B组）,对比分析2组患者的治疗有效率（RR）,中位肿瘤进展时间（TTP）和中位无进展生存期（PFS）。结果：A组与B组有效率（RR）比较无显著差异（36.4%比18.8%,P〉0.05）。结肠癌与直肠癌相比,RR无显著差异（33.3%比23.5%,P〉0.05）;肝转移比肺转移比其他部位转移,RR无显著差异（27.8%比25.0%比18.5%,P〉0.05）;初治者与复治者的RR有显著差异（66.7%比11.5%,P〈0.05）;A、B两组神经毒性不良反应的发生率分别为54.5%和6.3%,有差异（P〈0.05）;B组的腹泻发生率（68.8%）高于A组（36.4%）,但2组比较无显著差异（P〉0.05）。A组中位TTP6.9个月,中位PFS6.9个月;B组中位TTP7.4个月,中位PFS7.4个月,2组比较,差异均无统计学意义（P〉0.05）。结论：奥沙利铂或羟基喜树碱分别联合卡培他滨治疗转移性或复发性晚期大肠癌有效,2种方案的有效率相当,生存分析上无显著差异,有效率与患者既往是否用过化疗相关,与肿瘤转移的部位可能有关,与肿瘤原发部位为直肠或结肠无关。羟基喜树碱方案以腹泻较为常见,对于已患有基础神经病变的患者,应选择以羟基喜树碱为主的联合方案;奥沙利铂方案的不良反应主要为外周神经毒性,对于有基础肠道功能障碍的患者,应选用以奥沙利铂为主的联合方案更为安全。

The Clinical Study on Combined Chemotherapy ofOxaliplatin or Hydroxycamptothecine plus Capecitabinefor Metastatic or Recurrent Colorectal Cancer

Objective：To compare the efficacy and safety of Oxaliplatin or Hydroxycamptothecine combined with Capecitabine in the treatment of patients with metastatic or recurrent colorectal cancer.Methods： From January 2002 to February 2008,41 patients with sustains metastatic or recurrent advanced colorectal cancer patients were enrolled in this study,among them,23 patients were assigned in to oxaliplatin＋ capecitabine group（Group A）,while 18 patients were assigned into the hydroxycamptothecine ＋capecitabine group（Group B）.The primary endpoint was efficacy evaluation,the secondary endpoint was time to tumor progression（TTP） and progression-free survival（PFS） as well as the side effects between the two groups.Results： The response rates（RR） was 36.4% in Group A,while was 18.8% in Group B,there was no significant difference between the two groups（P0.05）.Sub-group analysis showed that there was no significant difference in RR between the patients with colon cancer and patients with colorectal cancer（33.3% vs.23.5%,P0.05）.There similar finding in RR in patients with liver metastasis or lung metastasis or other parts（27.8% vs.25.0% vs.18.5%,all P0.05）.However,statistical difference between patients with newly diagnosed RR was 66.7%,re-treated patients with RR for 11.5%（P0.05）.The toxicity rates in Group A and Group B were 54.5% and 6.3%,respectively（P0.05）.The incidence of diarrhea in Group A was 36.4%,while in Group B was 68.8%（P0.05）.Survival Analysis showed TTP of Group A was 6.9 months,the median PFS was 6.9 months;While in Group B was 7.4 months and 7.4 months,respectively.（P0.05）.Conclusions： The efficacy of oxaliplatin or hydroxycamptothecine combined with capecitabine in the treatment of metastatic or recurrent advanced colorectal cancer are similar.Oxaliplatin has mainly peripheral nerve toxicity,while hydroxycamptothecine had more common diarrhea.The foundation has been suffering from neuropathy patients,choose to hydroxycamptothecine-based plus programmes;basis for a bowel dysfunction in patients,the recommendations should be oxaliplatin consisting mainly of joint programmes which are more secure.