吉西他滨联合奥沙利铂治疗晚期胰腺癌患者的疗效

背景与目的:吉西他滨是目前治疗晚期胰腺癌的最有效的药物之一,初步的研究显示,与奥沙利铂联合(GEMOX)的疗效优于吉西他滨单药,但国内使用GEMOX方案治疗胰腺癌的研究报道并不多.本研究目的是观察GEMOX方案治疗晚期胰腺癌患者的有效率、生存期和毒副反应,为临床治疗提供指导.方法:本研究为单中心、回顾性临床分析.选择32例未接受过化疗的初治Ⅲ～Ⅳ期胰腺癌患者,所有患者均至少接受2个周期的GEMOX方案(吉西他滨1000 mg/m2,静脉滴入,d1、d8;奥沙利铂85～130 mg/m2,静脉滴入,d1;每21 d重复)化疗.结果:28例患者可评价疗效,8例部分缓解(partial remission,PR),8例病情稳定(stable disease,SD),12例病情进展(progressive disease,PD),4例不能评估(not assessable,NA),总有效率为25.0%,临床获益率46.9%(15例),中位无进展生存期(progression-free survival,PFS)为4.7个月,中位生存期8.6个月,1年生存率为32.6%.骨髓抑制的总发生率为70.9%,其中Ⅲ、Ⅳ度的发生率为32.3%(白细胞下降的发生率为19.4%,血红蛋白下降的发生率为12.9%,血小板下降的发生率为22.6%).恶心、呕吐和腹泻的发生率为56.2%,其中Ⅲ度呕吐2例.肝功能异常的总发生率为25.0%,全部为Ⅰ、Ⅱ度.外周神经毒性发生率为43.8%,全部为Ⅰ度.无化疗相关的死亡.结论:GEMOX方案是治疗晚期胰腺癌的有效方案,总体临床耐受性良好,其主要的不良反应为骨髓抑制.

Efficacy of gemcitabine combined oxaliplatin on advanced pancreatic cancer

BACKGROUND & OBJECTIVE: Gemcitabine (GEM) is efficient in treating advanced pancreatic cancer. Preliminary clinical studies showed that the efficacy of gemcitabine combined oxaliplatin (GEMOX regimen) is better than that of gemcitabine alone. But in China, the use of GEMOX regimen for advance pancreatic cancer has seldom been reported. This study was to analyze the efficacy of GEMOX regimen on advanced pancreatic cancer, and observe the adverse events. METHODS: Clinical data of 32 chemonaive patients with stage III-IV pancreatic cancer, treated with GEMOX regimen intravenous injection of gemcitabine (1 000 mg/m(2)) at Day 1 and Day 8, and intravenous injection of oxaliplatin (85-130 mg/m(2)) at Day 1; repeated every 21 days] at Cancer Center of Sun Yat-sen University from Feb. 2001 to Jun. 2006, were reviewed. RESULTS: Of the 32 patients, 8 achieved partial remission (PR), 8 had stable disease (SD), and 12 had progressive disease (PD)? the objective responses were not assessable (NA) in 4 patients. The response rate was 25.0%, and the clinical benefit response (CBR) rate was 46.9% (15 patients). The progression-free survival (PFS) was 4.7 months; the median overall survival was 8.6 months; the 1-year survival rate was 32.6%. The total occurrence rate of myelosuppression was 70.9%? the occurrence rate of grade III-IV myelosuppression was 32.3%: 12.9% for anemia, 19.4% for neutropenia, and 22.6% for thrombocytopenia. The occurrence rate of gastrointestinal adverse events was 56.2%? only 2 patients had grade III vomiting. Liver function damage (grade I-II) occurred in 8 (25.0%) patients; peripheral neurotoxicity (grade I) occurred in 14 (43.8%) patients. No chemotherapy-related death occurred. CONCLUSIONS: GEMOX is an effective regimen for pancreatic carcinoma with good clinical tolerance. The main adverse event is myelosuppression.