摘要
目的回顾性分析不同化疗方案对一线化疗失败的晚期胃癌患者进行解救治疗的疗效和安全性,探讨晚期胃癌二线治疗适宜的化疗方案。方法 88例一线化疗失败的晚期胃癌患者,分为紫杉类组（32例）：多西紫杉醇60~75mg/m2或紫杉醇135~175mg/m2,分d1、d8;5-FU500mg/m2d1~d5或顺铂20mg d1~d5,21天为1周期。奥沙利铂组（31例）：奥沙利铂85mg/m2d1;5-FU400mg/m2iv d1、d2,5-FU600mg/m2,civ 22h,d1、d2;CF 200mg/m2d1、d2,14天为1周期。伊立替康组（25例）：伊立替康150~180mg/m2,d1;5-FU400mg/m2iv d1、d2,5-FU600mg/m2,civ22h,d1、d2;CF200mg/m2d1、d2,14天为1周期。结果 88例均可评价不良反应,82例可评价客观疗效。紫杉类组、奥沙利铂组以及伊立替康组总有效率分别为3.2%、14.3%和17.4%,疾病控制率分别为48.4%、60.7%和65.2%;中位PFS分别为2个月（1.39~2.61个月）、3个月（2.16~3.84个月）和3个月（2.46~3.54个月）,差异无统计学意义（P=0.195）;中位OS为6个月（4.21~7.79个月）、7个月（6.12~7.88个月）和7个月（5.08~8.92个月）,差异无统计学意义（P=0.393）。3组不良反应易耐受,主要为1~2级血液学毒性。伊立替康组腹泻发生率较高,为48%,但3级以上发生率较低,仅为8%。奥沙利铂组外周神经毒性为48%。结论晚期胃癌一线治疗失败后采用目前常用的化疗方案解救治疗有一定的客观缓解率和临床受益率,但疗效有限,需要进一步积极探索有效的治疗方案。
Objective To retrospectively analyse the efficacy and safty of different rescue chemotherapies after failure of first-line chemotherapy in patients with advanced gastric cancer,to investigate the eligible second-line chemotherapy.Methods Eighty-eight patients progressive to first-line chemotherapy were enrolled.Subgroup and chemotherapy regimen were taxane-group（32 patients）： paclitaxel 135-175 mg/m2,or decetaxel 60-75mg/m2,separated to administrate on day 1 and day 8,plus infusion fluorouracil 500mg/m2 or cisplatin 20mg,administrated on day1-day5,every 3 weeks was a cycle.Oxaliplatin-group（31 patients）：oxaliplatin 85mg/m2,d1,folinic acid 200mg/m2,infusion on day 1 and day 2,fluorouracil 400mg/m2,bolus on day 1 and day 2,immediately followed by fluorouracil 600mg/m2 22h continuous infusion,day 1 and day 2,every 2 weeks was a cycle.Irinotecan-group（25 patients）：irinotacan 150-180mg/m2,folinic acid 200mg/m2,infusion on day 1 and day 2,fluorouracil 400mg/m2 were given on day 1 and day 2,followed by fluorouracil 600mg/m2 22h continuous infusion,day 1 and day 2,every 2 weeks was a cycle.Results Eighty-eight patients were evaluated adverse event,and 82 patients were evaluated efficacy.The response rate（RR） were 3.2%,14.3% and 17.4%,the disease control rate（DCR） were 48.4%,60.7% and 65.2% in taxane-group,oxaliplatin-group and irinotecan-group,respectively.The median PFS were 2 months（1.39-2.61）,3 months（2.16-3.84） or 3 months（2.46-3.54） in taxane-group,oxaliplatin-group and irinotecan-group,respectively,showing no significant difference（P=0.195）;the median OS were 6 months（4.21-7.79）,7 months（6.12-7.88） or 7 months（5.08-8.92）,in taxane-group,oxaliplatin-group and irinotecan-group,respectively,with no significant difference（P=0.393）.Toxicity was tolerable,major adverse event were grade Ⅰ and Ⅱ hematologic toxcity in three groups.The incidence rate of diarrhea（48%） was higher in irinotecan-group,but grade Ⅲ was less.The peripheral nerve toxicity was 48% in oxaliplatin-group.Conclusion Commonly used chemotherapy for the failure of first-line treatment of advanced gastric cancer patient gets a certain objective response rate and clinical benefit rate,but the effect are limited and need further explore actively to therapeutic schedule.
出处
《临床肿瘤学杂志》
CAS
2011年第7期613-616,共4页
Chinese Clinical Oncology
关键词
晚期胃癌
化学治疗
二线
伊立替康
奥沙利铂
紫杉类
Advanced gastric cancer
Chemotherapy
Second-line
Irinotecan
Oxaliplatin
Taxane
