减量FOLFIRINOX方案与伊立替康联合替吉奥二线治疗晚期胰腺癌的临床疗效及安全性比较

Comparison on clinical efficacy and safety of dose-reduced FOLFIRINOX or irinotecan combined with tegafur in second-line treatment of advanced pancreatic cancer

目的比较减量FOLFIRINOX方案与伊立替康联合替吉奥二线治疗晚期胰腺癌的临床疗效和安全性。方法回顾性分析34例符合纳入标准的晚期胰腺癌患者临床资料,根据治疗方法不同分为A组(16例)和B组(18例)。A组患者按照减量FOLFIRINOX方案治疗,B组患者按照伊立替康联合替吉奥方案治疗。比较两组患者临床疗效、无进展生存期、毒副反应发生情况。结果A组有效率为6.3%、疾病控制率68.8%,与B组的5.6%、55.6%比较,差异无统计学意义(P>0.05)。A组中位数无进展生存期为5.8个月[95%CI=(3.528,8.472)],B组中位数无进展生存期为3.9个月[95%CI=(2.877,5.123)],两组比较差异具有统计学意义(P<0.05)。两组存在的关键毒副反应为血液学毒性和消化道反应,A组有6例(37.5%)发生3度中性粒细胞减少,1例(6.3%)发生3度腹泻。B组1例(5.56%)发生3度中性粒细胞减少,1例(5.6%)发生恶心呕吐。A组毒副反应发生率43.8%高于B组的11.1%,差异具有统计学意义(P<0.05)。结论对体质较好的晚期胰腺癌患者实施减量的FOLFIRINOX方案二线治疗效果显著,有提高患者的临床治疗有效率和疾病控制率的趋势,且能够显著延长患者的中位无进展生存期,但毒副反应较重。因此在临床应用过程中,需注意筛选更合适的人群。因本实验为回顾性研究,仍需进一步研究证实。

Objective To compare the clinical efficacy and safety of dose-reduced FOLFIRINOX or irinotecan combined with tegafur in second-line treatment of advanced pancreatic cancer.Methods Clinical data of 34 patients with advanced pancreatic cancer who met the inclusion criteria were retrospectively analyzed and divided into group A(16 cases)and group B(18 cases)according to different treatment methods.Patients in group A were treated with dose-reduced FOLFIRINOX,and patients in group B were treated with irinotecan combined with tegafur.The clinical efficacy,progression-free survival and adverse reactions were compared between the two groups.Results The effective rate and disease control rate of group A were 6.3%and 68.8%,and the differences were not statistically significant from those of 5.6%and 55.6%in group B(P>0.05).The median progression-free survival in group A was 5.8 months[95%CI=(3.528,8.472)],and that in group B was 3.9 months[95%CI=(2.877,5.123)],and there was statistically significant difference between the two groups(P<0.05).The main toxic side effects were hematological toxicity and digestive tract reaction in both groups.In group A,6 cases(37.5%)had grade 3 neutropenia and 1 case(6.3%)had grade 3 diarrhea.In group B,there was 1 case(5.56%)of grade 3 neutropenia and 1 case(5.6%)of nausea and vomiting.The incidence of adverse reactions in group A was 43.8%,which was higher than that of 11.1%in group B,and the difference was statistically significant(P<0.05).Conclusion For patients with advanced pancreatic cancer who have good physique,dose-reduced FOLFIRINOX as a second-line therapy has significant effect,which tends to improve the clinical response rate and disease control rate of patients,and can significantly prolong the median progression-free survival of patients,but the adverse reactions are more severe.Therefore,in the process of clinical application,attention should be paid to screening more suitable populations.Since this study is a retrospective study,further research is needed to confirm it.