HCPT联合L-OHP方案治疗复发转移结直肠癌的近期临床疗效

Short-Term Effects of Chemotherapy Combined with Hydroxycamptothecine and Oxaliplatin in Treatment of Recurrent and Metastatic Colorectal Cancer

背景与目的:虽然含氟尿嘧啶(5-fluarouracil,5-FU)联合方案是目前治疗结直肠癌的标准方案,但是作为二线治疗的疗效不高,探索新的替代方案显得十分必要。本研究拟应用羟基喜树碱(hydroxycampothecin,HCPT)联合草酸铂(oxaliplatin,L-OHP)方案治疗复发转移结直肠癌,并观察其近期疗效、不良反应及1年生存率。方法:47例经病理学检查证实的复发转移结直肠癌,采用HCPT+L-OHP方案治疗86个周期,HCPT6mg/m2+NS500ml,静脉滴注d1～4;L-OHP130mg/m2+5%GS500ml,静脉滴注d1。每例治疗2个周期后进行近期临床疗效和不良反应评定,两次化疗间隔为3周。结果:38例可进行疗效评价,总有效率(CR+PR)为36.8%(14/38)。化疗后KPS改善和显著改善者20例,占52.6%。白细胞下降59周期,占68.6%,其中Ⅲ～Ⅳ度白细胞下降18周期,占30.5%;腹泻48周期,占55.8%,其中Ⅲ～Ⅳ度腹泻18周期,占37.5%。1年生存率为40.0%,中位总生存期(medianoverallsurvival,mOS)和中位无进展生存期(medianprogressionfreesurvival,mPFS)分别为11.7和7.8个月。结论:HCPT+L-OHP方案治疗一线化疗后复发的结直肠癌病例有较好的近期临床疗效,主要不良反应是白细胞下降和腹泻。

BACKGROUND ＆ OBJECTIVE： Although 5-fluarouracil （5-FU） -based chemotherapy has become a standard regimen for treatment of recurrent and metastatic colorectal cancer, the efficacy, as a second line therapy, is not high, Thus, it is necessary to find a new regimen as a substitute. This study was to evaluate the short-term effects and toxicity of combination of hydroxycamptothecine （HCPT） plus oxaliplatin （L-OHP） protocol in the treatment of recurrent and metastatic colorectal cancer. METHODS： 47 patients with pathological evidence of recurrent and metastatic colorectal cancer were enrolled and treated with HCPT plus L-OHP regimen for 86 cycles. All patients were treated with （L-OHP 130 mg/m^2, day 1 and HCPT 6 mg/m^2, day 1-4） and the chemotherapy was repeated every 3 weeks. The short-term effects and side effects were evaluated after every 2 cycles for each patient. RESULTS. 38 cases were evaluable and RR [complete remission （CR） ＋partial remission （PR）] was36.8% （14/38）. KPSwas improved in 20 cases （52.6%）. In total 86 cycles, leucopenia occurred in 59 cycles （68.6%）, 18 cycles （30.5%） in grade Ⅲ and Ⅳ, and diarrhea occurred in 48 cycles （55.8%）, 18 cycles （37.5%） in grade Ⅲ and Ⅳ, One year survival rate was 40.0% and medium overall survival （mOS） and medium progression free survival （mPFS） were 11.7 and 7.8 months, respectively. CONCLUSIONS; HCPT plus L-OHP regimen achieved relatively satisfactory short-term effects in the treatment for colorectal cancer patients, who suffered from recurrence and metastasis after the first-line chemotherapy with 5-FU. The main toxicities of the regimen were leucopenia and diarrhea.