紫杉醇联合草酸铂治疗32例晚期胃癌的临床观察

A Clinical Study of 32 Cases with Advanced Gastric Cancer Treated by Paclitaxel Combined with Oxaliplatin

目的 联合紫杉醇及草酸铂两种新药用于治疗晚期胃癌，并评价此方案的近期疗效及其毒副作用。方法 对入选32例晚期胃癌患者以紫杉醇联合草酸铂（单周或双周）方案予以全身化疗。结果 32例胃癌患者平均化疗2．8周期，CR2例，PR18例，总有效率RR（CR＋PR）为62．5％（95％可信区间为41％～85％）。毒副反应主要为骨髓抑制，发生率达78.1％。Ⅰ～Ⅱ度为62．5％，Ⅳ度9．4％。胃肠道反应、肝功损害、末梢神经炎、肾功损害、黏膜炎及心脏毒性发生率分别为40．6％、28.1％、12.5％、9．4％、9．4％及6.3％。大多为Ⅰ-Ⅱ度．所有患者均未因毒剐作用中断或退出治疗。结论 紫杉醇联合草酸铂的方案治疗晚期胃癌近期疗效肯定，毒副反应较轻，适合于对其它化疗反应大、有潜在心、肝、肾功能不全或年老体弱、多次化疗后、恶性度高或急需减瘤考虑根治手术的患者．

Objective To evaluate the efficacy and toxicity of chemotherapy of Paclitaxel combined with Oxaliplatin （two new drugs） in patients with locally advanced and （or） metastatic gastric adenocarcinoma（M/AGC）.Methods From September 2001 to May 2004,32 patients（24 males and 8 females） with a median age of 58 years old （range 35 - 75） were consecutively enrolled in this study. Paclitaxel and Oxaliplatin were administered as a two-hour infusion every one or two weeks. Results Thirtytwo patients were valuable of activity, with 2 complete and 18 partial responses, objective response rate（RR）62.5 % （95 % C I：41% -85% ）. Twenty-five of thirtytwo patients（78.1% ） experienced WHO grade Ⅰ - Ⅳ bone marrow suppression, which was the most common and serious toxicity. WHO Grade Ⅰ - Ⅱ side effect （non-hematological toxlcity） of gastrointestinal tract, liver, peripheral neuropathy, kidneys, mucositis and heart occurred in 40.6% ,28.1% , 12.5 % ,9.4% ,9.4% and 6.3 % of patients respectively. No patients were withdraw because of treatment-related toxicity. Conclusions The combination of Paclitaxel with Oxaliplatin has promising therapeutic activity in patients with advanced gastric cancer. This regimen showed good efficacy and an acceptable safety profile in M/AGC patients, and may prove to be a suitable alternative regimen in this indication, especially for the patients with bad function of the heart, liver and kidneys,or old physically weak patients.