以紫杉醇为基础的联合化疗方案在进展期胃癌二线治疗中的效果观察

Paclitaxel-based regimens as second-line chemotherapy for patients with advanced gastric cancer

目的评价以紫杉醇(PTX)为基础的联合化疗方案二线治疗进展期胃癌(AGC)的疗效和安全性。方法回顾性总结35例既往化疗失败AGC患者,以紫杉醇为基础方案进行二线治疗,评价客观有效率(RR)、疾病控制率(DC)、疾病进展时间(TTP)、PTX为基础方案二线治疗起始时间至死亡时间(TTD)、一线治疗起始时间至死亡时间(OS)及不良反应。结果35例AGC中32例可评价疗效,RR 8例(22.9%),SD 20例(57.1%),DC(PR+SD)80%,中位TTP、TTD、OS为4.5、8.8、15.8个月;30例(85.7%)为铂类治疗失败的患者,既往治疗方案对紫杉醇二线化疗疗效无明显影响。主要不良反应为中性粒细胞减少,3/4级发生率约22.9%,其他不良反应轻微。结论以紫杉醇为基础方案治疗既往化疗失败的AGC,患者耐受性好,疾病控制率高,生存期延长,是很有前景的二线化疗方案。

Objective No regimen has been accepted yet as standard second-line treatment for advanced gastric cancer （AGC）. The present retrospective study aimed to evaluate the efficacy and safety of paclitaxel-based regimens in the patients with chemo-refractory AGC. Methods Thirty-five AGC eases were treated with paclitaxel-based regimens in second-line settings, including paclitaxel and fluorouracil, paclitaxel and capecitabine, and paclitaxel, cisplatin combined with fluorouracil. Response rate （RR） and disease control rate （DC） were assessed according to Response Evaluation Criteria in Solid Tumors （RECIST）. Time of progression （TTP）, time to death （TTD） and overall survival （OS） were calculated by SPSS software and depicted in KaplarrMeier curve. Adverse events were assessed by Common Terminology Criteria for Adverse Events v3. 0 （CTCAE）. Results Thirty-two out of 35 AGC eases were included as candidates for evaluation of the result. Eight eases were considered as objectively efficient （RR 22. 9%）, 20 eases were regarded as stable （SD 57. 1%） and DC was 80%. TTP was calculated in 34 cases, the median value was 4. 5 months. The. median values of TTD and OS were 8. 8 months and 15. 8 months, respectively, as calculated from the total of 35 cases. 30 cases （85. 7%） were pretreated with oxaliplatin or cisplatin based regimens, among them the RR was 29. 6% and OS was 15. 8 months. For those patients who never accepted platinum-based regimens, no partial response （PR） was observed and OS was 12. 1 months. However, no significant difference existed in statistical analysis. Chemotherapy was not responsible for death. Neutropenia was the main dose-dependent adverse event, and grade 3 or 4 level of neutropenia was found in 22.9% of the entire patients. Other adverse events such as nausea and vomiting were mild and controllable. Conclusion PTX-based regimen was effective and tolerable and it can be used as a promising second-line chemotherapy for the patients who are refractory to the pre-treatment with AGC.