FOLFOX4方案和DP(O)F方案一线治疗晚期胃癌的疗效分析

FOLFOX4 Regimen Versus DP(O)F Regimen for Advanced Gastric Cancer

背景与目的:晚期胃癌目前尚无标准方案,FOLFOX4方案(FOLFOX4组)和DP(O)F方案[TXT+L-OHP/DDP+5-FU方案,DP(O)F组]是目前临床上常用且有效的治疗胃癌的方案。本研究对比这两个方案一线治疗晚期胃癌的疗效和不良反应。方法:收集70例接受FOLFOX4方案或DP(O)F方案一线治疗的晚期胃癌患者的临床资料,其中FOLFOX4组34例,醛氢叶酸(L-OHP)85mg/m2静滴,第1天;5-FU400mg/m2静推,第1、2天,5-FU600mg/m2持续静注22h第1、2天,14d为一周期。DP(O)F组36例,多西紫杉醇(TXT)剂量强度为20mg.(m2.w)-1;DDP40mg/m2静滴,第2、3天;L-OHP100mg/m2静滴第2天;5-FU500mg/m2静滴,第1～5天,21d为一周期。结果:FOLFOX4组和DP(O)F组的客观缓解率分别为45.5%和52.8%(P=0.628);中位疾病进展时间为5.27个月和4.70个月(P=0.848);中位生存时间分别为8.97个月和12.17个月(P=0.095)。两组方案主要不良反应为血液学毒性及恶心呕吐,FOLFOX4组和DP(O)F组Ⅲ～Ⅳ度白细胞下降发生率为11.8%和36.1%(P=0.025),Ⅲ～Ⅳ度中性粒细胞下降发生率为17.6%和41.7%(P=0.038),FOLFOX4组中有1例患者死于化疗相关的肝功能衰竭。结论:FOLFOX4方案和TXT+L-OHP/DDP+5FU方案一线治疗晚期胃癌疗效相近,后者血液学毒性较重。

BACKGROUND ＆ OBJECTIVE. Currently, there is no standard regimen for advanced gastric cancer. FOLFOX4 regimen [oxaliplatin（L-OHP） with 5-fluorouracil （5-FU）] and DP（O）F regimen [docetaxel （TXT）, oxaliplatin （L-OHP）/cisplatin （DDP） with 5-FU] are usually used in treating gastric cancer with satisfactory efficacy. This study was to compare the efficacy, time to disease progression （TTP）, overall survival （OS） and toxicity of the two regimens for advanced gastric cancer. METHODS. Clinical data of 70 chemotherapy-navve patients with advanced gastric cancer were analyzed. Of the 70 patients, 34 were treated with FOLFOX4 regimen, 36 were treated with DP（O）F regimen. The patients in FOLFOX4 group received intravenous infusion of L-OHP （85 mg/m2） at Day 1, bolus injection of 5-FU （400 mg/ m2） at Days 1-2, and continuous intravenous infusion of 5-FU （600 mg/m2） for 22 h at Days 1-2; 14 days as one cycle. The patients in DP（O）F group received administration of TXT E20 mg·（m^2·w）^-l], intravenous infusion of DDP （40 mg/m2） at Days 2-3 or L-OHP （100 mg/m2） at Day 2, and intravenous infusion of 5-FU （500 mg/m2） at Days 1-5- 21 days as one cycle. RESULTS. The objective response rates were 45.4% in FOLFOX4 group and 52.8% in DP（O）F group （P=0.628）. The median TTP was 5.27 months in FOLFOX4 group and 4.70 months in DP（O）F group （P=0.848）. The median survival time was 8.97 months in FOLFOX4 group and 12.17 months in DP（O） F group （P=0.095）. The most frequent adverse events were nausea, vomit and hematologic toxicities. The occurrence rates of grade Ⅲ -Ⅳ leukopenia and neutropenia were significantly lower in FOLFOX4 group than in DP（O）F group （11.8% vs. 36.1%, P=0.025; 17.6% vs. 41.7%, P=0.038）. One patient in FOLFOX4 group died of liver function failure. CONCLUSION. Both FOLFOX4 and DP（O）F regimens are effective in treating advanced gastric cancer. The hematologic toxicities of DP（O）F regimen are worse than those of FOLFOX4 regimen.