多西紫杉醇联合奥沙利铂和5-氟尿嘧啶双周方案治疗晚期胃癌的初步研究

Preliminary study of biweekly regimen of docetaxel, oxaliplatin, 5-fluorouracil and iencovorin for advanced gastric cancer

目的探讨多西紫杉醇（DOC）联合奥沙利铂（L—OHP）和5-氟尿嘧啶（5-Fu）的DOF双周方案对晚期胃癌的临床疗效和毒副反应。方法37例晚期胃癌患者均行锁骨下深静脉穿刺或外周肘正中静脉穿刺，置入单腔输液导管，经电脑输液泵控制5-Fu的输液速度。DOC35mg／m^2，静脉滴注1h，第1天；L．OHP85mg／m^2，静脉滴注2h，第1天；甲酰四氢叶酸（LV）200mg／m^2，静脉滴注2h，第1天；5．Fu1500mg／m^2，持续静脉滴注48h，第1—2天。14d为1个周期，至少应用3个周期进行疗效评估。结果全组37例均可评价疗效，总有效率为67．6％，其中完全缓解率为27．0％，部分缓解率为40．5％。至肿瘤进展时间为9．2个月，中位生存期为13．7个月。在初次化疗的11例患者中，有效率为81．8％；在既往接受过化疗的26例患者中，有效率为61．5％。主要剂量限制性毒性反应为骨髓功能抑制，其中Ⅲ-Ⅳ度白细胞下降率为29．7％，无治疗相关性死亡。结论DOF双周方案是晚期胃癌的有效化疗方案，其毒副反应轻微，患者易于耐受，值得进一步研究。

Objective To evaluate the efficacy and toxicity of a biweekly DOF regimen consisting of docetaxel, oxaliplatin, 5-fluorouracil and leucovorin for advanced gastric cancer. Methods The biweekly DOF regimen was administered in 37 advanced gastric cancer patients. Docetaxel, oxaliplatin and leucovorin were given intravenously at a dose of 35 mg/m^2, 85 mg/m2 and 200 mg/m^2 for 1 h, 2 h and 2 h on D1, respectively, and 5-Fu was administered as continuous intravenous infusion for 48 h at a dose of 1500 mg/m^2 on D1 and D2. This regimen was repeated every 2 weeks. The efficacy and toxicity were evaluated after completion of 3 cycles at least. Results The overall response rate （RR） of this series was 67.6%, complete response rate and partial response rate were 27.0% and 40.5%, respectively. The time to progression （TIP） was 9.2 months, and median survival time （MST） was 13.7 months. The RRs of 11 chemotherpy-naive patients and 26 patients pre-treated with chemotherapy were 81.8% and 61.5%, respectively. Conclusion Our preliminary results showed that this biweekly combination regimen of docetaxel, oxaliplatin, 5-fluorouracil and leucovorin is effective and tolerable for advanced gastric cancer. However, further investigation of this regimen is mandatory.