鸦胆子油乳注射液联合mFOLFOX方案一线治疗老年进展期胃癌的研究

Study of Brucea fruit water in oil emulsion combine with mFOLFOX regimen on old patients with advanced gastric cancer

目的探讨老年进展期胃癌内科治疗的合适方案。方法42例患者随机分为化疗组18例及中药联合化疗组24例,均接受改良的FOLFOX方案化疗:奥沙利铂85 mg/m2静滴,第1天;亚叶酸钙(CF)100 mg/m2快速冲入,5-氟尿嘧啶(5-Fu)400 mg/m2,第1—2天;5-Fu 600 mg/m2,持续静滴20 h/d,第1—2天;21 d为1个周期,共用4个周期。中药联合化疗组同时使用10%鸦胆子油乳注射液30 mL加入生理盐水250 mL中静滴,每天1次,28 d为1个周期,共用3个周期。观察有效率、无进展生存期(FTD)、生存质量改善情况以及毒副作用。结果化疗组CR 0例,PR 8例,中位FTP 5.2个月,生存质量改善率为50%;中药联合化疗组CR 1例,PR 12例,中位FTP 6.1个月,生存质量改善率为67%;白细胞下降发生率化疗组为44%,中药联合化疗组为25%。结论mFOLFOX方案一线治疗老年中晚期胃癌安全有效,联合应用鸦胆子油乳能增加临床疗效,减少毒副作用。

Objective It is to approach the appropriate regimen for old patients with advanced gastric cancer （AGC）. Methods 42 old patients with AGC were divided into the chemotherapy group （18 cases） and the the combination therapy group （24 cases）, and all patients were treated with modified FOLFOX regimen （mFOLFOX）, that is, Oxaliplatin 85 mg/ m2 ivdrip day 1, CF 100 mg/m2 and 5 - Fu 400 mg/m2 were given immediately after CF day 1 - 2, 5 - Fu 600 mg/m2 were given continuously after bolus for 20 hours day 1 - 2. All the patients received four cycles treatment with 21 days as one cycle. The patients of combination therapy group were added Brucea fruit water in oil emulsion at the same time, for totally three cycles with 28 days as one cycle. The curative effect, progression-free survival （PFS）, quality of life （QOL） and adverse reaction were observed and recorded. Results In the chemotherapy group, CR none, PR 8 cases, median FTP was 5.2 months, the improvement rate of QOL was 50%, WBC decreas rate was 44% ; In the combination therapy group, CR 1 case, PR 12 cases, median FTP was 6.1 months, the improvement rate of QOL was 67% , WBC decreas rate was 25% . Conclusion The mFOLFOX regimen is an appropriate choice as first line therapy for old patients with AGC, and the addition of Brucea fruit water in oil emulsion may further enhance the therapeutic effects and reduce the side effects.