卡培他滨单药或联合方案治疗晚期胃癌的临床研究

Retrospective study on regimens of capecitabine-based chemotherapy in the treatment for advanced gastric cancer

目的探讨卡培他滨单药或联合方案治疗晚期胃癌的疗效及安全性。方法104例晚期胃癌患者接受如下方案治疗：（1）卡培他滨单药组：卡培他滨1000mg／m^2，口服，20t／,a，第1～14天，21d为1个周期。（2）卡培他滨＋紫杉类组：卡培他滨1000mg／m^2，口服，2次／d，第1—14天；紫杉醇175mg／m。，静脉滴注，第1天（或80—90mg／m^2，静脉滴注，第1、8天）；或多西紫杉醇65—75mg／m^2，静脉滴注，第1天；21d为1个周期；（3）卡培他滨＋铂类组：卡培他滨1000mg／m^2，口服，2次／d。第1—14天；顺铂15～20mg／m^2，避光静脉滴注2h，第1-5天；或奥沙利铂130mg／m^2，静脉滴注2h，第1天；21d为1个周期。中位治疗3个周期。结果104例患者的总客观有效率为20．6％，中位生存时间为8．5个月，中位疾病进展时间为5．2个月。在可评价疗效的患者中，一线治疗的客观有效率为40。0％，疾病控制率为76．7％。卡培他滨＋紫杉类化疗组的总中位生存期为10．9个月，一线治疗的中位生存期为12．8个月。卡培他滨单药组的不良反应发生率最低。结论以卡培他滨为基础的治疗方案疗效尚可，患者耐受性好，单药治疗适用于KPS评分〈80分的患者，联合紫杉类化疗组的患者生存时间略长，但尚需进一步验证。

Objective To evaluate the toxicity and efficacy of capecitabine-based chemotherapy in the treatment of advanced gastric cancer. Methods 104 patients with advanced gastric cancers were treated with capecitabine-based chemotherapy regimens from Sept. 2001 to May 2007. Group 1 was treated by capecitabine 1000 mg/m^2 orally twice daily on Dl-14, repeated every 3 weeks;group 2 by capecitabine as that of group 1, and combined with paclitaxel 175 mg/m2 intravenous infusion on D1 （ or 80-90 mg/m2 on D1, D8 ） ,or docetaxel 65-75 mg/m^2 on D1 ,repeated every 3 weeks; group 3 by capecitabine as that of group 1, combined with cisplatin 15-20 mg/m2 intravenous infusion for 2 h on D1-5 ,or oxaliplatin 130 mg/m^2 for 2 h on D1, repeated every 3 weeks. The median cycles of treatment were 3 cycles. Results The overall response rate was 20.6%. The median overall survival and the median time to progression were 8.5 months and 5.2 months, respectively. For the first-line chemotherapy, ORR was 40.0% , disease control rate was 76.7%;the median overall survival in all patients and in the patients with first-line chemotherapy of capecitabine plus paclitaxel were 10. 9 months and 12. 8 months, respectively. The adverse events in capecitabine alone group were the least among all the groups. Conclusion The capecitabine-based chemotherapy was effective and tolerable. The patients with KPS 〈 80 may choose capecitabine alone for the chemotherapy. The regimen of capecitabine combined with paclitaxel was more effective than other regimens. However, further investigation to improve it is still required.