多西紫杉醇联合长春瑞滨二线治疗晚期胃癌的临床观察

Clinical Observation of Docetaxel Combined with Vinorelbine as Second Line Treatment for Patients with Advanced Gastric Cancer

目的探讨多西紫杉醇联合长春瑞滨二线治疗晚期胃癌的客观疗效和安全性。方法既往一线应用不同化疗方案化疗失败的32例晚期胃癌患者,采用TN方案,即TXT50mg/m2,静脉滴注,d1;NVB25mg/m2,静脉滴注,d1;14天为一个周期。结果 32例患者共完成134个周期化疗,有效率RR为43.8%(14/32),中位TTP5.0月,中位生存期9.0月,1年生存率为23.3%(7/30)。既往一线接受铂类和非铂类方案患者进行TN二线治疗的RR分别为50.0%和25.0%(P=0.412),中位生存期分别为9.0月和8.0月(P=0.174),1年生存率分别为27.3%和12.5%(P=0.115),差异无统计学意义。毒性反应主要为中性粒细胞减少(81.2%),全组毒性反应均为可逆性。结论 TN方案二线治疗晚期胃癌临床缓解率较高,不良反应可耐受;一线含铂与非含铂方案对其疗效基本没有影响。但由于观察数目较少,仍需扩大样本量进行进一步的研究。

Objective To evaluate the efficacy and toxicity of combination chemotherapy using Docetaxel plus Vinorelbine （TN regimen） as a second-line regimen for advanced gastric cancer （AGC） patients.Methods Thirty-two advanced gastric cancer patients who had been treated by multiple chemotherapy regimens with poor responses were allotted. TN regimen was adopted and the cycle was repeated every 14 days.Results Thirty-two patients were evaluated for clinical response after 134 cycles. There was no complete response and the overall response rate （RR） was 43.8%. Median time to progression （mTTP） was 5.0 months and 1-year survival rate was 23.3% with a median survival time of 9.0 months. Patients previously treated by cisplatin-containing regimen and non cisplatin-containing regimen were evaluated with RR 50.0% and 25.0% （P=0.412）, and 1-year survival rate was 27.3% and 12.5% （P=0.115） with mTTP of 9.0 and 8.0 months （P=0.174）. The major toxicity was neutropenia （81.2%） and all the toxicities were reversible.Conclusion TN regimen is an effective and well tolerated regimen in the second-line treatment of AGC which can relieve suffering and improve quality of life. Its therapeutic effect is not affected by the first-line regimen （cisplatin-containing or non cisplatin-containing）. But we still need more large survey sample for further research.