FOLFOX6方案和TLF方案一线治疗晚期胃癌的疗效分析

Therapeutic effects of FOLFOX6 versus TLF regimen as the first line chemotherapy for advanced gastric cancer

目的晚期胃癌目前尚无标准方案,FOLFOX6和TLF是目前临床上常用的治疗胃癌的方案。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81例接受FOLFOX6方案或TLF方案一线治疗的晚期胃癌患者的临床资料,其中FOLFOX6组41例,奥沙利铂(L-OHP)100mg/m2静滴,第1天;CF400mg/m2静滴,第1天;5-FU400mg/m2静推,第1天;5-FU1200mg/m/2d持续静注22h第1、2天,14d为1周期,共12周期。TLF组40例,紫杉醇(TAX)剂量为90mg/m2静滴,第1天;CF200mg/m2/d静滴,第1、2天;5-FU400mg/m/2d静推,第1、2天;5-FU400mg/m/2d持续静注22h第1、2天,14d为1周期,共12周期。结果 FOLFOX6组和TLF组的客观缓解率分别为48.8%和50%(P=0.962);中位疾病进展时间为6.30个月和6.50个月(P=0.958);中位生存时间分别为9.80个月和10.70个月(P=0.578)。两组方案主要不良反应为血液学毒性及恶心呕吐,FOLFOX6组和TLF组Ⅲ～Ⅳ度白细胞下降发生率为12.2%和30.0%(P=0.112),Ⅲ～Ⅳ度中性粒细下降发生率为14.6%和32.5%(P=0.126)。FOLFOX6组有3例患者出现肠梗阻。结论 FOLFOX6方案和TLF方案一线治疗晚期胃癌疗效相近,毒性均可耐受。

Objective To compare the efficacy,time to disease progression（TTP）,overall survival（OS） and toxicity of FOLFOX6 and TLF regimens foradvanced gastric cancer.Methods The clinical data of 81 chemotherapy-na？patients with advanced gastric cancerwere analyzed.Of the 81 patients,41 were treated with FOLFOX6 regimen and 40 with TLF regimen.The patients in FOLFOX6 group received intravenous infusion of L-OHP（100 mg/m2） at day 1,bolus injection of 5-FU（400 mg/m2） at day 1,and continuous intravenous infusion of 5-FU（1200 mg/m2/d） for 22 h at days 1-2,each treatment cycle lasting 14 days.The patients in TCF group received TAX（90 mg/m2） at day 1,bolus injection of 5-FU（400 mg/m2） at days 1-2,and continuous intravenous infusion of 5-FU（400 mg/m2/d） for 22 h at days 1-2,and each treatment cycle also lasted 14 days.Results The objective response rates were 48.8% in FOLFOX6 group and 50.0% in TLF group（P=0.962）.The median TTP in the two groups was 6.30 months and 6.50 months（P=0.958）,with median survival time of 9.80 months and 10.70 months（P=0.578）,respectively.The most frequent adverse events were nausea,vomiting and hematologic toxicities.The incidences of grade III-IV leucopenia and neutropenia were lowerin FOLFOX6 group than in TLF group,but the difference was not statistically significant（12.2%vs 30.0%,P=0.112;14.6%vs 32.5%,P=0.126）.Three patients in FOLFOX6 group developed intestinal obstruction during the chemotherapy.Conclusions Both FOLFOX6 and TLF regimens are effective in treating advanced gastric cancerand the toxicities can be tolerated.