FOLFOX4方案治疗晚期胃癌的临床观察

Clinical observation of FOLFOX4 regimen for advanced gastric cancer

目的观察奥沙利铂(L-OHP)联合氟尿嘧啶(5-Fu)、亚叶酸钙(CF)组成的FOLFOX4方案治疗晚期胃癌的疗效及不良反应。方法 26例晚期胃癌患者接受FOLFOX4方案化疗:L-OHP 85 mg.m-2静脉滴注2 h,第1天;CF 200 mg.m-2静脉滴注2h,第1,2天;5-Fu 400 mg.m-2于CF滴完后静脉推注5 min,第1,2天;随即5-Fu 600 mg.m-2持续静脉滴注22 h,第1,2天。每2周为1周期,所有患者至少接受2周期化疗后方可参与疗效评定,否则仅评价不良反应。按照实体瘤疗效评价标准中的"WHO通用评价方法"进行评价疗效及毒副反应,L-OHP神经毒性采用Levi专用分级标准。结果 26例患者均可评价,完全缓解(complete response,CR)1例,部分缓解(partial response,PR)10例,疾病稳定(stable disease,SD)7例,疾病进展(progressivedisease,PD)8例,总的有效率为42.3%,肿瘤控制率为69.2%,中位TTP为5.1个月(3～14个月),中位生存期7.2个月(3.2～18个月)。最常见的不良反应是白细胞减少46.2%(12/26)、周围神经感觉异常42.3%(11/26)和恶心呕吐30.8%(8/26)、腹泻19.2%(5/26)。结论 FOLFOX4方案治疗晚期胃癌近期疗效较好,毒副反应可以耐受,值得临床进一步研究应用。

Aim To observe the efficacy and toxicity of using oxaliplatin（L-OHP） in combination with 5-fluorouracil（5-FU） and calciumfolinate（CF）（FOLFOX4 regimen） in treatment of advanced gastric cancer.Methods A total of 26 advanced gastric cancer patients re-ceived FOLFOX4 regimen by administering L-OHP 85 mg.m-2 intravenous infusion dl,CF 200 mg.m-2 intravenous infusion lastingtwo hours dl,2,and then 5-Fu 400 mg.m-2 bolus infusion followed by 600 mg.m-2 continuous intravenous infusion lasting twenty-two hours d1,2 every fourteen days.WHO standard was used to evaluate clinical efficiency and toxic reaction,and Levi special standard was used to evaluate peripheral nerve toxicity.Results A median of 3.5 cycles（range,2～6） chemotherapy per patient had been adminis-tered,and the response rate of all the patients were evaluated.The best response rates were 1 complete response（CR）,10 partial response（PR）,7 stable disease（SD）,and progression of disease（PD） happened in other 8 patients.The overall response rate was 42.3% and disease control rate was 69.2%.The median time to progression（TTP） was 5.1 months（range,3～14 months）,and the median over allsurvival（OS） was 7.2 months（range,3.2～18 months）.The major toxic reaction included neutropenia 46.2%（12 /26）,peripheral nerve toxicity 42.3%（11 /26）,nausea and vomiting 30.8%（8 /26） and diarrhea 19.2%（5 /26） respectively.Most of the severity of theseeffects was grade 1～2 and well tolerated.Conclusion The FOLFOX4 regimen was effective in advanced gastric cancer with acceptable toxicity,It is worthy to be further used and studied clinically.