奥沙利铂+多柔比星+异环磷酰胺方案治疗耐药性和难治性卵巢上皮癌的临床疗效

Efficacy and tolerability of combination of oxaliplatin,ifosfamide,and doxorubicin in treatment of recurrent and platinum-resistant ovarian epithelial cancer patients

目的探讨奥沙利铂+多柔比星+异环磷酰胺(OXIA)方案治疗耐药性和难治性卵巢上皮癌的临床疗效。方法 2009年7月—2010年3月济南军区总医院肿瘤科收治的复发、进展及耐药的难治性卵巢癌患者26例,均采用OXIA方案(奥沙利铂130mg/m2,多柔比星50～60mg/m2,异环磷酰胺4g/m2,每3周为1个疗程)进行挽救性化疗。其中接受≥2个疗程OXIA方案化疗的22例纳入本研究,并对其疗效及化疗不良反应进行回顾性分析。22例患者共接受81个疗程的OXIA方案化疗,中位疗程数为4个(2～7个)。结果完全缓解5例(22.7%),部分缓解10例(45.4%),有效率达68.2%;病情稳定2例(9.1%),病情进展5例(22.7%)。Ⅲ～Ⅳ度血液学不良反应的发生率为29.6%(24/81),Ⅲ～Ⅳ度中性粒细胞减少症的发生率为24.7%(20/81),Ⅲ～Ⅳ度血小板减少症的发生率为8.6%(7/81),Ⅲ～Ⅳ度贫血的发生率为7.4%(6/81);Ⅲ～Ⅳ度消化道反应的发生率为34.6%(28/81),周围神经毒性反应的发生率为37.0%(30/81),Ⅲ～Ⅳ度心脏毒性的发生率为19.8%(16/81),浅表静脉炎的发生率为11.1%(9/81),脱发和皮疹的发生率分别为13.6%(11/81)。结论 OXIA方案用于耐药性和难治性卵巢癌患者的挽救性化疗的疗效较好,且不良反应可耐受。

Objective To evaluate the efficacy and tolerability of a combined regimen of oxaliplatin, ifosfamide and doxorubicin （OXlA） in treatment of recurrent and platinum-resistant ovarian cancer patients. Methods A total of 26 patients with recurrent and platinum-resistant ovarian cancer, who were hospitalized in our department during June 2009 to March 2010, received combined chemotherapy of ifosfamide （4 g/m^2 ）, doxorubicin （50-60 mg/m^2） and oxaliplatin （130 mg/m^2）. The treatment cycles were repeated every 21 days. The efficacy and toxicity were evaluated in 22 patients who received more than 2 cycles of OXlA chemotherapy. The efficiency of the combined regimen and chemotherapy adverse reaction were retrospectively analyzed. Totally 81 cycles were performed in the 22 patients, with a median of 4 （ranging from 2 to 7） cycles. Results The overall response rate was 68. 2%, including complete response in 5 （22. 7%） and partial response in 10 （45.4%）. Stable disease was found in 2 patients （9.1%）, and disease progression in 5 （23.7%）. The rate of grade Ⅲ～Ⅳ myelosuppression was 29.6% （24/91）, rate of grade Ⅲ～Ⅳ neutropenia was 24.7% （20/81）, rate of grade Ⅲ～Ⅳ thrombopenia was 8.6 % （7/81 ）, rate of gradeⅢ～Ⅳ anemia was 7.4 % （6/81）, and rate of grade Ⅲ～Ⅳ gastrointestinal disorder was 34.6% （28/81）. The most common non-hematologic toxicity was perineurotoxicity （37. 0%）, followed by cardiotoxicity （19. 8%, 16/81 ）, hair loss and skin rash （13. 6%, 11/81 ）, and superficial phlebitis （ 11.1%, 9/81 ）. Conclusions Our combined regimen of oxaliplatin, ifosfamide and doxorubicin shows satisfactory efficiency and sound tolerability in the treatment of recurrent and platinumresistant ovarian cancer. （Shanghai Med J, 2011, 34.. 660-663）