晚期胃癌内科治疗的研究进展

Progress in medical treatment of advanced gastric cancer

目的:总结晚期胃癌内科治疗发展历程及研究现状,探讨其治疗发展方向及最新动态。方法:应用Medline、PubMed及CNKI期刊全文数据库探索系统,以"晚期胃癌化疗、靶向治疗和二线"等为关键词,检索2000-2010年的相关文献,共检索到英文文献245条。纳入标准:1)胃癌治疗发展;2)晚期胃癌一线治疗;3)晚期胃癌二线治疗;4)长期生存获益;5)晚期胃癌靶向治疗。根据纳入标准,符合分析的文献35篇。结果:胃癌内科治疗发展缓慢,随机试验的Meta分析表明,一线联合化疗可以获益,但仍无统一的标准方案。对于适当的胃癌患者可以考虑给予二线治疗。随着靶向药物治疗胃癌研究的深入,尤其是抗血管生成及抗HER-2药物的加入,晚期胃癌的治疗前景逐渐广阔。结论:大多数晚期胃癌患者有机会接受一线治疗,当前的联合方案有更好的耐受性,治疗效果亦有所改善。分子靶向药物临床试验成效可喜,但最终靶向治疗联合化疗的治疗地位仍需大型多中心随机临床试验来验证。

OBJECTIVE： To summarize the progress and current status in medical treatment of advanced gastric cancer,and investigate its development trend and latest variation. METHODS： In Full-text database exploration system like Medline, PubMed and CNKI, we used chemotherapy of advanced gastric carcinoma, targeted therapy and second-line treatment as kedwords to index pertinent lit erature between 2000 to 2010. Totally 245 english literature were found. Inclusion criteria： Progress in gastric cancer, first-line treatment of advanced gastric cancer, second-line treatment of advanced gastric cancer, long term survival,targeted therapy of advanced gas tric cancer. Finally,35 literature fit were collected. RESULTS： Pro- gress in gastric cancer has been slow. Meta-analyses of randomized trials have shown a benefit for firs-line combination chemotherapy. But today there is no universally accepted reference standard chemotherapy for this disease, second-line treatment should be considered in appropriate patients, with the addition of targeted therapy, especially anti-angiogenic and ant-Her2 therapy,the treatment prospects of gastric cancer had been broader. CONCLUSIONS： Majority of advanced gastric cancer patients have the opportunity to received first-line therapy, current combination regimens are more tolerable and outcomes are improving. Molecular targeted drugs play a well role in clinical trials, but the status of targeted treatment eombinating with chemotherapy still need large multicenter randomized clinical trials to test.