奥沙利铂、5-氟尿嘧啶、亚叶酸钙联合方案治疗进展期胃癌疗效观察

Oxaliplatin,5-Fluorouracil and Leucovorin Combination Chemotherapy in Advanced Gastric Cancer

目的探讨奥沙利铂、5-氟尿嘧啶(5-Fu)、亚叶酸钙(FOLFOX-4)联合方案在进展期胃癌(Ⅳ期)治疗中的疗效和安全性。方法对28例进展期胃癌患者[初治16例,复治12例,东部肿瘤协作组织(ECOG)评分0～2分]予奥沙利铂、5-Fu、亚叶酸钙(FOLFOX-4)联合方案化疗。结果可评价疗效28例,周期中位数6个(4～12)个。完全缓解(CR)0例,部分缓解(PR)18例(64.3%),疾病稳定(SD)8例(28.6%),疾病进展(PD)2例(7.1%),总有效率(RR)64.3%(18/28),其中初治患者68.8%(11/16),复治患者58.3%(7/12),初治和复治患者疗效比较,差别无统计学意义(P>0.05),临床受益率(CR+PR+SD)92.9%(26/28),治疗至进展时间中位数6.1月,生存期中位数13月。常见的不良反应为骨髓抑制,肝功能损害和胃肠道反应。结论 FOLFOX-4联合方案在初治或复治的进展期胃癌均可取得较好疗效,且毒性反应轻,患者耐受性好。

Objective To determine the efficacy and safety of FOLFOX-4 chemotherapy as a salvage treatment for patients with advanced gastric cancer（AGC）.Methods 28 AGC patients with ECOG performance status of 0~2 were registered into this study.Patients received Oxaliplatin（85 mg/m2 on day 1）,Leucovorin（200 mg/m2 on days 1 and 2） and 5-Fluorouracil（400 mg/m2 as a bolus and 600 mg/m2 as a 22-hour infusion on days 1 and 2 every 2 weeks.Results For the 28 treated patients,administered median chemotherapy cycles were 6 and range from 4 to 12 cycles.Sixteen patients（57.1%） received FOLFOX-4 chemotherapy as a first-line treatment and 12 patients（42.9%） as a second-line treatment.On the intent-to-treat analysis,none cases achieved complete response（CR）,18 patients（64.3%） achieved a partial response（PR）,and 8 patients（28.6%） were stable disease（SD）and 2 cases（7.1%） had progression disease（PD）.The overall response rate（RR） was 64.3%（18/28）,in which first-line treatment patients was 68.8%（11/16）and second-line treatment patients was 58.3%（7/12）.There were no significant differences in response rate between patients as a first-line treatment and as a second-line treatment（P〉0.05）.The clinical benefit rate（CR＋PR＋SD）was 92.9%.The median time to progression（TTP） was 6.1 months and the median overall survival（OS） was 13 months.The most frequent side effects were bone marrow suppression,hepatic damage and gastrointestinal responses.Conclusion Combination chemotherapy with FOLFOX-4 is an effective and tolerable regimen for AGC patients as a first-line treatment and same as a second-line treatment.