吉西他滨联合多西紫杉醇方案治疗晚期肝癌的临床观察

A Retrospective Analysis of Combination of Gemcitabine and Docetaxel in Patients with Advanced Hepatocellular Carcinoma

目的评价吉西他滨联合多西紫杉醇治疗晚期肝细胞癌患者的疗效和不良反应。方法收集我科2006年2月—2010年2月间均诊断为晚期肝细胞癌患者42例。化疗方案剂量及方法设定:多西紫杉醇30 mg/m2,吉西他滨800 mg/m2在d1、d8天应用,静脉滴注。21天为1周期,2周期后评价疗效。结果全组42例患者均可评价疗效。其中未见完全缓解患者,部分缓解率为21.4%(9/42),稳定47.6%(20/42),进展31.0%(13/42)。中位进展时间4.1月(95%CI:2.14～7.26月),中位生存时间9.2月(95%CI:4.25～18.12月)。无治疗相关死亡,主要不良反应为外周血粒细胞下降、血小板减少、轻度贫血、消化道反应、疲劳、外周神经毒性及偶发的腹泻和皮疹。结论吉西他滨联合多西他赛治疗晚期肝细胞癌具有显著的抗肿瘤作用,化疗期间出现血液学不良反应,食欲下降、乏力是普遍现象,需要临床重视。早期实施有效的干预可明显减少不良反应的发生率。

Objective To determine the response rate,time to disease progression,survival,and safety profile of the therapeutic effects of Gemcitabine combinded with Docetaxel on patients with advanced hepatocellular carcinoma.Methods Forty-two patients with advanced hepatocellular carcinoma were enrolled from February 2006 to February 2010.Chemotherapy dose and method of setting：Docetaxel 30 mg/m2,Gemcitabine 800 mg/m2 intravenously over 30 minutes on days 1 and 8.21 days for one cycle,two cycles were evaluated.Results Whole group of 42 patients total effective rate was 21.4%,with an additional 47.6% of patients with stable disease,for a disease control rate of 69.0%.,complete response rate was 0（0/42）,partial remission rate was 21.4%（9/42）,stable was 47.6%（20/42）,progress was 31.0%（13/42）.The median time to progression was 4.1 months（95% confidence interval,2.14-7.26 months）,median survival time was 9.2 months（95% confidence interval,4.25-18.12 months）.No treatment-related death,this chemotherapy combination was generally well tolerated.Decline in peripheral blood granulocytes,thrombocytopenia,mild anemia,gastrointestinal reactions,fatigue and occasional diarrhea and rash were commonly observed but were easily managed without discontinuing further treatment.Conclusion The significant antitumor activity combined with a mild toxicity profile seen from this study argues that Gemcitabine and Docetaxel chemotherapy may benefit patients with advanced hepatocellular carcinoma.This regimen warrants further evaluation in a randomized study with survival and quality of life end points.