含雷替曲塞化疗方案在晚期结直肠癌二线及二线以上治疗的临床观察

Clinical observation of raltitrexed combination chemotherapy for advanced colorectal cancer as the second-line and second-line above treatment

目的 探讨含雷替曲塞化疗方案在晚期结直肠癌二线及二线以上治疗中的疗效及安全性.方法 收集二线或二线以上治疗均采用含雷替曲塞方案化疗的49例晚期结直肠癌患者资料,分为单纯化疗组28例,联合贝伐组21例.贝伐珠单抗5 mg/kg静脉滴注6小时,d1;雷替曲塞2 mg/m2静脉滴注15分钟,d2;伊立替康180 mg/m2静脉滴注1小时,d2;奥沙利铂85 mg/m2静脉滴注2小时,d2.所有方案均以14天为1周期.结果 49例mCRC患者的中位无进展生存时间（PFSx）为6.0个月（95％ CI：5.259～6.741个月）;RR为20.4％,DCR为87.8％.21例联合贝伐珠单抗组的中位PFSx为7.5个月（95％ CI：6.196～8.804个月）;28例单纯化疗组的中位PFSx为6.0个月（95％ CI：5.591～6.409个月）,两组中位PFSx差异无统计学意义（P＞0.05）.全组不良反应较轻,以1～2级为主,3～4级不良反应仅见于恶心呕吐、白细胞减少、血小板减少及肝功能损害,且发生率较低.结论 含雷替曲塞化疗方案在晚期结直肠癌二线及二线以上治疗中的疾病控制率高,不良反应可耐受,在联合贝伐珠单抗组中生存获益更加明显.

Objective To investigate the efficacy and safety of rahitrexed combination chemo- therapy for advanced colorectal cancer as the second-line and second-line above treatment. Methods 49 cases of advanced colorectal cancer were enrolled to receive regimens including rahitrexed. 28 cases were treated with chemotherapy alone ,21 cases were combined with bevacizumab. The doses of the drugs were as follows,bevaeizumab 5 mg/kg ivgtt 6h, dl ;raltitrexed 2.0 mg/m2 ivgtt 15 min, d2;irinotecan 180 mg/m2 ivgtt 1 h, d2;and oxaliplatin 85 mg/m2 ivgtt 2h,d2. Two weeks was a cycle for each regimen. Results The efficacy of the 49 patients could be evaluated. The median progress-free survival（mPFSx） was 6.0 months （95% C1：5. 259 ~ 6. 741 months） ,the response rate was 20.4% ,the disease control rate was 87.8%. 21 cases combined with bevacizumab, mPFSx was 7.5 months （95% CI ： 6. 196 - 8. 804 months） , 28 cases with chemotherapy alone, mPFSx was 6.0 months （95% C1：5. 591 - 6. 409 months） , two sets＇ mPFSx was no statistical differences（ P 〉0.05 ）. All the adverse effect is slight, and the main is 1-2 grade. The main 3-4 grade adverse effect was nausea/vomiting, leucopenia, thrombocytopenia, liver damage, etc. and the rate was low. Conclusion Raltitrexed combination chemotherapy as the second-line and second-line above treatment for advanced coloreetal cancer has high disease control rates, and the adverse effect is well tolerated, especially combined with bevacizumab.