重组人血管内皮抑素联合多西他赛、铂类和氟尿嘧啶类一线治疗进展期胃癌的临床观察

Rh-endostatin combined with docetaxel,platinates and fluoropyrimidines as first-line chemotherapy for advanced gastric cancer

目的：探讨重组人血管内皮抑素（恩度）联合多西他赛、铂类和氟尿嘧啶类一线治疗进展期胃癌的疗效和安全性。方法回顾性分析2011年1月至2013年6月收治的进展期胃癌患者25例。17例接受多西他赛、奥沙利铂和氟尿嘧啶（ DOF）方案：多西他赛40mg/m2静滴，d1；奥沙利铂85mg/m2静滴，d2；氟尿嘧啶400mg/m2静滴，600mg/m2持续泵入22h，d2～d3，2周为1周期。8例接受多西他赛、顺铂和卡培他滨（DCX）方案：多西他赛40mg/m2静滴，d1；顺铂25mg/m2静滴，d2～d3；卡培他滨1000mg/m2口服，每天2次，d1～d8，2周为1周期。25例均接受恩度15mg/天静滴，d1～d10。根据RECIST 1．1版标准评价近期疗效，根据NCI CTC 3．0版标准评价毒副反应，同时随访无进展生存期（ PFS）和总生存期（ OS）。结果24例患者可评价疗效，其中获PR 10例，SD 6例，PD 8例；有效率为41．7％，疾病控制率为66．7％。毒副反应以消化道反应和骨髓抑制为主，主要3～4级毒副反应为中性粒细胞减少（6例），仅1例患者出现心脏毒性。中位随访时间14．6个月，中位PFS为8．0个月，中位OS 为11．0个月。结论恩度联合多西他赛、铂类和氟尿嘧啶类一线治疗进展期胃癌疗效确切，安全性良好，值得进一步研究。

Objective To investigate the efficacy and safety of rh-endostatin （ endostar） combined with docetaxel, platinates and fluoropyrimidines as first-line chemotherapy for advanced gastric cancer. Methods Twenty-five patients with advanced gastric cancer were enrolled into this study from Jan. 2011 to Jun. 2013. Seventeen patients received docetaxel, oxalipatin and flourouracil （ DOF） regimen：docetaxel 40mg/m2 iv, d1;oxaliplatin 85mg/m2 iv,d2;flourouracil 400mg/m2 iv, 600mg/m2 continuous iv 22h d2-d3 , with 2 weeks as a cycle. Eight patients received docetaxel, cisplatin and capecitabine （ DCX） regimen：docetaxel 40mg/m2 iv, d1;cisplatin 25mg/m2 iv, d2-d3;capetitabine 1000mg/m2 bid po, d1-d8 , with 2 weeks as a cycle. Endostar was administered 15mg/d iv, d1-d10 . The response rate was evaluated according to RECIST1. 1 criteria, and the toxicities were evaluated according to NCI CTC 3. 0 standard.Progression-free survival （PFS） and overall survival （OS） were also observed. Results Among the 24 evaluable cases, PR was observed in 10 patients, SD in 6 patients, and PD in 8 patients. The response rate was 41. 7%, and the disease control rate was 66. 7%. Digestive reaction and myelosuppression were the most common toxicities. Neutropenia（ 6 cases） was the most frequent grade 3-4 toxicity. One patient experienced cardiac toxicity. The median follow-up was 14. 6 months, the median PFS was 8. 0 months, and the median OS was 11. 0 months. Conclusion Endostar combined with docetaxel, platinates and fluoropyrimidines is an effective and safe regimen as first-line chemotherapy for advanced gastric cancer. It is worthy of further large scale clinical trial.