白蛋白结合型紫杉醇联合替吉奥治疗吉西他滨治疗失败进展期胰腺癌的临床观察

Clinical observation of albumin-bound paclitaxel plus S-1 in patients with advanced pancreatic cancer after the failure of gemcitabine

背景与目的：化疗是晚期胰腺癌患者的主要治疗手段，但目前尚没有二线治疗晚期胰腺癌的标准方案。本研究旨在评估白蛋白结合型紫杉醇联合替吉奥二线治疗吉西他滨治疗失败进展期胰腺癌的近期疗效和安全性。方法：19例接受吉西他滨一线治疗失败的晚期胰腺癌患者，应用白蛋白结合型紫杉醇联合替吉奥二线治疗。白蛋白结合型紫杉醇用药剂量125 mg/m2，静脉滴注30 min，第1、8天给药；替吉奥胶囊40 mg，口服，每日2次，第1～14天；每3周重复。结果：所有患者均可评价疗效，其中完全缓解（complete response， CR）1例，部分缓解（partial response，PR）4例，疾病稳定（stable disease，SD）9例，客观有效率（objective response rate，ORR）为26.3%，疾病控制率（disease control rate，DCR）为73.7%，中位无进展生存期（progression free survival，PFS）为5.2个月。主要不良反应包括血液学毒性、肌肉关节酸痛、消化道反应、感觉神经病变、疲乏和脱发等。结论：白蛋白结合型紫杉醇联合替吉奥方案二线治疗既往吉西他滨治疗失败进展期胰腺癌疗效确切，且不良反应可以耐受。

Background and purpose： Pancreatic cancer is often diagnosed at advanced stage, therefore, chemotherapy remains the cornstone of treatment for advanced pancreatic cancer. However, no standard regimen has been established as second-line therapy for advanced pancreatic cancer. The purpose of the study was to evaluate the efifcacy and safety of albumin-bound paclitaxel plus S-1 for the treatment of advanced pancreatic cancer patients in second-line setting after the failure of gemcitabine treatment. Methods：Clinical outcomes of 19 patients with advanced pancreatic cancer were analyzed. These patients received albumin-bound paclitaxel plus S-1 as second-line therapy after the failure of gemcitabine treatment. Albumin-bound paclitaxel was administered at a dose of 125 mg/m2 over 30 minutes on day 1 and 8 of a 21-day cycle. From d1-14, all patients received oral S-1 40 mg/m2, twice daily. Results：All patients were available for evaluation. Of the 19 patients, 1 case got complete response （CR）, 4 cases had partial response （PR） and 9 cases had stable disease （SD）. The objective response rate （ORR） was 26.3%, the disease control rate （DCR） was 73.7%and the median progression free survival （PFS） was 5.2 months. The main toxicities include hematological toxicity, myodynia, gastrointestinal reactions, sensory neuropathy, fatigue and alopecia. Conclusion：The combination of albumin-bound paclitaxel and S-1 is effective and tolerated in the treatment of advanced pancreatic cancer patients who resistant to gemcitabine.