多西紫杉醇联合卡培他滨治疗晚期胃癌的临床应用

Efficacy and safety of docetaxel combined with capecitabine in the treatment of advanced gastric cancer

目的探讨多西紫杉醇联合卡培他滨治疗晚期胃癌的效果。方法选取2009年6月至2012年6月问收治的56例晚期胃癌患者，采用随机数字表法分为观察组（Tc方案）和对照组（FOLFOX4方案），各28例。观察组患者卡培他滨每天2000mg／m2，分早晚两次口服，第1—14天；多西紫杉醇35mg／m2静脉滴注，第1、8天。每21天为1个周期；对照组患者奥沙利铂130mg／m。静脉滴注，第1天；亚叶酸钙200mg／m2，静脉滴注2h，第1、2天；5．氟尿嘧啶400mg／m2，静脉推注，第1、2天；5-氟尿嘧啶600mg／m2，持续泵人22h，第1、2天，每14天重复，28天为1个周期。每2个周期评价疗效，每周期评价不良反应。结果所有患者均可评价疗效及不良反应。观察组与对照组患者治疗的有效率（分别为50．0％和46．4％）、疾病控制率（分别为82．1％和78．6％）、中位疾病进展时间（分别为5．8个月和5．2个月）、中位总生存期（分别为10．3个月和8．9个月）差异均无统计学意义（均P〉0．05）。两组患者血液学及胃肠道反应发生率差异无统计学意义，观察组脱发及手足综合征的发生率高于对照组（P〈0．05），对照组周围神经毒性发生率高于观察组（P〈0．05）。结论TC方案的治疗效果与FOLFOX4方案一线治疗晚期胃癌的治疗效果无明显差距，不良反应可耐受，值得临床推广。

Objective To explore the docetaxel combined capecitabine for the treatment of ad- vanced gastric cancer. Methods Fifty-six patients with advanced gastric cancer were randomly divided into two group：the study group with 28 patients （TAX 35mg/m2 dl,8;eapeeitabine 1000mg/ m2/d po bid dl- 14; 21 days as one cycle） and the control group with 28 patients（L-OHP 130 mg/m2 dl ;5-FU 400 mg/m2 iv dl-2; 5-FU 600mg/m2 eiv 22h dl-2;repeated every 14 days,28 days as one cycle）. The efficacy and side effects of two groups were evaluated. Results The efficacy and toxicity could be aessed among all pa- tients. There were no significant differences in therapeutic efficacy between the study group and the control group with the response rate（ 50.0% vs 46. 4% ） , disease control rate （82. 1% vs 78.6% ） , median progres- sion-free survival（5.8 months vs 5.3 months） and median overall survival（ 10. 1 months vs 8.9 months） ,re- speetively（P 〉 O. 05 ）. The toxicity of hematological and digestive toxic reactions had no significant differ- ences. Alopecia and hand-foot syndrome occurred more in the study group, while neurotoxieity was more fre- quent in the control group（ P 〈 0.05 ）. Conclusions The efficacy of docetaxel combined with capeeitabine regimen is similar with FOLFOX4 regimen in patients with advanced or metastatic gastric cancer and the side effects are tolerable. It is worthy further clinical study.