mEOX与FOLFIRI方案二线治疗晚期胃癌疗效对照观察

Comparison the efficacy of second-line modified EOX and FOLFIRI regimens in metastatic gastric cancer patients

目的晚期胃癌至今仍缺乏最佳二线治疗方案，如何选择高效低毒的化疗方案是临床函待解决的问题。比较mEOX（表柔比星，奥沙利铂和卡培他滨）与FOLFIRI（伊立替康，5-氟尿嘧啶和亚叶酸钙）在晚期胃癌二线治疗中的疗效及毒副作用。方法选取2010-01-01-2014-06-30在海口市人民医院肿瘤内科住院治疗患者105例，且均经病理明确诊断为胃腺癌，一线DCF化疗后进展。采用简单随机化分配，A组55例患者行mEOX方案化疗，B组50例患者行FOL-FIRI方案化疗。收集所有患者的临床病理学特征。无进展生存期（progression-free survival，PFS）及总生存期（overall survival，OS）使用Kaplan-meier进行生存分析。结果两组患者均一线接受mDCF方案治疗。二线使用mEOX和FOLFIRI方案各完成3．5（2～8个周期）和3个周期（1～5个周期），P=0．38。mEOX和FOLFIRI组客观缓解率（objec-tive response rate，ORR）分别为21．8％和18．0％，χ2=0．239，P=0．625。mEOX和FOLFIRI组中位PFS分别为5．3和6．4个月（χ2=4．01，P=0．045），2组患者从二线化疗开始后计算0S分别为7．0和7．2个月，组间比较差异无统计学意义，χ2=0．255，P=0．64。mEOX组较FOLFIRI纽出现更少的粒细胞减少、腹泻等不良反应。而FOLFIRI组较mEOX组因不良反应至化疗药物减量或延期使用的患者更多，P〈0．001。结论mEOX方案与FOLFIRI方案二线化疗晚期胃癌疗效相似，但mEOX方案不良反应更低，均值得临床推广使用。

OBJECTIVE The optimal second-line regimen for treating advanced gastric cancer remains unclear. How to choose a chemotherapy regimen with high efficacy and low toxicity is a clinical problem. This study aimed to com- pare the efficacy and toxicity of second-line modified EOX （Epirubicin, Oxaliplatin,and Capecitabine） and FOLFIRI （iri- notecan, 5-fluorouracil, and leucovorin） regimens in metastatic gastric cancer patients. METHODS Metastatic gastric cancer patients who progressed on DCF regimens were included. A total of 105 patients were included in this study,and 55 and 50 patients were treated with mEOX and FOLFIRI regimens, respectively. The clinicopathological and demo- graphic characteristics of all patients were collected from the medical charts. Kaplan-meier survival analysis was carried out for progression-free survival （PFS） and overall survival （OS）. RESULTS The median follow-up of our study was 16（4.1- 81.3） months. In both groups, all of the patients were treated with first-line mDCF. Median cycle of second- line chemotherapy was 3.5（2-8） and 3（1-5） in EOX and FOLFIRI groups,respectively （P=0. 38）. Objective response rate was 21.8% and 18.0%in mEOX and FOLFIRI groups, respectively（χ2 =0. 239,P=0. 625）. Median PFS was 5.3 and 6.4 months in mEOX and FOLFIRI groups, respectively（χ2 =4.01,P=0. 045）. Median OS was 7.0 and 7.2 months in mEOX and FOLFIRI groups, respectively, from the time of beginning second line chemotherapy protocol（χ2 =0. 255, P=0.64）. As compared with FOLFIRI regimen, mEOX regimen was associated with less neutropenia and stomatitis. Dose reduction and dose delay were significantly higher in FOLFIRI group compared to mEOX group（P〈0. 001）. CON- CLUSIONS mEOX and FOLFIRI regimens have similar efficacy as second-line treatment for patients with metastatic gastric cancer, mEOX regimen has significantly lower toxicity than the FOLFIRI regimen. Both of them are worth clinical promotion.