替吉奥联合沙利度胺治疗老年晚期胃癌临床分析

Maintenance treatment of S-1 combined thalidomide in elderly patients with advanced gastric cancer

目的探讨替吉奥联合沙利度胺维持治疗老年晚期胃癌的疗效与安全性。方法选取应用替吉奥联合低剂量顺铂方案一线化疗4~6个周期后疗效评价为疾病无进展的老年晚期胃癌患者56例。根据继续治疗方法不同分为2组:维持治疗组(28例)应用替吉奥联合沙利度胺维持治疗,直至疾病进展或出现不能耐受的不良反应;对照组(28例)给予营养支持治疗。结果维持治疗组客观有效率(35.7%)高于对照组(3.6%),疾病控制率(67.9%)高于对照组(21.4%),差异均有统计学意义(P<0.05)。维持治疗组中位无进展生存时间(6.9个月)长于对照组(4.3个月),差异有统计学意义(P<0.05)。维持治疗组与对照组中位总生存时间分别为11.7个月与9.8个月,差异无统计学意义(P>0.05)。维持治疗组主要不良反应为骨髓抑制、胃肠道反应、乏力、肝功能损伤等,对症治疗后均好转,无治疗相关性死亡。结论替吉奥联合沙利度胺在老年晚期胃癌患者的化疗后维持治疗中疗效确切,耐受性良好,可增加化疗有效率、延长疾病进展时间。

Objective To investigate the efficacy and safety of S-1 combined with thalidomide as maintenance treatment for elderly patients with advanced gastric cancer. Methods A retrospective study was performed on 56 elderly advanced gastric cancer patients without disease progression after 4 to 6 cycles of SP regimen as the first-line chemotherapy. According to the different treatment methods,patients were divided into the maintenance treatment group and the control group,with 28 patients in each group. Patients in the maintenance group received S-1 combined with thalidomide until disease progression or intolerable toxicity; patients in the control group were given nutrition supportive treatment. Results The response rate in the maintenance group（ 35. 7%） was higher than that in the control group（ 3. 6%）,the disease control rate in the maintenance group（ 67. 9%） was higher than that in the control group（ 21. 4%）（ P〈0. 05）. The median time to PFS in the maintenance group（ 6. 9 months） was longer than that in the control group（ 4. 3 months）（ P〈0. 05）. The median overall survival time was 11. 7 months in the maintenance group and 9. 8 months in the control group,which had no significant difference（ P〉0. 05）. The major adverse reactions in the maintenance treatment group were bone marrow suppression,gastrointestinal tract reaction,fatigue,liver function damage,and etc.,which were all improved after symptomatic treatment,there was no treatment-related death. Conclusion This combination of standard dose of S-1 and thalidomide after SP regimen first-line chemotherapy in the elderly patients with advanced gastric cancer as the maintenance treatment is effective,well tolerated,which can increase the efficiency of treatment and prolong disease progression,even extend the overall survival trend,worthy of further clinical application.