曲妥珠单抗联合伊立替康+顺铂化疗对Her-2阳性的局部进展期胃癌的疗效及安全性

Effect and safety of trastuzumab combined with irinotecan +cisplatin chemotherapy on patients with locally advanced gastric cancer in Her-2 positivity

目的探究曲妥珠单抗联合伊立替康+顺铂化疗治疗Her-2阳性局部进展期胃癌的临床效果。方法选择2013年1月—2016年5月笔者所在医院收治的Her-2阳性进展期胃癌患者86例,根据入院顺序分为对照组、观察组,每组43例。对照组予以IP方案化疗(盐酸伊立替康+顺铂),观察组在此基础上联合曲妥珠单抗治疗。测定两组治疗前后血清肿瘤标志物[糖类抗原(CA)199、CA724及癌胚抗原(CEA)水平],进行为期两年的随访,评价两组近期疗效、远期疗效及其不良反应发生情况。结果两组治疗后血清CA199、CA724、CEA含量均低于该组治疗前,观察组低于对照组,差异有统计学意义(P<0.05);观察组总控制率为88.37%、总有效率为55.81%,均明显高于对照组的65.12%、32.56%,差异有统计学意义(P<0.05);观察组中位生存时间、无进展生存时间均优于对照组,差异有统计学意义(P<0.05);两组不良反应主要为Ⅰ、Ⅱ级恶心呕吐、骨髓抑制、肝功能损害及手足综合征等,两组间对比,差异无统计学意义(P>0.05)。结论曲妥珠单抗联合化疗能够降低Her-2阳性患者血清肿瘤标志物水平,治疗效果显著且安全性较高,利于延长患者的生存期。

Objective To investigate the clinical effect and safety of trastuzumab combined with irinotecan plus cisplatin in the treatment of Her-2 positive locally advanced gastric cancer.Methods The 86 patients with Her-2 positive advanced gastric cancer admitted in author's hospital from January 2013 to May 2016 were enrolled in this study.According to the order of admission,they were randomly divided into control group and observation group,43 cases for each.The control group received IP regimen chemotherapy(irinotecan hydrochloride+cisplatin),on the basis the observation group was treated with trastuzumab.Serum tumor markers[carbohydrate antigen(CA)199,CA724 and carcinoembryonic antigen(CEA)]were detect before and after treatment in two groups.A two-year follow-up was performed on to evaluate the short-term efficacy,long-term efficacy and unward reaction of the two groups.Results The levels of serum CA199,CA724 and CEA in the observation group was significantly lower than the control group(P<0.05);the total control rate of the observation group was 88.37%,and the total effective rate was 55.81%,significantly higher than the 65.12%,32.56%of control group(P<0.05);the median survival time and progression-free survival time of the observation group were significantly better than the control group(P<0.05);the two groups of unward reaction were mainly gradeⅠandⅡnausea and vomiting,bone marrow suppression,liver function damage and hand-foot syndrome.There was no significant difference between the two groups(P>0.05).Conclusion Trastuzumab combined with chemotherapy can reduce serum tumor markers in Her-2 positive patients,and the treatment effect is significant and safe,which is beneficial to prolong the survival time.