紫杉醇联合草酸铂治疗30例晚期胃癌

Combination chemotherapy with paclitaxel and oxaliplatin in 30 patients with advanced gastric cancer

目的:研究联合紫杉醇及草酸铂两种新药用于治疗晚期胃癌,并评价此方案的近期疗效及其毒副作用。方法:对入选的30例晚期胃癌患者以紫杉醇联合草酸铂(单周或双周)方案予全身化疗,并配合每周1次顺铂(DDP)或氟嘧啶脱氧核苷(FUDR)单药腹腔灌注化疗。结果:30例胃癌患者平均化疗1.2个疗程,CR 2例,PR 17例,总有效率RR(CR+PR百分率)为63%(95%可信区间为46%-80%)。毒副反应主要为骨髓抑制,发生率达77%,但60%为Ⅰ-Ⅱ度,有3例(10%)为Ⅳ度;胃肠道反应、肝功损害、末梢神经炎、肾功损害、粘膜炎及心脏毒性发生率分别为40%、30%、13%、10%、10%及7％,大都为Ⅰ-Ⅱ度。所有患者均未因毒副作用中断或退出治疗。结论:紫杉醇联合草酸铂方案治疗晚期胃癌近期疗效是肯定的,毒副反应较轻,适合于对其他化疗反应大、有潜在心、肝、肾功不良或年老体弱、多次化疗后、恶性度高或急需减瘤考虑Ⅱ期手术的患者。

Purpose: To evaluate the efficacy and toxicity of combination chemotherapy with paclitaxel and oxaliplatin (two new drugs) in patients with locally advanced and(or) metastatic gastric adenocarcinoma ( M/AGC). Methods: Between May 2001 and May 2002, 30 patients (22 male and 8 female) with a median age of 58 years (range35-80) were consecutively enrolled in this study. Oxaliplatin and paclitaxel were administered as a two-hour infusion every one or two weeks, respectively, and DDP or FUDR were infused in abdominal cavity every one week. Results: Thirty patients were evaluable for activity, with 2 complete and 17 partial responses, objective response rate( RR): 63% ( 95% CI: 46% -80%). Twenty-three of thirty patients (77%) experienced WHO grade Ⅰ-Ⅳ bone marrow suppression, which was the most common and serious toxicity. WHO Grade Ⅰ-Ⅲ side effect ( non-hematological toxicity) of gastrointestinal tract, liver, peripheral neuropathy, kidney , mucositis and heart occurred in 40%, 30%, 13%, 10%, 10% and 7% of patients, respectively. No patients withdrew because of treatment-related toxicity. Conclusions: Our data suggest that the combination of paclitaxel and oxaliplatin has promising therapeutic activity in patients with advanced gastric cancer. This regimen shows good efficacy and an acceptable safety profile in M/AGC patients, and may prove to be a suitable alternative regimen in this indication, especially for the patients with bad function of the heart , liver and kidney or old, physically weak patients.