Discussion on gemcitabine combined with targeted drugs in the treatment of pancreatic cancer

Pancreatic cancer is a malignant tumor with poor prognosis.The treatment of pancreatic cancer depends on the tumor stage and type,and includes local treatment(surgery,radiotherapy and ablation intervention)and systemic therapy(chemotherapy,targeted therapy and immunotherapy).We read with great interest the review“Effective combinations of anti-cancer and targeted drugs for pancreatic cancer treatment”published on World J Gastroenterol and intended to share some of our perspectives in pancreatic cancer treatment.This review presents the therapeutic effects of the combination of gemcitabine and targeted drugs,which gives us a deeper insight into the combination treatments for pancreatic cancer.

First-line chemotherapy in very elderly patients with metastatic pancreatic cancer:Gemcitabine monotherapy vs combination chemotherapy

BACKGROUND Combination chemotherapy(gemcitabine plus nab-paclitaxel and FOLFIRINOX)is widely used as the standard first-line treatment for pancreatic cancer.Considering the severe toxicities of combination chemotherapy,gemcitabine monotherapy(G mono)could be used as a first-line treatment in very elderly patients or those with a low Eastern Cooperative Oncology Group status.However,reports on the efficacy of G mono in patients older than 75 years are limited.AIM To evaluate the efficacy of G mono and combination chemotherapy by comparing their clinical outcomes in very elderly patients with pancreatic cancer.METHODS We retrospectively analyzed 104 older patients with pancreatic cancer who underwent chemotherapy with G mono(n=45)or combination therapy(n=59)as a first-line treatment between 2011 and 2019.All patients were histologically diagnosed with ductal adenocarcinoma.Primary outcomes were progression-free survival and overall survival.We also analyzed subgroups according to age[65-74 years(elderly)and≥75 years(very elderly)].Propensity score matching was performed to compare the outcomes between the two chemotherapy groups.RESULTS The baseline characteristics were significantly different between the two chemotherapy groups,especially regarding age,ratio of multiple metastases,tumor burden,and Eastern Cooperative Oncology Group performance status.After propensity score matching,the baseline characteristics were not significantly different between the chemotherapy groups in elderly and very elderly patients.In the elderly patients,the median progression-free survival(62 d vs 206 d,P=0.000)and overall survival(102 d vs 302 d,P=0.000)were longer in the combination chemotherapy group.However,in the very elderly patients,the median progression-free survival(147 d and 174 d,respectively,P=0.796)and overall survival(227 d and 211 d,respectively,P=0.739)were comparable between the G mono and combination chemotherapy groups.Adverse events occurred more frequently in the combination chemotherapy group than in the G mono group,especially thromboembolism(G mono vs nab-paclitaxel vs FOLFIRINOX;8.9%vs 5.9%vs 28%,P=0.041),neutropenia(40.0%vs 76.5%vs 84.0%,P=0.000),and neuropathy(0%vs 61.8%vs 28.0%,P=0.006).CONCLUSION In elderly patients,combination therapy is more effective than G mono.However,G mono is superior for the management of metastatic pancreatic cancer in very elderly patients.

THE EFFECTS OF CHINESE DRUGS FOR SUPPORTING HEALTHY ENERGY AND REMOVING BLOOD STASIS ON POSTOPERATIVE METASTASIS OF GASTRIC CARCINOMA AND ORNITHINE DECARBOXYLASE

32 postoperative cases of gastric carcinoma were treated by traditional Chinese medicine (TCM) drugs for supporting healthy energy and removing blood stasis, and their therapeutic results were compared with those in the control group treated by western medicine. After 6 months of treatment, in the TCM group, the rate of metastatic recurrence was significantly reduced, and the level of ornithine decarboxylase was also markedly lowered. Therefore, it is considered that the action of anti-metastatic recurrence of TCM drugs in postoperative cases of gastric carcinoma is probably related to the lowered activity of ornithine decarboxylase.

Stimuli-responsive dual drugs-conjugated polydopamine nanoparticles for the combination photothermal-cocktail chemotherapy

We developed one-pot aqueous copolymerization of two dopamine prodrugs to prepare dual drugsconjugated polydopamine nanoparticles(PDOXCBs),which integrated near infrared(NIR)-mediated photothermal effect with cocktail chemotherapy into one copolymer nanoparticle.Upon a mild NIR irradiation(808 nm,1 W/cm^(2),10 min),PDOXCBs gradually heated aqueous solution over 12.8-13.9℃,which accordingly enhanced in vitro dual doxorubicin(DOX) and chlorambucil(CB) drug-release with assistance of the other stimuli of pH 5.0 and 10 mmol/L D,L-dithiothreitol(DTT).The combination photothermal-cocktail chemotherapy(PTT-CCT) treatment based on PDOXCB27 plus NIR irradiation gave a highly lowered half maximal inhibitory concentration(IC_(50)) of 2.23 μg/mL and a combination index of0.36,displaying a superior synergistic effect between PTT and CCT in vitro.

The effect of adenovirus expressing wild-type p53 on 5-fluorouracil chemosensitivity is related to p53 status in pancreatic cancer cell lines

AIM:There are conflicting data about p53 function on cellular sensitivity to the cytotoxic action of 5-fluorouracil (5-FU). Therefore the objective of this study was to determine the combined effects of adenovirus-mediated wild-type (wt) p53 gene transfer and 5-FU chemotherapy on pancreatic cancer cells with different p53 gene status. METHODS:Human pancreatic cancer cell lines Capan-1^(p53mut), Capan-2^(p53wt),FAMPAC^(p53mut),PANC1^(p53mut),and rat pancreatic cancer cell lines AS^(p53wt) and DSL6A^(p53null) were used for in vitro studies.Following infection with different ratios of Ad- p53-particles (MOI) in combination with 5-FU,proliferation of tumor cells and apoptosis were quantified by cell proliferation assay (WST-1) and FACS (PI-staining).In addition,DSL6A syngeneic pancreatic tumor cells were inoculated subcutaneously in to Lewis rats for in vivo studies. Tumor size,apoptosis (TUNEL) and survival were determined. RESULTS:Ad-p53 gene transfer combined with 5-FU significantly inhibited tumor cell proliferation and substantially enhanced apoptosis in all four cell lines with an alteration in the p53 gene compared to those two cell lines containing wt-p53.In vivo experiments showed the most effective tumor regression in animals treated with Ad-p53 plus 5-FU.Both in vitro and in vivo analyses revealed that a sublethal dose of Ad-p53 augmented the apoptotic response induced by 5-FU. CONCLUSION:Our results suggest that Ad-p53 may synergistically enhance 5-FU-chemosensitivity most strikingly in pancreatic cancer cells lacking p53 function.These findings illustrate that the anticancer efficacy of this combination treatment is dependent on the p53 gene status of the target tumor cells.

Point injection of Injectio Radici Astragali for Treatment of Post-chemotherapy Adverse Reactions

With injection of Injectio Radici Astragli into the point Zusanli (ST 36), we have obtained quite satisfactory therapeutic results for treating leukopenia and the impairment in immune functions occurred in cancer chemotherapy. A report follows.

Treatment of Interstitial Peumopathy by Fei Tong Oral Liquid in the Malignant Tumor Patients after Radio-and/or Chemotherapy

Fei Tong Kou Fu Ye (肺通口服液 Fei Tong Oral Liquid) was used to treat 30 cases of interstitial pneumopathy after radio- and/or chemotherapy.In comparison with the control group (15 cases) treated with hormones,the therapeutic effects in improving dyspnea,cough,respiratory rate,cyanosis,findings in X-films and CT examination,partial pressure of oxygen in artery,FVC and VC were found significantly better (P<0.05).The total effective rate obtained was 83.33%.

Micelles as potential drug delivery systems for colorectal cancer treatment

Despite the significant progress in cancer therapy,colorectal cancer(CRC)remains one of the most fatal malignancies worldwide.Chemotherapy is currently the mainstay therapeutic modality adopted for CRC treatment.However,the long-term effectiveness of chemotherapeutic drugs has been hampered by their low bioavailability,non-selective tumor targeting mechanisms,non-specific biodistribution associated with low drug concentrations at the tumor site and undesirable side effects.Over the last decade,there has been increasing interest in using nanotechnology-based drug delivery systems to circumvent these limitations.Various nanoparticles have been developed for delivering chemotherapeutic drugs among which polymeric micelles are attractive candidates.Polymeric micelles are biocompatible nanocarriers that can bypass the biological barriers and preferentially accumulate in tumors via the enhanced permeability and retention effect.They can be easily engineered with stimuli-responsive and tumor targeting moieties to further ensure their selective uptake by cancer cells and controlled drug release at the desirable tumor site.They have been shown to effectively improve the pharmacokinetic properties of chemotherapeutic drugs and enhance their safety profile and anticancer efficacy in different types of cancer.Given that combination therapy is the new strategy implemented in cancer therapy,polymeric micelles are suitable for multidrug delivery and allow drugs to act concurrently at the action site to achieve synergistic therapeutic outcomes.They also allow the delivery of anticancer genetic material along with chemotherapy drugs offering a novel approach for CRC therapy.Here,we highlight the properties of polymeric micelles that make them promising drug delivery systems for CRC treatment.We also review their application in CRC chemotherapy and gene therapy as well as in combination cancer chemotherapy.

四联方案预防含顺铂方案多日化疗致恶心呕吐的效果和安全性研究

目的评价四联方案预防含顺铂方案多日化疗所致恶心呕吐(CINV)的有效性和安全性。方法选取以含顺铂药物进行化疗的112例恶性肿瘤患者。以随机数字表法将患者分为试验组与对照组,每组56例。对照组接受含有顺铂的化疗方案时给予三联方案(福沙匹坦双葡甲胺+盐酸昂丹司琼+地塞米松),试验组在对照组基础上给予含奥氮平的四联方案。观察2组恶心及呕吐发生情况、生活质量[呕吐生活功能量表(FILE)]及焦虑抑郁[医院焦虑抑郁量表(HADS)]的变化。结果开始化疗后1~9 d,试验组恶心、呕吐发生率低于对照组,试验组延迟期恶心、呕吐发生率低于对照组(P<0.05);开始化疗后9 d,试验组FILE的恶心、呕吐及总分高于对照组(P<0.05);2组开始化疗后1、9 d焦虑、抑郁评分及不良反应发生率比较差异无统计学意义(P>0.05)。结论四联止吐方案可提高对含顺铂多日化疗方案致CINV的控制率,尤其是针对延迟性恶心、呕吐的控制,改善患者化疗期间的生活质量,且安全性较好。

胶质母细胞瘤相关药物治疗的研究进展

胶质母细胞瘤(GBM)是一种起源于颅内神经胶质细胞的高级别恶性肿瘤,复发率高,预后差。标准治疗模式是手术切除肿瘤联合放化疗,但因血脑屏障的限制和对化疗药物的耐药机制使疗效大大降低。近年来,针对替莫唑胺、亚硝基类、贝伐珠单抗等抗GBM常用药物作用及耐药机制的不断研究,发现了多种有效的联合治疗方式。此外,在纳米技术领域内,探索新方法对GBM化疗进程产生了极大的影响。本文综述了GBM常用药物的耐药机制、有效联合治疗及其他提高药物治疗疗效策略的最新研究进展。

A bicistronic retroviral vector to introduce drug resistance genes into human umbilical cord blood CD34^+ cells to improve combination chemotherapy tolerance

OBJECTIVE: To study whether human umbilical cord blood CD34+ cells transduced with human aldehyde dehydrogenase class-1 (ALDH-1) and multidrug resistance gene (MDR1) have increases resistance to 4-Hydroperoxycyclo-phosphamide (4-HC) and P-glycoprotein effluxed drugs. METHODS: A bicistronic retroviral vector G1Na-ALDH1-IRES-MDR1 was constructed and used to transfect the packaging cell lines GP + E86 and PA317 by LipofectAMINE method, using the medium containing VCR and 4-HC agents for cloning selection and ping-ponging supernatant infection between the ecotropic producer clone and the amphotropic producer clone, we obtained high titer amphotropic PA317 producing cells with high titers up to 5.6 x 10(5) CFU/ml. Cord blood CD34+ cells were transfected repeatedly with supernatant of retrovirus containing human ALDH-1 and MDR1cDNA under the stimulation of hemopoietic growth factors. RESULTS: Bicistronic retroviral vector construction was verified by restriction endonuclease analysis. Polymerase chain reaction (PCR), reverse transcription (RT)-PCR, Southern blot, Northern blot, fluorescenceactivated cell sorting (FACS) method and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) analyses showed that dual drug resistance genes have been integrated into the genomic DNA of cord blood CD34+ cells and expressed efficiently. The transgenes recipient cells confered 4-fold stronger resistance to 4-HC and 5.5 to 7.2-fold P-glycoprotein effluxed drug than untransduced cells. CONCLUSION: The bicistronic retroviral vector-mediated transfer of two different types of drug resistance genes into human cord blood CD34+ cells and co-expression provided an experimental foundation for improving combination chemotherapy tolerance in tumor clinical trial.

Self-Motivated Supramolecular Combination Chemotherapy for Overcoming Drug Resistance Based on Acid-Activated Competition of Host–Guest Interactions

In this work,we propose a nanoparticle-based strategy of self-motivated supramolecular combination chemotherapy that carries drugs stably and releases them actively in the acidic tumor microenvironment to overcome the drug resistance of cancer cells.This self-motivated nanoparticle consists of a cucurbit[7]uril-containing polymer(PCB)-based core.

复发/难治性套细胞淋巴瘤治疗进展

套细胞淋巴瘤(MCL)是一种罕见的B细胞恶性肿瘤,占所有非霍奇金淋巴瘤(NHL)的3%~10%,常见于男性,中位发病年龄67岁,具有不可治愈、易复发和耐药等特点,复发后患者预后常较差,治疗选择有限。近年来,随着布鲁顿酪氨酸激酶抑制剂(BTKi)、B细胞淋巴瘤因子2抑制剂(BCL-2i)等为代表的靶向药物的应用,以及嵌合抗原受体T细胞(CAR-T)及异基因干细胞移植(allo-SCT)等疗法的进展,复发难治性(R/R)MCL患者的生存期明显延长。本文拟对目前R/R MCL的治疗进展进行综述。

中晚期肝癌肝动脉灌注化疗的研究进展

对于部分无法接受肝癌切除术的中晚期肝癌患者来讲,则需要采取如动脉灌注化疗、门静脉插管灌注化疗等姑息性外科手段治疗来抑制病情进展。如果患者肝功能尚可且无法进行切除,肝动脉灌注化疗(hepatic artery infusion chemotherapy,HAIC)则可成为重要治疗手段,其在使肿瘤缩小、坏死的同时又不会对周围健康细胞造成较大负面影响。随着医疗技术的发展进步,临床出现了越来越多的化疗药物。该选择哪种治疗药物,如何进行优化药物配伍方式来抑制肝癌进展,提升患者生存率及预后,成为临床关注的热点问题。文章在参考相关资料的基础上对中晚期肝癌HAIC展开总结分析,以供参考。

五阶梯营养支持对胃癌术后辅助化疗患者营养状态及化疗毒副反应的影响

【目的】探讨五阶梯营养支持对胃癌术后辅助化疗患者营养状态及化疗毒副反应的影响。【方法】行胃癌术后辅助化疗的80例患者,随机分成两组,每组40例。观察组给予五阶梯营养支持,对照组给予常规营养支持,比较两组干预前后营养状态、血液生化指标水平、化疗毒副反应和生存质量。【结果】干预后,两组主观整体营养状况评估量表(PG-SGA)评分降低,体重指数(BMI)、小腿最大周径升高(P<0.05),且观察组PG-SGA评分低于对照组,BMI、小腿最大周径高于对照组(P<0.05);干预后,两组血红蛋白(Hb)、血清白蛋白(Alb)、血清前蛋白(PA)水平较干预前均升高(P<0.05),且观察组高于对照组(P<0.05);观察组化疗毒副反应总发生率(17.50%)低于对照组(45.00%)(P<0.05);干预后3个月、6个月,两组胃癌患者生命质量测量量表评分均低于干预前,且观察组低于对照组(P<0.05)。【结论】在胃癌术后辅助化疗患者中应用五阶梯营养支持可以改善患者营养状态、血液生化指标,减轻化疗毒副反应,改善患者生存质量,值得临床推广应用。

贝伐珠单抗联合含氟尿嘧啶类化疗方案治疗晚期转移性结直肠癌的前瞻性、非干预性、全国多中心临床研究(REACT)

背景和目的 在欧美国家,贝伐珠单抗联合化疗业已成为治疗晚期转移性结直肠癌（m CRC）的标准方案。在我国,贝伐珠单抗的注册临床研究亦显示贝伐珠单抗联合化疗可以提高m CRC客观缓解率和显著改善生存预后。但是,缺乏贝伐珠单抗联合化疗治疗国人m CRC的大样本资料,特别是安全性数据。为此,我们开展了上市后临床研究——REACT研究（REal world study of Avastin in Colorec Tal cancer;注册号：NCT 01319877）,系统观察和评价真实世界（real world）中贝伐珠单抗联合氟尿嘧啶类药物为基础的化疗方案治疗国人m CRC的安全性和有效性。方法 本研究为一项前瞻性、非干预性、全国多中心的上市后临床研究。根据预设的入排标准,纳入m CRC一线或二线治疗患者,采用贝伐珠单抗联合氟尿嘧啶类药物为基础的常规化疗方案进行治疗。主要终点指标是评估治疗的安全性,次要终点指标为评估总体缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）、KRAS突变状态和贝伐珠单抗用药周期（〈8或≥8周期）对疗效以及生活质量（Qo L）的影响。分别采用RECIST 1.1版和NCI-CTC AE 4.03版评价客观疗效和不良反应。结果 自2011年3月至2013年12月,24家研究中心共纳入606例m CRC,中位年龄56.6岁（22-81岁）,ECOG PS 0-1占76.7%;其中,一线患者453例,二线患者153例。贝伐珠单抗中位用药周期为5.0个（3.0-8.0个）周期。安全性方面：有102例患者（16.8%）发生≥3级不良事件（AE）;66例（10.9%）发生≥3级可能与贝伐珠单抗有关的AE。特别关注的不良事件（AESI）为高血压（1.8%）、蛋白尿（0.8%）、胃肠穿孔（0.5%）、出血（3.3%）、动脉血栓栓塞（0.3%）、静脉血栓栓塞（1.0%）、肠瘘（0.8%）以及伤口愈合并发症（0.2%）。有效性方面：ORR为18.3%（95%CI：15.3%-21.6%）,一线患者和二线患者的ORR分别为21.0%（95%CI：17.3%-25.0%）和10.5%（95%CI：6.1%-16.4%）（P=0.0035）;中位无进展生存期（m PFS）为9.1个月（95%CI：8.1-9.8个月）;中位总生存期（m OS）为21.9个月（95%CI：17.1-25.7个月）。一线患者与二线患者的m PFS和m OS差异均无统计学意义（m PFS：P=0.6530;m OS：P=0.3695）。按治疗周期划分,应用贝伐珠单抗〈8周期患者的m PFS和m OS分别为7.8个月（95%CI：6.2-8.9个月）和17.6个月（95%CI：14.9-24.8个月）;用药≥8周期患者的m PFS和m OS分别为11.6个月（95%CI：10.9-14.4个月）和30.8个月（95%CI：21.3个月-未达）。用药≥8周期患者的生存获益明显优于〈8周期患者（m PFS：P=0.0001;m OS：P=0.001）。按KRAS突变状态划分,KRAS野生型和突变型患者的m PFS分别为9.8个月（95%CI：6.7-12.3个月）和8.6个月（95%CI：6.2-9.9个月）,差异无统计学意义（P=0.2784）。KRAS野生型和突变型患者的m OS分别为25.7个月（95%CI：16.9个月-未达）和14.3个月（95%CI：10.3-21.9个月）,差异无统计学意义（P=0.1015）。结论 REACT研究结果表明,贝伐珠单抗联合氟尿嘧啶类药物为基础的化疗,用于一线或二线治疗国人m CRC患者的总体安全性良好,临床获益明显;贝伐珠单抗联合含氟尿嘧啶类药物化疗使用时间长（≥8周期）的患者比使用时间短（〈8周期）的患者,具有更佳生存获益。这与欧美国家和中国注册临床研究的情况类似,值得临床上进一步推广应用。

奥沙利铂联合醛氢叶酸和5氟脲嘧啶用于进展期胃癌术后辅助化疗的临床观察

目的 :观察奥沙利铂、醛氢叶酸和 5 氟脲嘧啶治疗进展期胃癌的疗效和毒性。方法 :5 0例选择性D3 清扫术后的Ⅲ期胃癌患者随机分为OLF治疗组 (L OHP 130mg/m2 ,d1;LV 10 0mg/m2 ,dl～ 5 ;5 FU 5 0 0mg/m2 ,d1～ 5 )和FLP对照组 (DDP 2 0mg/m2 ,d1～ 5 :LV 10 0mg/m2 ,d1～ 5 ;5 Fu 5 0 0mg/m2 ,d1～ 5 )。以上方案均为三周重复。结果 :OLF治疗组和FLP对照组的 1,3年总生存率比较分别为 84 0 %vs72 0 %和 76 2 %vs 5 5 6 % ,无异著差异。OLF治疗组和FLP对照组的 1、3年无进展生存率比较分别为 76 0 %vs 4 4 0 %和 6 6 7%vs 2 7 8% ,均有显著差异。结论 :奥沙利铂联合醛氢叶酸和 5 氟脲嘧啶是Ⅲ期胃癌选择性D3 清扫术后较为理想的辅助化疗模式。

子宫颈癌的新辅助介入化疗

目的 评价新辅助介入化疗治疗局部晚期宫颈癌的疗效。方法 采用回顾性分析方法分析应用新辅助介入化疗的巨块型和中晚期宫颈癌 95例 ,FIGO分期Ib期 1 2例、Ⅱa期 4 5例、Ⅱb期 2 8例、Ⅲ期 4例和Ⅳ期 6例。化疗方案为DDP(顺铂 ) 80mg + 5 FU( 5 氟尿嘧啶 ) 1 50 0mg +AT12 5 8(消瘤芥 )或ADM(多柔比星 ,阿霉素 ) 60mg ,化疗后根据检查决定手术或放疗。术后病理发现有宫旁浸润、盆腔淋巴结转移、脉管癌栓或阴道切缘阳性者均给予术后补充放疗。 95例都得到随访 ,中位随访期 3 4月 ( 2 0～ 66月 )。结果 新辅助化疗的总有效率为 89% ( 85/95) ,其中完全缓解 2 6例( 2 7% )。部分缓解 59例 ( 62 % )。化疗后行宫颈癌根治术 85例 ,行根治性放疗 1 0例。术后辅助放疗 3 3例。 5年生存率分别为Ⅰb期 1 0 0 %、Ⅱa期 91 %、Ⅱb期 75 5%、Ⅲ期 3 9%和Ⅳ期 2 1 % ,其中 2 4例Ⅱb期化疗后行手术治疗的 5年生存率为 77 4 % ,而化疗后放疗组仅 51 % ,二者有显著性差异。结论 新辅助化疗有效率高 ,可增强治疗效果 ;化疗联合手术是提高Ⅱb期宫颈癌生存率的有效方法。

表柔比星联合奥沙利铂和短期5-FU持续滴注的EOF_5方案一线治疗晚期胃癌的疗效评估

背景与目的：晚期胃癌治疗中，ECF（表柔比星、顺铂及5-FU持续滴注21 d）方案系经典一线方案，2004年起我们以奥沙利铂取代顺铂，以低剂量5-FU持续滴注120 h取代标准剂量持续滴注21 d，组成EOF5方案，以期提高疗效及依从性，先后开展了小样本探索性研究及扩大样本的Ⅱ期研究。方法：本研究回顾性分析了该两项Ⅱ期研究结果。患者均接受了表柔比星50 mg/m2，静脉推注，第1天；奥沙利铂130 mg/m2，静脉滴注2 h，第1天；每天5-FU的剂量为375~425 mg/m2，低剂量持续输注5 d共120 h；每3周重复，每6周评价疗效。治疗到进展、不能耐受或患者退出，对于6~8个疗程后稳定以上疗效的患者根据医师推荐及患者的意愿，选择氟尿嘧啶类药物维持治疗或观察。结果：178例晚期胃癌患者纳入本研究，170例可行疗效及不良反应评估，7例（3.9%）完全缓解（complete response，CR），76例（42.7%）部分缓解（partial response，PR），总有效率（overall response rate，ORR，CR＋PR）为46.6%，69例（38.8%）疾病稳定（stable disease，SD），18例（10.1%）疾病进展（progressive disease，PD）。中位无进展生存期（progress free survival，PFS）为6.0个月（95%CI：5.2~6.8），中位总生存期（overall survival，OS）为12.6个月（95%CI：8.9~16.3），1、2年生存率分别为50.9%和28.0%。3~4度以上不良反应主要有白细胞及中性粒细胞减少23.0%及38.8%、血红蛋白下降6.5%、血小板下降23.5%、恶心呕吐14.1%、手足麻木1.2%。接受二线治疗的75例患者，二线治疗中位生存时间8.0个月（95%CI：4.8~11.2）。结论：EOF5方案治疗晚期胃癌有效率高，PFS和OS同ECF及其改良方案类似，不良反应可控，是安全有效的晚期胃癌一线治疗方案。