Clinical Analysis of Bevacizumab Plus FOLFIRI Regimen as Front-Line Therapy for Chinese Patients with Advanced Colorectal Cancer

The study was designed to evaluate the therapeutic and side effects of Bevacizumab plus FOLFIRI regimen as front-line therapy for Chinese patients with advanced colorectal cancer. A total of 15 previously untreated patients with advanced colorectal cancer received Bevacizumab plus FOLFIRI regimen as font-line therapy, in detail, irinotecan 180 mg/m2 was given intravenously on day1, then calcium folinate (CF) 200 mg/m2, F-fluorouracil (5-Fu) 400 mg/m2 given in bolus immediately after CF, day 1 - 2;5-Fu 600 mg/2 given continuously after bolus for 22 hours on day1, day2;Bevacizumab was given intravenously at dosage of 5 mg/kg, on day-1. Therapeutic and side effects were evaluated at least after four cycles of treatment. The results showed that all the cases among the group were valid for response evaluation, with CR 0, PR 10, SD 3, and PD 2. The response rate is 66.7% and median time to progression (mTTP) was 10.6 months. The main toxicities were bone marrow suppression, nausea and vomiting, stomach pain and diarrhea;there was no chemotherapy-related death. The data suggested that the combination regimen with Bevacizumab plus FOLFIRI regimen was effective as front-line therapy for Chinese patients with advanced colorectal cancer, and the side effects were tolerable and manageable.

Therapeutic strategy in colorectal cancer based on Traditional Chinese and Western Medicine: from the lipid metabolism perspective

Colorectal cancer(CRC)is a major cause of morbidity and mortality and is closely associated with lipid metabolism,of which fatty acid metabolism,the release of fat factors and the abnormal level of blood lipids are all important pathogenic mechanisms.With the increasing awareness of lipid metabolism,advances in lipid-regulating therapy have made it possible for anti-tumor effect in CRC.However,there are still many research gaps and limitations.Given the complexity and uncertainty of targeted lipid-regulating therapy for CRC,traditional Chinese medicine(TCM)may have a leg up when it comes to the theory of“holistic concept”and“treatment based on syndrome differentiation”.Meanwhile,proper dietary direction,healthy lifestyles,and normal serum lipid levels contribute directly to the prognosis of CRC patients.

Clinical observation of Fufangchangtai decoction combined with FOLFOX4 regimen for postoperative colorectal cancers

Objective:The aim of the study was to observe the therapeutic effect of FOLFOX4 regimen plus Fufangchangtai decoction on postoperative colorectal cancers.Methods:Thirty postoperative colorectal cancer patients were allocated into control and experiment groups respectively.Patients in experiment group were given Fufangchangtai decoction combined with FOLFOX4 regimen.Patients in control group were given FOLFOX4 regimen alone.Efficacy was evaluated after 2 periods of treatment.Results:The improvement rate of symptoms were 86.6% in experiment group compared to 53.3% in control group.KPS was stable in experiment group,and decreased in control group.QOL was increased in experiment group,and stable in control group after the treatment.For impact of immunity parameters,there were enhancements of CD3+ and CD4+ in experiment group,while they did not change in control group.In experiment group,WBC reduction was slighter than that of control group.The differences were not remarkable in PLT reduction,alimentary response,and toxicity of liver and kidney and nervous system.Conclusion:The clinical observation showed that Fufangchangtai decoction plus FOLFOX4 regimen could effectively enhance KPS,improve the symptoms,the quality of life and the immunity state,and down-regulate the side effects.In conclusion,Fufangchangtai decoction can decrease the toxicity so as to increase the treatment effect.

Effectiveness and Safety Evaluation of Chinese Medicine in Treatment of Metastatic Colorectal Cancer after Chemotherapy Failure: Protocol of a Prospective Multicenter Cohort Study

Background:Colorectal cancer(CRC)is the second most common cause of cancer-related deaths and has the third highest incidence in the world.Almost half of the patients with CRC have metastases at the time of diagnosis.However,the treatment for patients with metastatic CRC that progresses after approved conventional chemotherapy is still controversial.Chinese medicine(CM)has unique characteristics and advantages in treating metastatic CRC.Objective:To assess the effectiveness and safety of CM in patients with metastatic CRC after failure of conventional chemotherapy.Methods:The study is a multicenter prospective cohort study.A total of 384 patients with documented metastatic CRC after failure of conventional chemotherapy will be included from 9 hospitals at Beijing,Shanghai,Nanjing,and Guizhou,and assigned to three groups according to paitents'wishes:(1)integrated Chinese and Western medicine(ICM)group receiving CM herbal treatment combined with Western medicine(WM)anti-tumor therapy,(2)Chinese medicine(CM)group receiving only CM herbal treatment,and(3)WM group receiving only WM anti-tumor therapy.The primary endpoint is the overall survival(OS).Secondary endpoints include the progression free survival(PFS),quality of life(QOL)assessed by the Functional Assessment of Cancer Therapy-Colorectal(FACT-C)questionnaire,tumor control,and CM symptom score.Discussion:This prospective study will assess the effectiveness and safety of CM in treating metastatic CRC after conventional chemotherapy failure.Patients in the ICM group will be compared with those in the WM group and CM group.If certified to be effective,national provision of CM treatment in metastatic CRC will probably be advised.(Registration No.NCT02923622).

Cohort Study on the Effect of a Combined Treatment of Traditional Chinese Medicine and Western Medicine on the Relapse and Metastasis of 222 Patients with Stage Ⅱ and Ⅲ Colorectal Cancer after Radical Operation

Objective： To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine （TCM） in reducing the relapse and metastasis of stage Ⅱ and Ⅲ colorectal cancer based on conventional Western medicine （WM） therapy. Methods： Two hundred and twenty-two patients in total, diagnosed as stage Ⅱ and Ⅲ colorectal cancer from February 2000 to March 2006, were recruited from Xiyuan Hospital, China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area. They were followed-up once every 3-6 months. Twenty cases dropped out from the cohort. The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation, or chemotherapy or/and radiotherapy according to national comprehensive cancer network （NCCN） clinical guidelines]. These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy （orally administered with a decoction according to syndrome differentiation, combined with a traditional patent drug over one year）. Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM （combined group）, and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone （WM group）. The demographic data at baseline were comparable, including the operation times, age, sex, TNM staging, and pathological types. The patients were followed-up for one to five years. Up to now, there are 98, 98, 77, 64, and 47 patients with 1, 2, 3, 4, and 5 years of follow-up in the combined group, respectively; and 104, 104, 97, 81, and 55 patients in the WM group, respectively. The results of the 5-year follow-up of all the patients will be available in 2011. Results： The relapse/metastasis rate of 1-, 2-, 3-, 4-, and 5-year were 0 （0/98）, 2.04% （2/98）, 11.69% （9/77）, 14.06% （9/64）, and 21.28% （10/47） in the combined group, and were 4.80%（5/104）, 16.35% （17/104）, 21.65% （21/97）, 25.93% （21/81）, and 38.18%（21/55） in the WM group, respectively. A significant difference was found in the second year between the two groups （X^2=12.117, P = 0.000）. Median relapse/metastasis time was 26.5 months in the combined group and 16.0 months in the WM group. Conclusion： The combined therapy of TCM and WM may have great clinical value and a potential for decreasing the relapse or metastasis rate in stage Ⅱ and Ⅲ colorectal cancer after conventional WM therapy.

Treatment of Middle/Late Stage Pri mary Hepatic Carci noma by Chinese Medicine Comprehensive Therapy:A Prospective Randomized Controlled Study

Objective：To observe the efficacy of Chinese medicine comprehensive therapeutic project in treating the middle/late stage primary hepatic carcinoma（PHC）.Methods：With prospective randomized controlled design, 97 patients with PHC were assigned to the test group（49 cases） treated with Chinese medicine comprehensive therapy using Oleum fructus bruceas intervention combining oral intake of Ganji Decoction（肝积方） and external application of Ailitong（癌理通）,and the control group（48 cases） treated with chemotherapeutic agents combining iodized oil chemo-embolization and analgesics.The immediate and long-term efficacy,adverse reaction,pain-relieving initial time（PRIT） and pain-relieving sustained time（PRST） of the treatment,as well as the change in patients＇ quality of life（QOL） were observed.Results：The difference between the two groups in illness control rate was statistically insignificant（P〉0.05）,but the adverse reaction occurence rate in the test group was lesser than that in the control group（P〈0.05）.PRIT was insignificantly different in the two groups（P〉0.05）,but the PRST was significantly superior in the test group than that in the control group（10.37±2.18 h vs 7.78±1.95 h,P〈0.01）.After treatment,the increased Karnofsky scores in the test group indicated that the patients＇ somatic activity,symptoms and QOL were improved significantly,which were significantly superior to those in the control group（P〈0.05）.The survival rate in the two groups was similar at the 3rd month after treatment,but the test group did show superiority in terms of half- and 1-year survival rate（65.9%vs 42.5%and 38.6%vs 18.1%,respectively,P〈0.05）.The median survival time in the test group was 8.9 months and that in the control group was 5.3 months.Conclusion：Chinese medicine comprehensive therapy is an effective treatment for the middle/late stage patients of PHC,and it could extend the PRST,improve the patients＇ QOL and long-term survival with less adverse reaction.

健脾温中益气方联合针灸对结直肠癌术后患者胃肠道功能及胃肠道激素水平的影响

目的观察健脾温中益气方联合针灸对结直肠癌术后患者胃肠道功能及胃肠道激素水平的影响。方法将102例结直肠癌术后患者按照随机数字表法分为2组,对照组51例予西医常规治疗,治疗组51例在对照组治疗基础上加用健脾温中益气方联合针灸治疗,2组均治疗30天。比较2组胃肠功能、胃肠道激素水平、免疫功能指标变化;比较2组不良反应。结果治疗组首次排气时间、首次排便时间及肠鸣音恢复时间均较对照组短(P<0.05)。2组治疗后胃动素、胃泌素水平均较本组治疗前降低(P<0.05),治疗后治疗组胃动素、胃泌素水平均高于对照组(P<0.05)。2组治疗后CD8^(+)较本组治疗前降低(P<0.05),CD4^(+)、CD3^(+)较本组治疗前升高(P<0.05);治疗后治疗组CD8^(+)低于对照组(P<0.05),CD4^(+)、CD3^(+)高于对照组(P<0.05)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论健脾温中益气方联合针灸治疗可改善结直肠癌术后患者胃肠道功能和胃肠道激素水平,提高机体免疫功能,安全性较高。

医护一体化中西医结合快速康复护理模式在结直肠癌手术患者中的应用

目的:探究医护一体化中西医结合快速康复护理模式在结直肠癌手术患者中的应用。方法:研究对象选择2022年6月—2023年12月佛山市中医院收治的结直肠癌手术患者60例根据随机数字表法分为两组,每组30例。对照组采用常规护理,试验组在对照组基础上采用医护一体化中西医结合快速康复护理模式。比较两组围术期情况、不良情绪及疼痛情况。结果:试验组首次肠道排气、排便、下床活动、进食时间以及手术至出院天数均短于对照组(P<0.001);两组术后焦虑自评量表评分较术前下降,试验组低于对照组(P<0.05);两组术后第5天的数字疼痛评分法评分低于术后第3天与术后第1天(P<0.05);试验组术后第1、3、5天的数字疼痛评分法评分均低于对照组(P<0.001)。结论:将医护一体化中西医结合快速康复护理模式应用于结直肠癌患者中,可改善患者术后情况、缓解不良情绪、减少疼痛,具有良好的临床应用价值。

基于虚实辨证的大肠癌血瘀证中医药治疗和作用机制研究进展

血瘀证是大肠癌患者常见的中医证型,血瘀贯穿于大肠癌发生发展的各个阶段,活血化瘀法是临床治疗大肠癌的常用方法。从因虚致瘀、由实成瘀两个角度探讨大肠癌血瘀证的病因病机和临床治疗,并从增殖凋亡、血管新生、细胞自噬、侵袭转移、免疫调节、微循环障碍等方面综述活血化瘀中药治疗大肠癌血瘀证的作用机制,以期为临床使用活血化瘀法治疗大肠癌提供依据。

肺癌分子靶向治疗EGFR-TKI患者证候及中医处方用药研究进展

表皮生长因子受体酪氨酸激酶抑制剂(Epidermal growth factor receptor tyrosine kinase inhibitor,EGFR-TKI)是肺癌治疗领域的里程碑,中医药与分子靶向治疗EGFR-TKI相结合是肺癌综合治疗的新模式。辨证论治是中医的特色,中医药的精准配合,可以贯穿于分子靶向治疗EGFR-TKI的全程。通过查阅、归纳及分析近年来不同专家学者对分子靶向治疗EGFR-TKI相关肺癌患者不同治疗阶段的中医证候及中医处方用药研究的文献,总结肺癌分子靶向治疗EGFR-TKI患者在不同治疗阶段的证候分布及中医处方用药特点,促使中医辨证论治更加精准,旨在进一步提高临床上中医药配合分子靶向治疗EGFR-TKI的效果。

健脾为主的中药干预对KRAS突变型Ⅱ~Ⅲ期结直肠癌患者预后的影响

目的观察以健脾为主的中药治疗对KRAS突变型Ⅱ~Ⅲ期结直肠癌患者预后的影响。方法采用回顾性非随机同期对照研究方法,收集2015年1月-2021年12月就诊于上海中医药大学附属龙华医院、复旦大学肿瘤医院闵行分院的116例KRAS突变型Ⅱ~Ⅲ期结直肠癌患者资料,以持续接受中药治疗≥3个月的患者为治疗组,以未接受中药规范治疗或持续时间<3个月的患者为对照组。比较2组患者的中位无病生存期(采用Kaplan-Meier法计算)及1,2,3,5年无病生存率,分析影响患者无病生存期的危险因素。结果治疗组中位无病生存期为23.13个月,较对照组的16.90个月明显延长(P<0.05);治疗组1,2,3,5年无病生存率分别为83%,46%,40%,30%,对照组分别为67%,38%,18%,6%,治疗组无病生存率明显高于对照组(P<0.05)。中药治疗为患者无病生存期的独立保护因素(P<0.05),脉管内癌栓是患者复发转移的独立危险因素(P<0.05),淋巴结分期为N1期的患者相比于N2期患者复发转移的风险更低(P<0.05)。结论健脾为主的中药治疗可有效延长KRAS突变型Ⅱ~Ⅲ期结直肠癌患者的无病生存期,降低复发转移率;脉管内癌栓及区域淋巴结是KRAS突变型Ⅱ~Ⅲ期结直肠癌患者复发转移的高危因素。

基于“土壅木郁”探讨消化道恶性肿瘤相关性抑郁的病机与治法

通过阐释“土壅木郁”的理论内涵,探讨消化道恶性肿瘤相关性抑郁的中医病机及治法。认为“土壅木郁”是消化道恶性肿瘤相关性抑郁的重要病机。治疗首当抗癌解毒、养正固本以断其源;治疗核心为疏土达木、调和肝脾,强调土壅疏之、木郁达之、运通中焦、和畅气机;治疗关键在于畅达情志、调摄精神。

细胞焦亡在结直肠癌中的作用及中医药治疗进展

结直肠癌(CRC)作为一种具有高发病率和高死亡率的恶性肿瘤,其发病机制复杂,现代治疗手段效果不甚理想,寻找低毒、高效的防治方案仍是CRC研究的重点和难点。临床防治CRC中,中医药发挥着重要作用,其具有多方面的手势,包括毒副作用小、多靶点、多途径等。近年来,随着分子机制及药理作用的深入研究,多数学者发现,CRC发病涉及多个信号通路的异常。其中,细胞焦亡是一种机体调节细胞程序性死亡的模式,能调节多种细胞信号级联反应,可参与CRC的调控过程。此外,在中医药领域中,随着分子生物学技术的不断发展,中医药与细胞焦亡影响CRC的研究也逐渐兴起。通过文献筛选和相关报道发现,一些中药复方和中药单体能通过靶向干预细胞焦亡在CRC中发挥抗肿瘤作用,现对其进行简要归纳总结,以期在中医药防治CRC领域提供理论和诊疗思路参考。

李雁治疗结直肠癌经验撷菁

介绍李雁主任治疗结直肠癌的临床经验。认为结直肠癌的基本病机为正气虚损、诸邪久滞于肠腑,临证以“扶正祛邪”为治疗原则。根据病情因人而变,灵活调整治疗侧重,注重“以通为补”,内外兼治,肺肠同治,脏腑同调,则邪去正安,疗效显著。并附验案1则。

中药联合分子靶向药物治疗非小细胞肺癌用药规律

目的:收集整理中药联合靶向治疗非小细胞肺癌文献数据,分析常用中药组方规律。方法:通过检索中国生物医学文献数据库、万方数据库、中国知网中中药联合靶向药物治疗非小细胞肺癌临床观察的文献,经筛选后运用古今医案云平台进行频次分析、聚类分析、关联规则分析、复杂网络分析等。结果:使用频次排名前3的药物为茯苓、白术、黄芪;功效以清热解毒最多见,中药四气、五味、归经以味甘、性平、归肺经为主;通过关联规则得出核心药对28个;聚类分析得到核心药组5类;复杂网络分析得出治疗非小细胞肺癌联合靶向治疗的核心处方共计11味药。结论:中药联合靶向药物治疗非小细胞肺癌核心中药为茯苓、白术、黄芪;治法以健脾益气为主,以六君子汤为基础方,同时配合燥湿化痰、清热解毒、养阴等治标。

肠内营养和中医药防治结直肠癌5-氟尿嘧啶类化学疗法致肌少症的研究进展

综述肠内营养及中医药在预防和治疗结直肠癌5-氟尿嘧啶(5-FU)类化学疗法(以下简称“化疗”)所致肌少症中的作用机制及研究进展。结直肠癌5-FU类化疗导致的肌少症是化疗副作用,肠内营养与中药被证明能够改善骨骼肌丢失,调节肌肉力量,调节免疫过程及炎症反应,最终改善肌少症症状。二者联用可以进一步改善骨骼肌质量指数、握力、营养学指标等,减少结直肠癌5-FU类化疗致肌少症的损害。

正念减压疗法联合中医情志护理对胃肠道癌术后患者知觉压力及遵医行为的影响

目的:探讨正念减压疗法联合中医情志护理在胃肠道癌术后的应用价值。方法:选取2021年2月—2023年2月384例胃肠道癌术后患者,按入院顺序分为常规组(n=192)、正念减压组(n=192),2组均行常规护理,常规组在常规护理基础上行中医情志护理,正念减压组在常规组基础上行正念减压疗法,2组均干预3个月。比较2组胃肠道功能、知觉压力[中文版知觉压力量表(CPSS)]、遵医行为、生活质量[生活质量量表(GQOL-74)]。结果:正念减压组肛门排气、肠鸣音恢复、排便、进食时间均短于常规组(P<0.05);与干预前比较,干预后各组CPSS评分明显降低,且正念减压组改善更为显著(P<0.05);干预后正念减压组遵医用药、健康饮食、适当运动、按时复诊等遵医行为评分升高幅度>常规组(P<0.05);与干预前比较,各组GQOL-74评分明显升高,且正念减压组改善更为显著(P<0.05)。结论:对胃肠道癌术后患者实施正念减压疗法联合中医情志护理,能减轻知觉压力、提高遵医行为、改善胃肠道功能、提高生活质量。

结直肠癌术后患者中医生存质量量表的研制及条目筛选

目的研制结直肠癌术后患者中医生存质量量表(quality of life questionnaire of Chinese medicine for postoperative patients with colorectal cancer,QLQ-CMPPCC),以全面、客观地评价中医药在结直肠癌术后的临床疗效。方法根据WHO生存质量量表制定原则,结合中医基础理论,提出量表的理论结构模型,广泛查阅国内外多种普适性及结直肠癌专用生存质量量表,采用结构化决策的方法,编制初始量表。用调查方式对205例结直肠癌术后患者进行测试,运用专家重要性评分法、条目分布考察法、离散趋势法、t检验法、相关系数法、因子分析法、克朗巴赫α系数法联合进行条目筛选。结果研制出含有生理、心理、独立性和社会功能4个领域、20个方面及54个条目的QLQ-CMPPCC。其中,非造口手术患者回答43条,造口手术患者回答46条,生存质量总评价1条。结论 QLQ-CMPPCC具有中医特色,全面反映了结直肠癌术后患者生存质量的内涵,可作为结直肠癌术后中医临床疗效评价的工具。

化疗对大肠癌中医证候影响的研究

目的:研究大肠癌中医证候分类特征,明确化疗对其中医证候演变规律的影响。方法:收集780例1998年1月—2008年1月浙江省中医院肿瘤科住院大肠癌患者,将复杂证型分拆为单一证型进行统计,凡出现相应证型者即予归类。患者初次、末次入院及化疗前、后分别进行1次证型分类,比较初次末次入院及化疗前、后证型分布,观察化疗前后证型变化。统计接受化疗且存在证型变化患者,剔除化疗前即出现证型变化患者,分析化疗次数与中医证型变化相关性。结果:患者初、末次入院整体证型分布大致相仿,中医证候频数从多到少依次为气虚证、脾虚证、阴虚证、血虚证、痰湿证、热毒证、气滞证、阳虚证和血瘀证;末次与初次入院证型出现频率比较气虚证减少,脾虚证和阴虚证增加,差异均有统计学意义(P<0.05)。化疗后大肠癌脾虚证及阴虚证病例明显增加(P<0.05),气虚证及血虚证例数减少(P>0.05),其他证型基本相仿;化疗2次发生证型变化例数最多,占53.2%;从证型的纵向比较来看,接受化疗的病例与未接受化疗的病例,其发生中医证型变化的概率相比较有统计学意义(P<0.05)。结论:中医药介入大肠癌治疗需要考虑化疗对证型的影响,化疗后应着重对脾虚证和阴虚证的干预。

复方肠泰联合FOLFOX4方案治疗大肠癌的临床观察

目的观察中药复方肠泰联合FOLFOX 4方案治疗大肠癌根治术后患者的疗效及毒副反应。方法将30例符合入选标准的大肠癌根治术后患者分为治疗组和对照组。对照组仅应用FOLFOX 4方案全身化疗,治疗组在化疗同时服用复方肠泰水煎剂。FOLFOX 4方案:奥沙利铂(OXA)85mg/m2静滴2h,第1、2天;亚叶酸钙(CF)200mg/m2静滴2h,第1、2天;氟尿嘧啶(5-FU)400mg/m2静脉推注,第1、2天,600mg/m2持续静滴22h,第1、2天。复方肠泰每日1剂,早晚各1次水煎服。14天为1周期。2个周期结束后评价疗效及毒副反应。结果 30例患者全部完成治疗。经中医证候评定,治疗组和对照组的显效+有效率分别为86.6%和53.3%(P<0.01);治疗组治疗前后Karnofsky评分未见统计学差异,对照组则降低(P<0.01);治疗组治疗后较治疗前QOL评分提高(P<0.05),对照组未见明显改变;治疗组治疗后较治疗前CD3+、CD4+升高(P<0.05),对照组未见明显改变。治疗组的白细胞减少发生率低于对照组(P<0.05),两组血小板减少、消化道反应、肝肾功能毒性及神经毒性无显著差异。结论中药复方肠泰联合FOLFOX 4方案治疗大肠癌能够有效提高患者体力状况,改善中医证候、生活质量及免疫状态,降低白细胞减少发生率,起到减毒增效作用。