Clinical Observation of Arteriovenous Combined Chemotherapy in Advanced Gastric Cancer

Objective:To analyze the therapeutic effect and influencing factors of arteriovenous combined chemotherapy in 39 patients with advanced gastric cancer,and to explore the choice of therapeutic strategy.Methods:In this group of patients,the sequence of combined use of arteriovenous chemotherapy was 2 cycles of arterial chemotherapy first,followed by 3~4 cycles of systemic intravenous chemotherapy,and then changed to traditional Chinese medicine,oral chemotherapeutic drugs or immunotherapy after stable disease.Results:Thirty-five patients achieved complete disappearance of symptoms,significant tumor reduction of 26%(PR:13/39),moderate tumor reduction of 51%,18 patients with tumor markers decreased by more than 50%,4 patients completely reduced to normal,half-year survival rate of 90%,1-year survival rate of 56%,3-year survival rate of 33%,5-year survival rate of 10%.Conclusion:The use of arteriovenous combined chemotherapy and embolization in patients with middle and advanced gastric cancer is not only feasible,but also less complications.It can enable some patients to achieve stage II surgical resection,reduce or delay the metastasis and recurrence of patients,improve the quality of life of patients and prolong the survival time.

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.

A NEW EXPERIMENTAL AND CLINICAL APPROACH OF COMBINING USAGE OF HIGHLY ACTIVE TUMOR-INFILTRATING LYMPHOCYTES AND HIGHLY SENSITIVE ANTITUMOR DRUGS FOR THE ADVANCED MALIGNANT TUMOR

In recent years, tumor-nfiltrating lymphocytes (TILs) have been reported to be effective for tumors in experimental and clinical research. In order to increase the therapeutical effect, we modified some steps of Rosenberg's approach a. cold digestion with collagenase at 4C for 24 hours; b. sedimentation instead of centrifugation; c. elimination of tumor cells before the cultivation procedure. Compared with the original approach, the proliferation, activity and cytotoxicity of TILs obtained by the modified procedure were much improved. TILs' expansion-old was greater than that with the original approach. Cytotoxicity against rumor cells was more potent. Increased TILs' subsets were CD3 and CD8 cells. Meanwhile, we took tumor cells from tumor tissues to test their in vitro chemosensitivities to different drugs in order to select highly sensitive antitumor drugs for treatment of cases with advanced tumors. According to the design of using highly active TILs and highly sensitive drugs (H & H therapy), preliminary clinical results of 50 cases showed higher response rates than those in treatment with TIL / IL2, LAK / 1L2 and TIL+IL2+CTX. Less toxic side effects were observed in 14 patients.

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。

多载药纳米递药系统用于提高多西紫杉醇抗肿瘤疗效的研究进展

目的对多西紫杉醇与其他抗癌药物共载药纳米递药系统在肿瘤治疗中的作用机制进行综述,旨在为以多西紫杉醇为代表的化疗药物共载药纳米递药系统研究提供一定的参考。方法以“多西紫杉醇”、“联合治疗”、“纳米递药系统”、“肿瘤”等检索词对国内外文献进行查阅,总结多西紫杉醇与其他药物共载药纳米递药系统对肿瘤的治疗效果,并对其治疗机制进行归纳。结果多西紫杉醇属于典型的紫杉烷类抗肿瘤药物,在临床中,多西紫杉醇对多种恶性肿瘤具有显著的治疗效果。然而,现有多西紫杉醇注射剂由于其组织特异性差、使用有机溶剂增溶、易产生耐药性等原因,一定程度上影响其抗肿瘤疗效的发挥及产生一定的不良反应。将其他药物与多西紫杉醇联用是提高多西紫杉醇抗肿瘤效果、克服其耐药性和减少其不良反应的一种有效方法。然而,将多种药物简单物理混合所构建的制剂尚不能解决多西紫杉醇制剂现有的缺陷;而借助于纳米递药系统,可以有效克服以上缺陷。结论今后应深度挖掘纳米递药系统在共载抗肿瘤药物递送方面的意义,促使以多西紫杉醇为代表的化疗药物共载药在肿瘤治疗方面取得更大的进展。

原位水凝胶作为联合递药系统在肿瘤治疗中的研究进展

原位水凝胶因其具有生物相容性、环境敏感性、高稳定性、可注射性等优点,成了医药领域的研究热点。由于原位水凝胶独特的相转变性质,它能够在给药部位实现药物在局部的持续释放。此外,原位水凝胶还可以将多种治疗手段(如化疗、光热疗法、光动力疗法、基因疗法和免疫疗法等)结合使用,以实现肿瘤的联合治疗。本文综述了近年来原位水凝胶作为联合递药系统在肿瘤治疗中的研究进展和发展前景。

DIP付费下肿瘤病种药品辅助目录与日间化疗支付政策研究

目的:探讨DIP付费下肿瘤病种支付中药品辅助目录设置及日间化疗支付的精细化调整方法,以及机构等级系数设置与调整方法,完善科学的分值形成机制与动态调整机制。方法:选取福建省厦门市所有三级医院2021—2023年住院患者作为样本,对抗肿瘤药物治疗住院医疗费用医保基金支付金额的影响因素进行单因素及多因素分析,分析住院天数与抗肿瘤药物对住院医疗费用医保基金支付金额的影响、住院医疗费用变异系数情况以及不同医疗机构费用差异等。结果:抗肿瘤药物与住院天数对住院医疗费用医保基金支付金额影响显著。结论:DIP付费下,建议部分肿瘤细分病种设置肿瘤药品辅助目录;对日间化疗测算分值,与非日间化疗进行有效差异化支付,以便更加科学精准;对不同医疗机构实行机构等级系数调整,完善医保精细化管理。

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%.

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。

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.

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.

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.

中医药网络药理学进展与抗肿瘤临床应用

癌症是复杂的系统性疾病,克服多药耐药性是癌症治疗的主要挑战。网络药理学由于其系统性、整体性的特点与中医整体观念有共通之处,结合中药多成分、多靶点的特性,在中药复方药物、中医病证结合和中药药性理论研究等领域近年来均有进展,在抗肿瘤药物研发领域也受到广泛关注。随着网络药理学技术的发展,通过其进行药物组合设计,充分利用SL大数据,有望发挥中药多靶点作用特点和组方用药模式的优势,实现肿瘤中药/成分“合成致死”配伍组方,提升中医药在肿瘤临床治疗疗效。

113例抗肿瘤药物相关肝损伤的临床特点及危险因素分析

目的分析抗肿瘤药物所致药物性肝损伤(DILI)的临床特点及危险因素。方法回顾性分析上海中医药大学附属曙光医院2021年1月1日至2022年6月30日接受抗肿瘤药物治疗致DILI的113例患者临床资料,包括性别、年龄、个人史、原发肿瘤部位、抗肿瘤治疗方案、血常规、肝肾功能、肿瘤指标等。采用χ^(2)检验、t检验和非参数检验(两独立样本检验)进行分析。结果113例抗肿瘤药物致DILI患者中,男女比例1.13∶1,55岁以上老年患者居多。在肿瘤原发部位方面,结肠癌(25.7%)、肺癌(13.3%)、胃癌(12.4%)患者抗肿瘤治疗中发生DILI较多。抗肿瘤治疗方案中以化学治疗及靶向联合化疗的治疗方案导致DILI最多见。DILI的临床分型中胆汁淤积型患者比例最高(107例,94.7%),混合型次之(6例,5.3%);在肝损伤程度方面以轻度肝损伤为主(107例,94.7%)。Logistic回归分析显示,饮酒(OR 4.336,P=0.042)是抗肿瘤药物诱导DILI发生的独立危险因素。结论抗肿瘤药物致DILI多发生于老年患者,以化疗及靶向联合化疗方案最常见,临床表现以胆汁淤积型为主,肝损伤程度较轻,饮酒史是重要风险因素。

抗肿瘤药物联合疗法价值归因探索

目的:准确评估抗肿瘤药物联合疗法及组成联合疗法的各药物价值。方法:详细介绍价值归因的原理及使用条件。结果:总结基于各单药疗效比值的归因、基于边际价值的归因和分段分配价值归因三种基本价值归因类型及相关变型,在此基础上进一步对比分析不同情况下各价值归因方法的结果,给出选择思路。结论:价值归因应用具有独特优势,也存在局限性,应全方位收集证据,进一步完善方法,权衡各方利益谨慎选择适用方法,最终构建适合我国的特色价值归因体系。

伴有睾丸侵犯的淋巴母细胞淋巴瘤患儿17例病例系列报告

背景儿童原发睾丸淋巴母细胞淋巴瘤(LBL)罕见,多为继发性,既往治疗方案多采用化疗联合睾丸局部放疗,而现代治疗方案应用含大剂量甲氨蝶呤(HD-MTX)等的系统化疗而不行睾丸放疗。目的 总结伴有睾丸侵犯的LBL患儿的临床特征及应用含HD-MTX的急性淋巴细胞白血病(ALL)样方案化疗的预后。设计病例系列报告。方法 回顾性纳入2009年1月至2017年4月首都医科大学附属北京儿童医院(我院)收治的以肿瘤性病灶起病的伴有睾丸侵犯的LBL患儿,采用BCH-NHL-2009-LBL方案(来自改良BFM-90方案)化疗,总结其临床特征和疗效。主要结局指标5年总生存率(OS)和无事件生存率(EFS)。结果 277例LBL患儿中17例(6.1%)伴有睾丸侵犯,其中T-LBL 5例,B-LBL 12例,发病中位年龄6.2(2.6~13.7)岁。临床分期:Ⅲ期4例,Ⅳ期13例。纵隔占位5例,CNS侵犯3例,骨髓侵犯12例(其中8例已达白血病期),腹股沟区、盆腔、坐骨/耻骨等侵犯11例,巨大瘤灶7例。原发性睾丸淋巴瘤1例,继发性16例。双侧睾丸侵犯6例,单侧11例。诱导缓解治疗后评估睾丸瘤灶均消失。中位随访时间为103(3~129)个月,复发6例,其中睾丸复发1例,再次按标准方案治疗后完全缓解,长期无病生存;死亡2例,均为复发后死亡。5年OS和EFS分别为(87.5±8.3)%和(68.8±11.6)%,与同期LBL患儿总生存情况比较差异无统计学意义。结论 儿童LBL发生睾丸侵犯临床症状隐匿,化疗前常规B超检查可提高诊断率,伴有腹股沟区、骨盆、盆腔侵犯者睾丸受累风险增高。经不含睾丸放疗的标准方案规律化疗后可持续完全缓解,且可保留睾丸功能。