紫杉醇联合氟脲嘧啶/亚叶酸钙双周方案二线治疗晚期胃癌的疗效及毒性分析

目的评价紫杉醇联合氟脲嘧啶/亚叶酸钙双周方案二线治疗晚期胃癌的疗效及毒性。方法分析一线化疗失败后采用紫杉醇联合氟脲嘧啶/亚叶酸钙双周方案作为二线化疗方案的48例晚期胃癌患者资料,评价缓解率（RR）、疾病进展时间（TTP）、总生存（OS）及不良反应。治疗方案为：紫杉醇100 mg.m-2,静脉滴注3 h;亚叶酸钙200 mg.m-2,静脉滴注2 h;随后给予氟脲嘧啶400 mg.m-2静脉推注,氟脲嘧啶2.4 g.m-2为微量泵持续泵注46 h。每2周给予1次化疗,每2次为1个疗程。结果 48例患者中,近期缓解率为22.9%,中位TTP及OS分别为3.6月和7.8月,获缓解患者中位OS明显长于未获缓解者（P〈0.05）;患者耐受性良好,主要的不良反应为骨髓抑制、外周神经毒性、脱发、腹泻和肌肉关节疼痛。结论紫杉醇联合氟脲嘧啶/亚叶酸钙双周方案二线治疗PS评分高的晚期胃癌缓解率较高,不良反应可耐受,值得进一步开展前瞻性研究证实。

Efficiency and Toxicity of Biweekly Paclitaxel Combined with 5-FU/Leucovorin as Second-line Chemotherapy for Advanced or Recurrent Gastric Cancer

Objective To evaluate the efficiency and toxicity of biweekly paclitaxel combined with 5-FU/leucovorin as second-line chemotherapy for advanced or recurrent gastric cancer.Methods The regimen of biweekly paclitaxel combined with 5-FU/leucovorin was used to treat 48 patients with metastatic or recurrent gastric cancer who had received one prior chemotherapy.The regimen was comprised of 3-hour intravenous infusion of 100 mg·m-2paclitaxel,2-hour infusion of 200 mg·m-2 leucovorin,intravenous bolus of 400 mg·m-25-FU,and 46 hour infusion of 5-FU 2.4 g·m-2（all given every 14 days,twice each cycle）.Response rate（RR）,Time to progression（TTP）,overall survival（OS） and toxicity were evaluated.Results In the 48 patients,response rate was 22.9%,with a median TTP of 3.6 months and a median OS of 7.8 months.Median survival was obviously longer for patients attaining response compared with patients with partial response or stable disease（P0.05）.The toxicity of chemotherapy was mild and manageable,and the most frequent adverse events were bone marrow suppression,peripheral neuropathy,alopecia,diarrhea,and muscle and joint pain.Conclusion Biweekly paclitaxel combined with 5-FU/leucovorin as second-line chemotherapy for advanced or recurrent gastric cancer leads to high response rate and mild toxicity and is deserving of further prospective study.