伊立替康二线治疗晚期结直肠癌疗效观察  

Clinical observation on irinotecan as second-line treatment of patients with advanced colorectal carcinoma

作　　者：陈栋晖[1] 宋卫峰[1] 王理伟[1] 

机构地区：[1]上海交通大学附属第一人民医院肿瘤科,上海200080

出　　处：《中国癌症杂志》2008年第7期542-544,共3页China Oncology

摘　　要：背景与目的:结直肠癌是癌症相关死亡的主要原因之一。对大多数晚期结直肠癌患者全身化疗是最佳的姑息治疗。20世纪90年代多项Ⅲ期临床研究证实拓扑异构酶Ⅰ抑制剂依立替康(开普拓,CPT-11)联合5-FU、LV方案(FOLFIRI)治疗结直肠癌疗效显著。本研究旨在观察FOLFIRI方案二线治疗晚期结直肠癌的生存、疗效及毒副反应。方法:60例经病理学证实的一线治疗失败后的进展期结直肠癌患者接受FOLFIRI方案化疗至少2个周期,伊立替康180mg/m2,静脉滴注,第1天;四氢叶酸200mg/m2,静脉滴注,第1、2天;5-FU400mg/m2,静脉推注,第1、2天;5-FU600mg/m2,静脉持续滴注22h,第1、2天,每2周重复。结果:全组60例患者均能评价毒副反应,其中58例可评价疗效。全组无完全缓解(CR),部分缓解(PR)14例(24.14%),稳定(SD)30例(51.72%),总有效率(CR+PR)24.14%,疾病控制率(CR+PR+SD)75.86%,中位至疾病进展时间6.09个月,中位总生存期(OS)9.65个月。非血液学毒性不良反应轻微,大多为Ⅰ、Ⅱ度。只有2例患者出现Ⅲ度延迟性腹泻,1例患者出现Ⅲ度恶心呕吐。常见的血液学毒性为粒细胞减少症。有5例患者出现Ⅲ度粒细胞减少症。没有发生粒缺性发热。结论:伊立替康联合5-FU和叶酸二线治疗进展期结直肠癌有较高的近期疗效,不良反应可控。Background and purpose： Colorectal carcinoma（CRC） is a major cause of cancer-related mortality. In the 1990s, several first-line phase Ⅲ trails showed a significant improvement in result with the addition of CPT-11 （irinotecan, which is a specific inhibitor of topoisomerase Ⅰ ） to FU-LV combination therapy（FOLFIRI）.We observed the survival rate, efficacy and adverse reaction of the combination chemotherapy of irinotecan plus folinic acid/continuous 5-fluorouracil bimonthly FOLFIRI regimen as second chemotherapy in treating advanced colorectal adenocarcinoma. Methods： Sixty patients with histologically proved advanced colorectal adenocarcinoma whose disease had progressed after treatment with first-line oxaliplatin or other chemotherapeuties agents were included to receive at least 2 cycles of chemotherapy with irinotecan 180 mg/m^2 day 1 and folinic acid 200 mg/m^2 iv,5-FU 400 mg/m^2 iv bolus,days 1 and 2, 5-FU 600 mg/m^2 iv infusion over 22 hours, days 1 and 2.Treatment was repeated every two weeks. Results： All patients were assessable for toxicity and 58 patients were evaluable for treatment response. The non-hematological toxicity was mild. Most was grade Ⅰ or Ⅱ. Only two patients experienced grade Ⅲ diarrhea and one patient experienced grade Ⅲ nausea and vomiting, There were no cases with grade Ⅳ toxicity, The most common hematological toxicity was neutropenia. Grade Ⅲ neutropenia were observed in five patients. There was no case of febrile neutropenia. Based on intention to treat analysis, there were no complete responses （CR）, 14（24.14%） partial response （PR）, and 30 （51.72%） stable disease, the median time to disease progression was 6.09 months. The median overall survival was 9.65 months. Conclusions： Bimonthly irinotecan in combination with folinic acid and 5-fluorouracil was active with acceptable toxicities and a prolonged survival time in retreated colorectal cancer.

关 键 词：结直肠癌 化疗 伊立替康 氟尿嘧啶: 四氢叶酸 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]