改良DCF方案治疗27例晚期胃癌的临床观察  

Clinical observation of mDCF regimen as therapy for 27 patients with advanced gastric adenocarcinoma

作　　者：陈奕贵[1] 杨建伟[1] 蔡雄超[1] 高炜[1] 陈帆[1] 李惠[1] 

机构地区：[1]福建省肿瘤医院消化内科,福州350014

出　　处：《临床肿瘤学杂志》2010年第1期55-59,共5页Chinese Clinical Oncology

摘　　要：目的研究改良的多西紫杉醇联合顺铂(DDP)加亚叶酸钙(CF)和氟尿嘧啶(5-FU)方案(mDCF)治疗术后复发或不能手术的晚期胃癌的疗效及其毒副作用。方法对入选的27例晚期胃癌患者给予国产多西紫杉醇(艾素)50mg/m2d1、DDP25mg/m2d2～d3、CF0.2g/m2d2～d3、5-FU2g/m2持续静滴46小时(d2～d3)双周方案全身化疗,观察其疗效及毒副作用。结果2006年5月至2007年7月,27例胃癌患者平均化疗4.5个周期,CR1例,PR12例,总有效率(RR)为48.1%(95%CI:32%～64%),对紫杉醇耐药者仍然33.3%(2/6)有效,中位肿瘤进展时间(TTP)为6.2个月,中位总生存时间(OS)11.8个月。毒副反应主要为骨髓抑制,发生率达100.0%,且48.9%为3～4级(其中16.3%为4级),出现2例(7.4%)因骨髓抑制停止化疗;口腔黏膜炎、恶心呕吐、周围神经毒性、肝功能损害、腹泻、肾功能损害及心脏毒性发生率分别为59.2%、51.9%、48.1%、44.4%、25.9%、18.5%及11.1%,大部分为1～2级。没有治疗相关死亡。结论改良的多西紫杉醇联合DDP加CF和5-FU双周方案(mDCF)治疗晚期胃癌疗效肯定,骨髓抑制等毒副反应仍然偏高,但有一定的治疗优势,与紫杉醇无完全交叉耐药,值得在临床中进一步改良和验证。Objective To evaluate the toxicity and efficacy of combination chemotherapy with mndified docetaxel and cisplatin plus CF/fluorouracil regimen（mDCF） as therapy for 27 patients with relapse or metastatic gastric adenoearcinoma. Methods Between May 2006 and July 2007, 27 patients（ 18 males and 9 females） with a median age of 49 years（ range 19-66） were consecutively enrolled in this study. Docetaxel iv 50mg/m^2 , d1 and cisplatin 25mg/m^2 , iv, d2-d3 ,plus CF 0. 2g/m^2 ,iv, d：-ds and fluorouracil 2g/ m^2 ,civ for 46h, d2-d3 were administered eveD, two weeks. Results Twenty-seven patients were evaluable for activity and toxicity. A median of 4. 5 cycles was given. We observed 1 complete and 12 partial responses for an overall intent to treat response rate（RR） 48. 1% （95% CI：32%-64% ）. Median TTP was 6. 2 months and OS was 11.8 months. 100% patients experienced WttO grade 1-4 bone marrow suppression, of them 48.9% were grade 3-4, which was the most common and serious toxicity. We recorded 2 patients （7.4%） ceased chemotherapy because of bone marrow suppression. WHO grade 1-4 non-hematological toxicity, such as oral mucositis, nausea/emesia,peripheral neuropathy, liver impairment, diarrhea, kidney and heart impairment, occurred in 59. 2% ,51.9%, 48. 1%,44. 4% ,25.9% , 18.5% and 11.1% , respectively, and much of them were grade 1-2. There were no direct treatment-related deaths. Conclusion Modified doeetaxel and cisplatin plus CF/fluorouracil regimen（mDCF） is active in relapse or metastatic gastric adenocareinoma with a high response rate and long TFP/OS in this trial. Despite its severe hematotoxieity, this regimen has some superiority, such as no cross-resistance with paclitaxel. We consider that this regimen is feasible and might warrant further investigation in relapse or metastatic gastric adenocarcinoma.

关 键 词：晚期胃癌 化学治疗 多西紫杉醇 顺铂 亚叶酸钙 氟尿嘧啶 

分 类 号：R730.53[医药卫生—肿瘤] R735.2[医药卫生—临床医学]