1、1會計學(xué)表阿霉素聯(lián)奧沙利鉑卡培他濱表阿霉素聯(lián)奧沙利鉑卡培他濱EOX一線一線治療晚期胃癌的臨床研究分析治療晚期胃癌的臨床研究分析 Wagner AD, et al. J Clin Oncol 2006; 24Wagner AD, et al. J Clin Oncol 2006; 241. ECF vs FAMTXWaters JS, et al, Br J Cancer 1999Waters JS, et al, Br J Cancer 1999ECF vs FAMTXRoss P, et al, J Clin Oncol ,2002 3. ECF vs CF (a meta-analysis

2、 ) Wagner AD, et al. J Clin Oncol 2006; 24 cisplatinvenous hydration, renal toxicity、ototoxicity and severe emesis 5-FU needs a central venous catheter, associated with significant morbidity, particularly venous thrombosis and infections. EOX regimenSumpter, et al. British Journal of Cancer 2005; 92

3、 患者特點(diǎn)對照組對照組(N)性別性別 男男 35女女21年齡年齡 54（30-68）病理診斷病理診斷 低分化腺癌低分化腺癌 40 中分化腺癌中分化腺癌 5 印戒細(xì)胞癌印戒細(xì)胞癌 7 粘液腺癌粘液腺癌 4PS評分評分 0分分 15 1分分 30 2分分 11原發(fā)部位原發(fā)部位 胃胃46 連接部連接部10 轉(zhuǎn)移部位轉(zhuǎn)移部位 淋巴結(jié)淋巴結(jié) 27 肝臟肝臟 18 腹膜腹膜 14 其他部位其他部位 16轉(zhuǎn)移部位個數(shù)轉(zhuǎn)移部位個數(shù) 0或或1 38 2 18 epirubicin50mg/oxaliplatin 85mg/capecitabine 625mg/ 2h infusion,d1bid, orally

4、, d1-14iv,d1每3周重復(fù) nCRPRSDPDRRTTPMST1-y SR562(3.6) 25(44.6) 21(37.5) 8(14.4)27(48.2) 6.5m10.6m44%Time to progression (months)20151050Probability1.0.8.6.4.20.0Overall survival (months)302520151050Probability1.0.8.6.4.20.0療效討論: 1. Oxaliplatin 奧沙利鉑是第三代鉑類化療藥，其化學(xué)結(jié)構(gòu)不同于順鉑。奧沙利鉑在體內(nèi)與DNA結(jié)合的速率較順鉑快10倍以上，結(jié)合牢固，有更強(qiáng)的

5、細(xì)胞毒作用。與順鉑相比，奧沙利鉑有更廣譜的抗癌活性且無交叉耐藥性. 聯(lián)合5-FU而組成的FOLFOX方案,已是晚期大腸癌治療的首選方案。Oxaliplatin聯(lián)合5-FU用于胃癌Zaniboni A, et al. J Chemother 2005;17Al-Batran S, et al. J Clin Oncol 2008; 26 Oxaliplatin+LV/5-FU vs cisplatin+LV/5-FUFLO vs FLPAl-Batran S, et al. J Clin Oncol 2008; 26 TTFPFSOS療效討論: 2. capecitabineAjani, et

6、al. Cancer 2006; 107 AuthorsRegimensORRTTPOSHoff PM, (650 pats)X vs bolus 5-FU/LV24.8 vs 15.5%（p= 0.005）4.3 vs 4.7m(p=0.72)12.5 vs 13.3m(p=0.974)Van Cutsem E,(602 pats)X vs bolus 5-FU/LV18.9 vs 15.0%5.2 vs 4.7m(p=0.65)13.2 vs 12.1m(p=0.33)Porschen R, (474 pats)X+O vs FUFOX48 vs 54%7.1 vs 8.0m(0.117)

7、16.8 vs 18.8m(p=0.26)Daz-Rubio E, (348 pats)X+O vs FUFOX37 vs 46%(p=0.54)8.9 vs 9.5m(0.153)18.1 vs 20.8m(0.145)Cassidy J (2034 pats)X+O vs FOLFOX47 vs 48%8.0 vs 8.5m19.8 vs 19.6mCapecitabine alone or in combination in advanced CRCCapecitabine in combination in advanced GC AuthorsRegimensORRTTPOSKim

8、TW, (42 pats，phase 2)XP54.7%6.3m10.1mKang Y ,(316 pats phase 3)XP vs FP41 vs 29%（p=0.03）5.6 vs 5.0m10.5 vs 9.3mKim TW, et al. Ann Oncol 2002; 13 Kang Y, et al. JClin Oncol 2006; 24療效討論: 3. EOX方案的療效Sumpter K, et al. British Journal of Cancer 2005; 92Cunningham D, et al. N Engl J Med 2008; 35811.2 vs

9、9.9 months; p = 0.02 Cunningham D, et al. N Engl J Med 2008; 358ToxicityGrade1(%)Grade 2(%)Grade3(%)Grade4(%)Grade 34(%)Neutropenia 10(17.9)15(26.8)8(14.3)4(7.2)12(21.4)Febrile neutro-002(3.6)2(3.6)4(7.2)Anemia16(28.6)12(21.4)4(7.2)04(7.2)Throbocytopenia7(14.3)3(5.4)2(3.6)02(3.6)nausea/vomiting21(37

10、.5)13(23.2)4(7.2)2(3.6)6(10.7)Diarrhea 13(23.2)9(16.1)5(8.9)05(8.9)Stomotitis12(21.4)6(10.7)1(1.9)01(1.9)Hand-foot syn-12(21.4)6(10.7)3(5.4)03(5.4)Neurotoxicity 24(42.9)7(12.5)2(3.6)02(3.6)Alopecia16(28.6)19(33.9)6(10.7)1(1.9)7(12.5)化療毒性Cunningham D, et al. N Engl J Med 2008; 358Hoff PM, et al. J Cl

11、in Oncol 2001; 19Van Cutsem E, et al. J Clin Oncol 2001; 19 結(jié)論Waters JS, et al, Br J Cancer 1999ECF vs FAMTX療效討論: 1. Oxaliplatin 奧沙利鉑是第三代鉑類化療藥，其化學(xué)結(jié)構(gòu)不同于順鉑。奧沙利鉑在體內(nèi)與DNA結(jié)合的速率較順鉑快10倍以上，結(jié)合牢固，有更強(qiáng)的細(xì)胞毒作用。與順鉑相比，奧沙利鉑有更廣譜的抗癌活性且無交叉耐藥性. 聯(lián)合5-FU而組成的FOLFOX方案,已是晚期大腸癌治療的首選方案。FLO vs FLPAl-Batran S, et al. J Clin Oncol 2008; 26 TTFPFSOSCapecitabine in combination in advanced GC AuthorsRegimensORRTTPOSKim TW