2016 年第 2 期 第 14 卷

伊立替康和奥沙利铂联合氟尿嘧啶类药物一线治疗晚期结直肠癌的临床观察

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关键词：结直肠癌伊立替康奥沙利铂5氟尿嘧啶替吉奥卡培他滨

• 摘要：
• 【摘要】目的：观察伊立替康（IRI）和奥沙利铂(OXA)联合氟尿嘧啶类药物（5-FU/替吉奥胶囊/卡培他滨）一线治疗晚期结直肠癌的近期疗效和不良反应。方法：回顾性分析中国医学科学院肿瘤医院肿瘤内科自2013年3月至2014年10月有可测量指标的晚期结直肠癌患者35例，应用IRI130～l60mg/m2,第1天；奥沙利铂85～100mg/m2，第2天；亚叶酸钙（CF）200mg/m2，后5-Fu400mg/m2，静脉推注，第1天，5-Fu 2400mg/m2持续静滴46小时，第1天；或替吉奥胶囊 40～60mg/次（根据体表面积确定）或卡培他滨1000mg/m2/次，早晚饭后各1次，连续服用10天，停药4天，14天为1周期。每3周期评价疗效及相关毒性反应。结果：全组35例可评价疗效，中位化疗周期为4个（3-11）。有效率（ORR）54.3％(19/35)，其中完全缓解（CR） 1例，部分缓解（PR）18例。化疗后接受手术的25例患者中，20例患者达到R0切除(57.1％，20/35)，其中18例患者系初始局部晚期，2例患者初始伴肝转移。所有35例患者在治疗期间均未出现治疗相关性死亡，Ⅲ级不良反应发生率为54.3％(19/35)，其中粒细胞下降发生率为20.0％(7/35)，恶心发生率为17.1％(6/35)，呕吐发生率为14.3％(5/35),腹泻发生率40%（14/35）。Ⅳ级不良反应发生率为17.1％(6/35)，主要为粒细胞下降。结论:三药联合方案一线治疗晚期结直肠癌近期疗效高，毒性反应可以耐受。
• Objective: To evaluate the efficacy and safety of irinotecan (IRI)/oxaliplatin (OXA) combined with fluoropyrimidine (5-FU / S-1 / capecitabine) in first-line treatment of advanced colorectal cancer. Methods: A total of 35 advanced colorectal cancer cases were enrolled from March 2013.The doses are as follows: IRI130 ~ l60mg / m2, day 1; oxaliplatin 85 ~ 100mg / m2, day 2; 5-Fu400mg / m2, intravenous injection, day 1, 2400mg / m2 continuous infusion 46 hours, leucovorin (CF) 200mg / m2, after 5Fu; or S-1 40 ~ 60mg / timesor capecitabine 1000mg / m2 ,bid orally taking, for 10 days, 14 days for a cycle. The efficacy and safety were assessed every 3 cycles. Results:Of 35 evaluable patients, the median number of chemotherapy cycles was 4 (3-11). The objective response (ORR) was 54.3% (19/35). Complete response (CR) was observed in 1 case, with a partial response (PR) in 18 cases. 25 patients underwent surgery after chemotherapy, 20 patients achieved R0 resection (57.1%, 20/35)，including 18 local advancement and 2 hepatic matastases. Among 35 patients，no drug-related death was observsed .The rate of grade 3adverse event was 54.3%(19/35), including neutropenia 20.0% (7/35), nausea 17.1 (6/35) vomiting 14.3 (5/35) and diarrhea 40.0% (14/35). The rate of grade 4 adverse event was 17.1%(6/35),the main events were neutropenia. Conclusion: The three-drug combined regimen in first-line treatment of advanced colorectal cancer was associated withgood short-term efficacy and tolerable toxicity.