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背景与目的:晚期胃癌不能根治,替吉奥(S-1)及多西他赛均是治疗晚期胃癌的有效药物,但标准剂量DCF(多西他赛、顺铂、氟尿嘧啶)方案的耐受性欠佳,限制了其在临床中的应用。观察小剂量多西他赛联合标准剂量S-1一线治疗晚期胃癌患者的疗效及不良反应。方法:收集40例局部晚期不能手术、复发或伴有远处转移的胃腺癌患者。多西他赛40 mg/m2第1天静脉滴注,联合S-1 80 mg/m2第1～14天口服,每21 d重复,直至疾病进展或不能耐受。评估该方案的客观疗效、中位疾病无进展生存期(progression-free survival,PFS)及中位生存期(median survival time,MST),观察化疗临床受益反应(clinical benefit response,CBR)及不良反应。结果:1例残胃复发患者因上消化道出血,2例腹膜转移患者因肠梗阻未完成第1个周期化疗,37例患者可评价疗效,累计完成211个周期化疗,中位治疗周期数为6(3～14)。CR 1例(2.7%),PR 15例(40.5%),SD 17例(46.0%),PD 4例(10.8%),总有效率43.2%,疾病控制率可达89.2%。最佳CBR有效者19例(51.4%),17例稳定(45.9%),1例无效(2.7%)。中位PFS为6.0个月,MST为11.5个月。本方案主要的血液学和非血液学不良反应分别是白细胞/中性粒细胞降低(50%)和疲乏(50%),多为Ⅰ、Ⅱ级。Ⅲ、Ⅳ级不良反应发生率较低:白细胞/中性细胞粒下降7例(17.5%),恶心4例(10.0%),食欲减低3例(7.5%),疲乏2例(5%),血小板降低、出血各1例(2.5%)。3例因Ⅲ、Ⅳ级不良反应S-1减量20%。结论:小剂量多西他赛联合标准剂量S-1一线治疗晚期胃癌疗效令人满意,不良反应多为轻度,给药方便,是值得推广和尝试的有效胃癌姑息化疗方案。
BACKGROUND & OBJECTIVE: Gastric cancer of the advanced stage can not be cured. Both tiotropium (S-1) and docetaxel are effective drugs in the treatment of advanced gastric cancer. However, the tolerability of standard dose DCF (docetaxel, cisplatin and fluorouracil) Poor sex, limiting its clinical application. To observe the low dose docetaxel combined with standard dose of S-1 first-line treatment of advanced gastric cancer patients with adverse reactions and adverse reactions. Methods: Forty patients with locally advanced gastric adenocarcinoma who could not be operated, recurred or had distant metastasis were collected. Docetaxel 40 mg / m2 on day 1 by intravenous infusion, combined with S-1 80 mg / m2 on days 1 to 14, repeated every 21 days until disease progression or intolerance. The objective curative effect, progression-free survival (PFS) and median survival time (MST) of the disease were evaluated. The clinical benefit response (CBR) and adverse reactions . Results: One case of residual gastric reoperation due to upper gastrointestinal bleeding, 2 cases of peritoneal metastasis due to intestinal obstruction did not complete the first cycle of chemotherapy, 37 patients can evaluate the efficacy of the cumulative completed 211 cycles of chemotherapy, the median number of cycles 6 (3 ~ 14). The total effective rate was 43.2% and the rate of disease control was 89.2% in 1 case of CR (2.7%), 15 cases of PR (40.5%), 17 cases of SD (46.0%) and 4 cases of PD (10.8%). The best CBR effective in 19 cases (51.4%), 17 cases of stable (45.9%), 1 case of ineffective (2.7%). Median PFS was 6.0 months and MST 11.5 months. The main hematological and non-hematological adverse reactions of this program are leukopenia / neutropenia (50%) and fatigue (50%), respectively, mostly grade Ⅰ and Ⅱ. The incidence of grade Ⅲ and Ⅳ adverse reactions was lower: leukocyte / neutrophil granule decreased in 7 cases (17.5%), nausea in 4 cases (10.0%), appetite decreased in 3 cases (7.5%), exhausted in 2 cases (5% Thrombocytopenia, bleeding in 1 case (2.5%). 3 cases due to Ⅲ, Ⅳ adverse reactions S-1 20% reduction. Conclusion: The low-dose docetaxel combined with standard dose of S-1 first-line treatment of advanced gastric cancer is satisfactory, the adverse reactions are mild, convenient administration, it is worthwhile to promote and try effective gastric cancer palliative chemotherapy.