紫杉醇脂质体联合卡培他滨治疗晚期胃癌临床观察

目的：评价紫杉醇脂质体联合卡培他滨治疗34例晚期胃癌临床疗效和毒副反应。方法64例晚期胃癌患者分为对照组30例（多西紫杉醇、顺铂联合5-氟尿嘧啶，DCF方案）和实验组34例（紫杉醇脂质体联合卡培他滨，PC方案）。对照组：多西紫杉醇75mg/m2，d1；顺铂20mg/m2，d1～5；5-氟尿嘧啶350mg/m2，d1～5，21天/周期。实验组：紫杉醇脂质体135mg/m2，d1；卡培他滨2000mg/（m2· d），口服，2次/天，d1～14，21天/周期。结果对照组：总计化疗122周期，平均化疗4.07周期，其中CR 2例，PR 12例，SD 7例，PD 9例，近期有效率（ RR）为46.7％，疾病控制率（ DCR）为70％，中位PFS为6.9个月，中位OS 12.5个月。实验组：总计化疗169周期，平均化疗4.97周期，其中PR14例， SD9例， PD11例， RR 为41.2％，DCR为67.6％，中位PFS为6.2个月，中位OS 12个月。两组的RR、DCR、无进展生存曲线及总生存曲线的差异统计学上无显著性。两组主要的毒副反应均为血液学毒性，对照组和实验组出现Ⅲ～Ⅳ度白细胞减少症的发生率分别为56.7％和17.6％，出现Ⅲ～Ⅳ度贫血的发生率分别为13.3％和2.9％。结论紫杉醇脂质体联合卡培他滨为一线治疗晚期胃癌较好的方案，临床耐受性好，值得进一步推广。

Clinical observation of paclitaxel liposome combined with capecitabine in the treatment of advanced gastric cancer

Objective To evaluate the efficacy and toxic side effects of paclitaxel liposome combined with capecitabine for trea -ting 34 patients with advanced gastric cancer.Methods A total of 64 patients with advanced gastric cancer were enrolled and as-signed to experimental group （paclitaxel liposome combined with capecitabine as PC regimen ,34 cases） and control group （docetax-el,cisplatin and 5-fluorouracil as DCF regimen,30 cases）.Control group was treated with DCF regimen：docetaxel 75mg/m2,d1, cisplatin 20mg/m2 ,d1~5 and 5-fluorouracil 350mg/m2 ,d1~5,21d/cycle.Experimental group was given PC regimen：paclitaxel liposome 135mg/m2,d1;capecitabine 2000mg/（m2· d）,po,bid,d1~14,21d/cycle.Results Control group：the total chemothera-py time was 122 cycles,averagely 4.07 cycles.Two patients got complete remission （CR）,12 partial remission （PR）,7 stable dis-ease （SD） and 9 progressive disease （PD）.The short -term response rate （RR） was 46.7%,disease control rate （DCR） was 70%,median progression free survival （ mPFS） was 6.9 months and median overall survival （ mOS） was 12.5 months.Experimental group：the total chemotherapy time was 169 cycles,averagely 4.97 cycles.Fourteen patients got PR,9 SD and 11 PD.The short -term RR was 41.2%,DCR was 67.6%,mPFS was 6.2 months and mOS was 12 months.There were no significant differences re-garding RR,DCR,progression -free survival curves and overall survival curves of two groups.The major toxic side effects of two groups are hematologic toxicities.The incidences of leukopenia and anemia at grades Ⅲ~Ⅳin control group and experimental group were 56.7%and 17.6%as well as 13.3%and 2.9%,respectively.Conclusion Paclitaxel liposome combined with capecitabine as the first line chemotherapy for advanced gastric cancer is effective ,tolerable,and recommendable.