南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (12): 1815-.

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晚期结直肠癌联合化疗后卡培他滨维持治疗的临床评价

杨冬阳,黎莹,刘建化,江韦韦,马冬   

  • 出版日期:2013-12-20 发布日期:2013-12-20

Efficacy and tolerance of maintenance therapy in patients with incurable advanced
colorectal cancer

  • Online:2013-12-20 Published:2013-12-20

摘要: 目的评价晚期结直肠癌患者联合化疗后卡培他滨维持治疗的临床疗效、安全性、可行性。方法采用回顾性研究方法,分
析我科2009年5月~2012年12月住院治疗的73例晚期结直肠癌连续病例,均采用含氟尿嘧啶类联合奥沙利铂或伊立替康化
疗。肿瘤达到化疗最大缩小率后,其中42例给予单药卡培他滨1000 mg/m2 bid *14 d/3周的维持治疗至不能耐受或进展;另31
例停止化疗随访观察。使用Kaplan-Meier分析两组的疗效,χ2检验分析安全性。结果卡培他滨维持治疗的42例中位PFS为
11.6月(95% CI:10.22~11.78),联合化疗的有效率(RR):42.8%。31例停止化疗病例对照观察中位PFS为7.4月(95% CI:5.79~
8.21),联合化疗的RR:38.7%。两组RR相似但PFS疗效有统计学差异(P<0.01)。联合化疗时大多数所有级别的不良反应进入
维持或停药观察后都有明显减少,两组分别与强烈化疗时对比血液或非血液不良反应差异有统计学意义(P<0.05),而两组不良
反应之间除手足综合征外无统计学差异(P>0.05)。结论通过卡培他滨维持治疗的晚期结直肠癌患者得到较长的PFS,且耐受
性好,保留了再次进展后接受强烈化疗的可能性,为提高晚期结直肠癌患者生存获益和生活质量提供基础,同时提供了一种有
效并有良好耐受性的治疗模式,具有进一步研究探索的可行性和临床前景。

Abstract: Objective To evaluate efficacy, safety, and feasibility of maintenance therapy with capecitabine after
fluoropyrimidines/oxaliplatin or fluoropyrimidines/irinotecan chemotherapy in patients with incurable colorectal cancer.
Methods Seventy-three hospitalized patients with incurable colorectal cancer who received fluoropyrimidines/oxaliplatin or
fluoropyrimidines/irinotecan as the first-line chemotherapy between May 2009 and December 2012 in our department were
retrospectively analyzed. When the maximum percentage tumor size reduction was achieved, 42 patients received a
maintenance therapy with capecitabine at 1000 mg/m2 in two daily doses on days 1-14, and the other 31 patients without
further chemotherapy or the maintenance therapy were followed up. The treatment was repeated every 3 weeks as a cycle
until disease progression or intolerable toxicity. The efficacy and safety were evaluated by Kaplan-Meier analysis and χ2
analysis. Results The 42 patients receiving capecitabine maintenance therapy achieved a median progression free survival
(PFS) of 11.6 months (95%CI 7.8-15.4), significantly longer than the PFS of 7.4 months (95% CI 4.9-11.8) in the 31 patients
without the maintenance therapy (P<0.01). The response rate (RR) after combined chemotherapy in the two groups were
similar (42.8% vs 38.7%). χ2 analysis indicated significant reductions in the adverse reactions (P<0.05) in both groups after
therapy without significant differences between the two groups (P>0.05) except for hand-foot syndrome. Conclusion In
patients with incurable colorectal cancer, capecitabine maintenance therapy following combined chemotherapy can achieve a
prolonged PFS with a good safety and tolerance and retains the possibility of further intense therapy in the event of disease
progression.