Boxberger F, Happich K, Schirner I, Brueckl W M, Hohenberger W, Hahn E G, Wein A
Department of Medicine I, Friedrich-Alexander University Erlangen-Nuremberg, Germany.
Z Gastroenterol. 2002 Oct;40(10):881-4. doi: 10.1055/s-2002-35262.
The most commonly used treatment in the palliative first-line therapy of metastatic pancreatic adenocarcinoma is the Gemcitabine (Gem) monotherapy, while several combination therapies are currently being tested in clinical trials. With regard to pancreatic cancer, a palliative second-line therapy has not been established, yet. The four patients presented in this paper received a palliative second-line therapy with Oxaliplatin (L-OHP), Gem and high-dose 5-Fluorouracil (5-FU) as a 24-h infusion after a first-line therapy with Gem and weekly high-dose 5-FU as a 24-h infusion. During second-line therapy, four patients received 67 chemotherapy applications, which were well tolerated. As severe symptom of toxicity, thrombocytopenia (CTC toxicity grade 4) was observed in one patient. As a result of second-line therapy, stable disease (SD) with a significant decrease of CA 19 - 9 was achieved in three patients and partial remission (PR) in one patient. After palliative first- and second-line treatment the survival time of the patients was 9, 9, 15 and 20 months. Currently, a multicentre phase I study has been started aiming at an optimisation of the three-drug combination dosage.
转移性胰腺腺癌姑息一线治疗中最常用的方法是吉西他滨（Gem）单药治疗，而目前几种联合治疗方案正在临床试验中进行测试。关于胰腺癌，姑息二线治疗方案尚未确立。本文介绍的4例患者在接受以Gem及每周一次大剂量5-氟尿嘧啶（5-FU）24小时静脉滴注作为一线治疗后，接受了以奥沙利铂（L-OHP）、Gem及大剂量5-FU 24小时静脉滴注作为姑息二线治疗。在二线治疗期间，4例患者共接受了67次化疗，耐受性良好。作为严重毒性症状，1例患者出现血小板减少（CTC毒性分级为4级）。二线治疗的结果是，3例患者病情稳定（SD）且CA 19-9显著下降，1例患者部分缓解（PR）。经过姑息一线和二线治疗后，患者的生存时间分别为9个月、9个月、15个月和20个月。目前，一项旨在优化三药联合剂量的多中心I期研究已经启动。
