Hoff Paulo M, Fuchs Charles S
Center for Clinical Studies in Cancer, Albert Einstein Hospital, Sao Paulo, Brazil.
Semin Oncol. 2003 Aug;30(4 Suppl 15):54-61. doi: 10.1016/s0093-7754(03)00406-8.
The treatment for advanced gastroesophageal tumors is still largely based on 5-fluorouracil and cisplatin combinations, and the treatment for advanced pancreatic tumors principally relies on gemcitabine. The need for more active agents is evident in light of the poor outcomes for patients with these tumors. Oxaliplatin is an important chemotherapeutic agent currently being investigated in the treatment of gastrointestinal carcinomas. This diaminocyclohexane-platinum compound has significant differences from cisplatin and carboplatin with respect to its activity and toxicity. It appears to have activity in tumors believed to be marginally sensitive to the other platinum agents, and it is neither ototoxic nor nephrotoxic. The main side effect of oxaliplatin is a sensory neuropathy exacerbated by cold exposure. After extensive clinical development, oxaliplatin has become an important option in the treatment of colorectal cancer. Its role in the treatment of upper gastrointestinal cancers is less well established, but is the focus of intense investigation. Much of what we currently know is based on small phase I and II studies, but knowledge is rapidly accumulating. The fact that cisplatin remains an important drug in the treatment of several upper gastrointestinal cancers raises the hope that oxaliplatin will contribute significantly to the treatment of those malignancies as well. Larger randomized phase III trials are being designed and conducted to fully define the role of oxaliplatin in the treatment of upper gastrointestinal tumors in the relatively near future.
晚期胃食管肿瘤的治疗仍主要基于5-氟尿嘧啶和顺铂联合用药，而晚期胰腺肿瘤的治疗主要依赖吉西他滨。鉴于这些肿瘤患者预后较差，显然需要更有效的药物。奥沙利铂是目前正在研究用于治疗胃肠道癌的一种重要化疗药物。这种二环己烷铂化合物在活性和毒性方面与顺铂和卡铂有显著差异。它似乎对被认为对其他铂类药物敏感性较低的肿瘤有活性，且无耳毒性和肾毒性。奥沙利铂的主要副作用是冷刺激会加重的感觉神经病变。经过广泛的临床研发，奥沙利铂已成为治疗结直肠癌的重要选择。其在上消化道癌治疗中的作用尚不明确，但已成为深入研究的重点。我们目前所了解的大部分内容基于小型I期和II期研究，但相关知识正在迅速积累。顺铂在几种上消化道癌的治疗中仍然是一种重要药物，这使得人们希望奥沙利铂也能对这些恶性肿瘤的治疗做出重大贡献。目前正在设计和开展更大规模的随机III期试验，以便在相对不久的将来全面确定奥沙利铂在上消化道肿瘤治疗中的作用。
