Kulke Matthew H, Wu Bingyan, Clark Jeffrey W, Enzinger Peter C, Lynch Thomas J, Vincitore Michele, Michelini Ann, Fuchs Charles S
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Cancer Invest. 2006 Apr-May;24(3):229-34. doi: 10.1080/07357900600633924.
The combination of epirubicin, cisplatin, and infusional 5-fluorouracil (ECF) currently represents a standard and effective regimen for the treatment of advanced gastroesophageal cancer. The use of doxorubicin as an alternative to epirubicin in the ECF regimen has not been evaluated.
Thirty-two patients with metastatic adenocarcinoma of the stomach, gastroesophageal junction, or esophagus were treated with cisplatin 60 mg/m2 and doxorubicin 30 mg/m2 repeated every 21 days, in combination with infusional 5-fluorouracil 200 mg/m2/day (ACF).
Major objective responses were observed in 28 percent of patients (46 percent previously untreated; 13 percent previously treated), with one complete response. The median progression-free survival was 4.0 months, and the median overall survival was 5.8 months (9.3 months previously untreated; 4.5 months previously treated). The major (Grade 3-4) toxicities were neutropenia (34 percent), anorexia (31 percent), nausea (28 percent), diarrhea (19 percent), and stomatitis (16 percent).
In comparison with historical data taken from published trials of ECF, the ACF regimen appears similar in efficacy when differences in prior treatment status are taken into account. However, ACF appears to be associated with a higher incidence of major toxicities. Our findings therefore support the continued use of epirubicin rather than doxorubicin in combination chemotherapy regimens for advanced gastroesophageal cancer.
表柔比星、顺铂与持续输注5-氟尿嘧啶（ECF）联合方案目前是治疗晚期胃食管癌的标准有效方案。ECF方案中用多柔比星替代表柔比星的疗效尚未得到评估。
32例胃、胃食管交界或食管转移性腺癌患者接受顺铂60mg/m²和多柔比星30mg/m²治疗，每21天重复一次，联合持续输注5-氟尿嘧啶200mg/m²/天（ACF）。
28%的患者观察到主要客观缓解（46%为既往未治疗患者；13%为既往接受过治疗患者），1例完全缓解。无进展生存期的中位数为4.0个月，总生存期的中位数为5.8个月（既往未治疗患者为9.3个月；既往接受过治疗患者为4.5个月）。主要（3-4级）毒性反应为中性粒细胞减少（34%）、厌食（31%）、恶心（[28%）、腹泻（19%）和口腔炎（16%）。
与已发表的ECF试验的历史数据相比，考虑到既往治疗状态的差异，ACF方案的疗效似乎相似。然而，ACF方案似乎与较高的主要毒性发生率相关。因此，我们的研究结果支持在晚期胃食管癌的联合化疗方案中继续使用表柔比星而非多柔比星。
