Ajani Jaffer A
Department of GI Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 426, Houston, TX 77030, USA.
Expert Opin Pharmacother. 2006 Aug;7(12):1627-31. doi: 10.1517/14656566.7.12.1627.
Despite continuing decline in its incidence, gastric cancer remains the fourth most commonly diagnosed malignancy and is the second leading cause of cancer death around the world. There are > 50% of patients who develop metastatic cancer, which in the majority is beyond cure and, despite many advances that have been achieved in the management of gastric cancer over the past 15 years, patient prognosis remains very poor. The need for the development of more effective therapies that are likely to further improve survival time cannot be overemphasised. A number of new active classes of agents have been identified and these include camptothecins, taxanes, platinols and oral fluoropyrimidines. This review explicitly focuses on the development of docetaxel in the treatment of advanced gastric or gastroesophageal cancer. Docetaxel, a potent taxane, is active as a single agent and in combination with other active agents. Most importantly, the final results of a pivotal randomised Phase III trial have demonstrated a higher overall response rate, longer time to progression and longer overall survival when docetaxal was added to cisplatin plus 5-fluorouracil and compared with cisplatin plus 5-fluorouracil (a reference regimen). This regimen with docetaxel, cisplatin and 5-fluorouracil is intense and proper patient selection and monitoring of the patients is recommended. Future developments will lead to the incorporation of docetaxel in regimens with improved safety profile.
尽管胃癌的发病率持续下降，但它仍是第四大最常被诊断出的恶性肿瘤，也是全球癌症死亡的第二大主要原因。超过50%的患者会发展为转移性癌症，其中大多数无法治愈，并且尽管在过去15年里胃癌治疗取得了许多进展，但患者的预后仍然很差。开发更有效的疗法以进一步延长生存时间的需求再怎么强调也不为过。已经确定了一些新的活性药物类别，包括喜树碱类、紫杉烷类、铂类和口服氟嘧啶类。本综述明确聚焦于多西他赛在晚期胃癌或胃食管癌治疗中的发展。多西他赛是一种强效紫杉烷类药物，作为单一药物以及与其他活性药物联合使用时均具有活性。最重要的是，一项关键的随机III期试验的最终结果表明，当多西他赛添加到顺铂加5-氟尿嘧啶中，并与顺铂加5-氟尿嘧啶（一种对照方案）相比时，总体缓解率更高、疾病进展时间更长且总生存期更长。这种含多西他赛、顺铂和5-氟尿嘧啶的方案强度较大，建议进行适当的患者选择和患者监测。未来的发展将导致多西他赛被纳入安全性更高的方案中。
