Feng Q, Zhao J R, Zhang A X, Li S L
Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng 252000, China.
Zhonghua Zhong Liu Za Zhi. 2018 Sep 23;40(9):696-702. doi: 10.3760/cma.j.issn.0253-3766.2018.09.012.
To investigate the efficacy and safety of lobaplatin (LBP) plus S-1 for advanced gastric cancer (AGC) and determine the potential role of circulating tumor cells (CTC) for predicting the therapeutic response and prognosis. From January 2014 to February 2015, 64 consecutive patients with AGC received lobaplatin plus S-1 chemotherapy in Liaocheng People's Hospital. The clinical features, clinical response, adverse effects, prognosis and CTC pre- and post-treatment were retrospectively analyzed. The correlation between CTC and patients' disease control rate (DCR), objective response rate (ORR), progression free survival (PFS) as well as overall survival (OS) were investigated. All 64 patients completed 2 cycles of chemotherapy.The number of patients who achieved complete regression, partial regression, stable and progression were 0, 24 (37.5%), 18 (28.1%) and 22 (34.4%), respectively. ORR was 37.5% and DCR was 65.6%. The median PFS was 10.8 months(95% 7.1-12.0) and the median OS was 16.1 months(95% 12.4-18.8). The ORR and PFS were not significantly different between patients with baseline CTC≥2 and CTC<2 (25.0% vs 53.6%, =0.150; 6.2 months vs 7.5 months, =0.780), while the DCR and OS were significantly different (45.9% vs 90.0%, =0.008; 10.5 months vs 17.2 months, <0.001). After 2 cycles of chemotherapy, the ORR and DCR in patients with CTC≥2 were 16.7% and 45.9%, respectively, which were significantly lower than those observed in patients with CTC<2 (50.0% and 90.0%, respectively). The former also had shorter median PFS and OS (6.6 months vs 8.9 months, 8.4 months vs 15.0 months, respectively). Patients with persistently CTC<2 or those exhibiting an conversion to CTC<2 following chemotherapy had an improved PFS and OS, while patients with persistently CTC≥2 or those exhibiting an conversion to CTC≥2 following therapy had shorter PFS and OS.The most frequent adverse effects were grade 1 or 2 gastrointestinal discomfort and myelosuppression. No patients discontinued chemotherapy because of adverse events. Lobaplatin plus S-1 had manageable safety profile and promising antitumor activity in patients with AGC. CTC could be used as a biomarker in evaluating therapeutic response and predicting their prognosis.
探讨洛铂（LBP）联合替吉奥（S-1）治疗晚期胃癌（AGC）的疗效和安全性，并确定循环肿瘤细胞（CTC）在预测治疗反应和预后方面的潜在作用。2014年1月至2015年2月，聊城市人民医院64例连续的AGC患者接受了洛铂联合S-1化疗。对其临床特征、临床反应、不良反应、预后及治疗前后的CTC进行回顾性分析。研究CTC与患者疾病控制率（DCR）、客观缓解率（ORR）、无进展生存期（PFS）以及总生存期（OS）之间的相关性。64例患者均完成了2周期化疗。达到完全缓解、部分缓解、病情稳定和疾病进展的患者数分别为0例、24例（37.5%）、18例（28.1%）和22例（34.4%）。ORR为37.5%，DCR为65.6%。中位PFS为10.8个月（95%可信区间7.1 - 12.0），中位OS为16.1个月（95%可信区间12.4 - 18.8）。基线CTC≥2和CTC<2的患者之间，ORR和PFS无显著差异（2个周期化疗后，CTC≥2的患者ORR和DCR分别为16.7%和45.9%，显著低于CTC<2的患者（分别为50.0%和90.0%）。前者的中位PFS和OS也较短（分别为6.6个月对8.9个月，8.4个月对15.0个月）。持续CTC<2或化疗后转变为CTC<2的患者PFS和OS改善，而持续CTC≥2或化疗后转变为CTC≥2的患者PFS和OS较短。最常见的不良反应为1级或2级胃肠道不适和骨髓抑制。无患者因不良事件而停止化疗。洛铂联合S-1在AGC患者中具有可控的安全性和有前景的抗肿瘤活性。CTC可作为评估治疗反应和预测预后的生物标志物。 25.0%对53.6%，P = 0.150；6.2个月对7.5个月，P = 0.780），而DCR和OS有显著差异（45.9%对90.0%，P = 0.008；10.5个月对17.2个月，P<0.001）。
