Department of Oncology, National Taiwan University Hospital, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taiwan; Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taiwan.
Department of Oncology, National Taiwan University Hospital, Taiwan; Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taiwan.
J Formos Med Assoc. 2020 Jan;119(1 Pt 1):97-105. doi: 10.1016/j.jfma.2019.01.015. Epub 2019 Mar 7.
Heavily pretreated pancreatic cancer patients have a grave prognosis. In this case series study, we evaluated the safety and efficacy of nab-paclitaxel-based chemotherapy for such patients.
The data of pancreatic adenocarcinoma patients (n = 40) treated with nab-paclitaxel after the failure of gemcitabine or fluoropyrimidines at our institution in 2013-2015 were reviewed.
The median number of prior chemotherapy regimens was two (range, 1-6). Eighteen patients had an Eastern Cooperative Oncology Group performance status of ≥2. The regimens comprised nab-paclitaxel combined with the following drugs: gemcitabine (n = 28), gemcitabine and fluoropyrimidine (n = 3), platinum and fluoropyrimidine (n = 4), fluoropyrimidine (n = 4), and irinotecan and fluoropyrimidine (n = 1). The median dose of nab-paclitaxel was 63 (range, 51-72) mg/m/dose, with the schedule of D1/15, D1/8, and D1/8/15 followed in 23, 14, and 3 patients, respectively. The median overall survival was 5.1 (95% CI, 4.6-5.7) months. Among 32 evaluable patients, two partial responses and six stable diseases were observed. The median progression-free survival was 2.6 (95% CI, 1.9-3.2) months. Grade 3/4 leucopenia or neutropenia was observed in three and two patients, respectively. Grade 3/4 anemia was observed in four patients. Other significant (grade 3 or more) nonhematological toxicities were not frequent, except for sepsis/infection (n = 7). However, more severe anemia or sepsis/infection was significantly associated with disease control.
In heavily pretreated pancreatic adenocarcinoma patients, low-dose nab-paclitaxel-based chemotherapy was fairly tolerable with modest efficacy.
经过大量预处理的胰腺癌患者预后严重。在本病例系列研究中，我们评估了纳武利尤单抗联合紫杉醇治疗此类患者的安全性和有效性。
回顾了 2013 年至 2015 年我院接受纳武利尤单抗治疗的胰腺腺癌患者（n=40）的数据，这些患者在接受吉西他滨或氟嘧啶治疗失败后接受了纳武利尤单抗治疗。
中位预处理化疗方案数为 2 个（范围，1-6）。18 例患者的东部肿瘤协作组表现状态为≥2。方案包括纳武利尤单抗联合以下药物：吉西他滨（n=28）、吉西他滨和氟嘧啶（n=3）、铂类和氟嘧啶（n=4）、氟嘧啶（n=4）和伊立替康和氟嘧啶（n=1）。纳武利尤单抗的中位剂量为 63（范围，51-72）mg/m/剂量，分别有 23、14 和 3 例患者采用 D1/15、D1/8 和 D1/8/15 方案。中位总生存期为 5.1（95%CI，4.6-5.7）个月。在 32 例可评估患者中，观察到 2 例部分缓解和 6 例疾病稳定。中位无进展生存期为 2.6（95%CI，1.9-3.2）个月。分别有 3 例和 2 例患者出现 3/4 级白细胞减少或中性粒细胞减少。4 例患者出现 3/4 级贫血。除感染/脓毒症（n=7）外，其他严重（3 级或更高级别）非血液学毒性并不常见。然而，更严重的贫血或感染/脓毒症与疾病控制显著相关。
在经过大量预处理的胰腺腺癌患者中，低剂量纳武利尤单抗联合紫杉醇化疗耐受性良好，疗效适中。
