Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
Third Department of Internal Medicine, University of Toyama, Toyama, Japan;
In Vivo. 2022 Sep-Oct;36(5):2447-2452. doi: 10.21873/invivo.12979.
BACKGROUND/AIM: Advanced gastric cancer (AGC) rarely presents with disseminated intravascular coagulation (DIC) at the time of diagnosis. Chemotherapy should be selected in consideration of hematological toxicities because these patients are at high risk of hemorrhagic complications. The leucovorin, fluorouracil, and oxaliplatin (FOLFOX) regimen is an effective and less toxic regimen for patients with AGC and poor performance status.
The present study assessed overall survival of all patients receiving first-line chemotherapy with and without DIC using Kaplan-Meier methods and examined the clinicopathological factors, DIC parameters, response, and survival of five patients with AGC and DIC who received FOLFOX in the first-line setting between February 2017 and February 2020.
Among the patients, four patients (80%) recovered from DIC after a median of 12 days of FOLFOX therapy (range=12-25), and their platelet count gradually increased within 1 week after the start of chemotherapy. The median progression-free survival and overall survival were 46 (range=22-296) and 115 days (range=83-324), respectively. No patients experienced adverse events necessitating treatment discontinuation, including gastrointestinal bleeding and thrombocytopenia. Moreover, all patients received second-line treatment after progression, and one patient exhibited improvement of DIC symptoms following nab-paclitaxel and ramucirumab treatment.
FOLFOX therapy is well tolerated and effective in patients with AGC initially presenting with DIC and subsequent second-line treatment might be crucial for better prognosis.
背景/目的：在诊断时，晚期胃癌（AGC）很少伴有弥散性血管内凝血（DIC）。由于这些患者有发生出血并发症的高风险，应考虑血液学毒性选择化疗。奥沙利铂、亚叶酸钙和氟尿嘧啶（FOLFOX）方案是治疗 AGC 和身体状况不佳的患者的一种有效且毒性较小的方案。
本研究使用 Kaplan-Meier 方法评估了接受一线化疗且伴有和不伴有 DIC 的所有患者的总生存期，并检查了 5 例在一线治疗中接受 FOLFOX 的伴有 DIC 的 AGC 患者的临床病理因素、DIC 参数、反应和生存情况，这些患者的入组时间为 2017 年 2 月至 2020 年 2 月。
在这些患者中，有 4 例（80%）在接受 FOLFOX 治疗后 12 天中位数（范围=12-25）从 DIC 中恢复，并且他们的血小板计数在化疗开始后 1 周内逐渐增加。中位无进展生存期和总生存期分别为 46 天（范围=22-296）和 115 天（范围=83-324）。没有患者因胃肠道出血和血小板减少等需要停止治疗的不良事件发生。此外，所有患者在进展后均接受二线治疗，1 例患者在接受nab-紫杉醇和雷莫芦单抗治疗后 DIC 症状得到改善。
FOLFOX 治疗在初始伴有 DIC 且随后进行二线治疗的 AGC 患者中耐受性良好且有效，后续二线治疗可能对改善预后至关重要。
