Hsu C H, Yeh K H, Chen L T, Liu J M, Jan C M, Lin J T, Chen Y C, Cheng A L
Department of Oncology, National Taiwan University Hospital, Taipei.
Oncology. 1997 Jul-Aug;54(4):275-80. doi: 10.1159/000227702.
Systemic chemotherapy for advanced gastric cancer is frequently associated with significant treatment-related toxicity, which is particularly serve in patients presenting with a poor general condition. A search for effective and low-toxic regimens for this group of patients is mandatory. A weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and leucovorin (HDFL) has previously been demonstrated to be an effective treatment for advanced colorectal cancer with minimal toxicity. In the past 3 years, this regimen has been tested at our institutes in patients with advanced gastric cancer, the general condition of whom had made the use of intensive combination chemotherapy impossible. The regimen consisted of a weekly 24-hour infusion of 2,600 mg/m2 of 5-FU and 300 mg/m2 of leucovorin. From August 1992 to December 1995, 34 patients had been treated with this regimen for a total of 488 courses (average: 14.4 per patient). Hematological toxicity of this regimen was minimal, with grade 3 or 4 leukopenia developing in only 1 (2.9%) patient. Other nonhematological toxicities were also negligible except a reversible neurotoxicity which developed in 2 patients. Twenty-five patients were eligible for response analysis. One complete response, 11 partial responses, 5 stable diseases, and 8 progressive diseases were observed. The response rate was 48% (32-72%, 95% CI). The median overall survival (OS) of the whole group was 7 months (range: 1-18+). The median OS and time to progression of the responders were 8.5 months (range: 2-18) and 5 months (range: 2-10+), respectively. The palliative effect was satisfactory with the Karnofsky performance status of the responders improving from a median of 50% (range: 20-90%) to 70% (range: 50-100%). Our retrospective data suggested that HDFL is an effective and low-toxic palliative treatment even in patients with a very poor general condition. We advocated that this regimen should be further tested in ordinary patients with advanced gastric cancer.
晚期胃癌的全身化疗常常伴有显著的治疗相关毒性，这在一般状况较差的患者中尤为严重。为这组患者寻找有效且低毒的治疗方案势在必行。先前已证明，每周24小时输注高剂量5-氟尿嘧啶（5-FU）和亚叶酸（HDFL）是治疗晚期结直肠癌的有效方法，且毒性极小。在过去3年里，我们研究所对一般状况使强化联合化疗无法进行的晚期胃癌患者试用了该方案。该方案包括每周24小时输注2600mg/m²的5-FU和300mg/m²的亚叶酸。从1992年8月至1995年12月，34例患者接受了该方案治疗，共488个疗程（平均：每位患者14.4个疗程）。该方案的血液学毒性极小，仅1例（2.9%）患者出现3或4级白细胞减少。除2例患者出现可逆性神经毒性外，其他非血液学毒性也可忽略不计。25例患者符合疗效分析条件。观察到1例完全缓解、11例部分缓解、5例病情稳定和8例病情进展。缓解率为48%（32-72%，95%CI）。全组患者的中位总生存期（OS）为7个月（范围：1-18+）。缓解者的中位OS和疾病进展时间分别为8.5个月（范围：2-18）和5个月（范围：2-10+）。缓解者的卡氏功能状态评分从中位50%（范围：20-90%）提高到70%（范围：50-100%），姑息效果令人满意。我们的回顾性数据表明，即使对于一般状况极差的患者，HDFL也是一种有效且低毒的姑息治疗方法。我们主张该方案应在晚期胃癌普通患者中进一步试验。
