伊立替康联合化疗方案治疗原发性肝癌的临床研究

Clinical study of combination chemotherapy based on CPT-11 on hepatocellular carcinoma

关键词:  原发性肝癌  伊立替康  化疗  肝动脉灌注  5-FU  DDP

Key words:  hepatocellular carcinoma  Irinotecan  chemotherapy  hepatic arterial infusion  5-FU,DDP

摘要:

［目的］探讨伊立替康联合化疗治疗原发性肝癌的疗效和毒性反应。［方法］2004年9月～2007年3月于大连医科大学第二临床学院肿瘤科确诊为原发性肝癌的患者21例，采用依立替康（CPT-11）联合5-FU、DDP化疗,其中A组11例，CPT-11 100 mg，DDP 60 mg，5-FU 1000 mg，1次/d，经肝动脉灌注， B组10例，CPT-11 100 mg，第1、8、15天，DDP 75 mg/m2，静脉滴注，5-FU 300 mg/d，1次/d，连续7 d，持续静脉灌注，全部21～28 d为1周期。评价指标：有效率、临床获益率（完全缓解+部分缓解+稳定），AFP下降情况、mTTP、毒性反应。［结果］A组疗效均为稳定，临床获益率100%，AFP下降者占50%， mTTP 为5个月，B组1例部分缓解（10%），5例稳定（50%），临床获益率60%， AFP下降者20%，mTTP为5个月。毒性反应主要表现为骨髓毒性、肝功能毒性、迟发性腹泻。［结论］CPT-11联合化疗对于原发性肝癌有一定的疗效，与常规治疗相比，疗效相当，但在临床获益率和中位肿瘤进展时间方面显示一定的优势，毒性反应较轻微。其中,肝动脉灌注给药较静脉给药临床获益率较高，毒性反应较低，中位肿瘤进展时间相当，初步认为肝动脉灌注化疗优于静脉全身化疗。但对于无肝动脉灌注治疗指征或已出现血行转移的原发性肝癌患者采用静脉化疗，亦可获得一定的有效率，中位肿瘤进展时间延长，患者可明显获益。

Abstract:

［Objective］This study explore the effect and adverse reaction of combination chemotherapy based on CPT-11 on hepatocellular carcinoma.［Methods］From September 2004 to March 2007, the twenty-one patients were diagnosed with advanced and un-resectable hepatocellular carcinoma(HCC)in oncology department of the second affiliated hospital of DaLian Medical University. The therapy with CPT-11 combinated with 5-FU and DDP was : 11 cases were given with CPT-11 100 mg ,5-FU 1000 mg and DDP 60 mg through hepatic arterial infusion (group A), d1, 21～28 days a cycle; 10 cases were given with CPT-11 100 mg d1,8,15,in vein drop and 5-FU 300 mg/d d1～7,in persistently drop(group B), 21～28 days a cycle;44 cycles were done. The evaluation standard include: response rate ,clinical benefit response CBR(CR+PR+SD),the decrease rate of AFP(the decrease of AFP exceed 50% than pre-therapy is positive),mTTp,adverse reaction.［Results］Eleven cases of group A were all evaluated as SD . The clinical benefit rate (CBR) was 100%, the decrease rate of AFP was 50%, mTTP was 5 months; 10 cases of group B with results of PR 1 case(10%) and SD 5 case (50%). The clinical benefit rate (CBR) was 60%, the decrease rate of AFP was 20%, mTTP was 5 months too. The incidence rate of adverse reaction were: bone marrow depression,hepat-toxicity and tardive diarrhe.［Conclusion］The combination chemotherapy based on CPT-11 is effective in the treatment of patients with HCC is equivalent effective with conventional therapy and has some advantages on CBR and mTTP but the toxicities are tolerable, so it may be a new choice of chemotherapy on HCC.The combination chemotherapy based on CPT-11 through HAI is better than through vein on HCC because of higher CBR, lower incidence rate of adverse reaction and equivalent mTTP.But for patients with advanced HCC or inability through HAI, this chemotherapy through vein is effective.