- 期刊
Use of N(2)-L-Alanyl-L-Glutamine Dipeptide in Stage III Colon Cancer Patients with Oxaliplatin-based Chemotherapy, Benefit or Harm?
第三期大腸癌病患接受奧沙利鉑基底化療合併使用雙胜肽丙氨醯谷氨酸治療是否對治療有所助益？
摘要
Purpose. Oxaliplatin plays an important role in adjuvant chemotherapy but its toxicity often results in dose reduction or discontinuance. We evaluated the clinical benefits or harm of parenteral glutamine dipeptide (N2-LAlanyl-L-Glutamine Dipeptide, 20 g ． m/100 ml, IV) for stage III colon cancer patients receiving oxaliplatin-based chemotherapy. Methods. Between January 2015 and December 2017, 74 stage III colon cancer patients who received FOLFOX-4 as adjuvant chemotherapy were enrolled and their data analyzed retrospectively. Among these patients, 31 had received IV glutamine dipeptide (20 g ． m IV) days 1-2 with FOLFOX- 4 repeated every 15 days (glutamine dipeptide group), and 43 patients received only FOLFOX-4 (control group). Main measures were neurotoxicity symptoms and signs before each cycle, non-neurological toxicities and events (dosage reduction, disease recurrence or progression) and clinicopathologic features, neurotoxicity, disease recurrence, and prognosis. Results. Patients receiving glutamine dipeptide had significantly fewer neurologic symptoms than controls, including significantly lower incidence of grade 1-2 neuropathy after four and six cycles (6.45% vs. 32.56%, p = 0.0113; 6.45% vs. 51.16%, p ＜ 0.001 respectively). No significant differences were found between groups in nausea, vomiting, neutropenia, and thrombocytopenia. Compared to controls, patients with intravenous glutamine dipeptide had less mucositis (3.23% verse 20.93%, p = 0.0382), a lower percentage of incomplete FOLFOX courses (p = 0.0204) and no increased recurrence rates or impaired prognosis. No significant differences were found in overall, disease-free, and cancer-specific survival between groups. Conclusion. Supplemental IV glutamine dipeptide significantly decreases the incidence and severity of oxaliplatin-induced neurotoxicity in stage III colon cancer.
並列摘要
目的：在患有第三期大腸癌的患者中，奧沙利鉑在化療中扮演重要作用。但奧沙利鉑的毒性如神經毒性，嗜中性白血球低下症或血小板減少症可能導致治療過程中劑量減少甚至暫停化療。在先前的論文中報導了雙胜胺可預防神經毒性。本研究旨在討論雙胜胺對第三期結腸癌患者的臨床益處或危害。方法：2015年至2017年期間，奇美醫院大腸直腸外科共有74名患者診斷為第三期結腸癌患者接受FOLFOX-4治療。31位患者於每次15天的化療週期中有合併使用雙胜胺，另外43位則否。神經毒性症狀於每次化療週期前評估。其它毒性相關如化療劑量減少，疾病復發和進展等事件亦被記載。我們統計分析兩組間的臨床病理結果，神經毒性與非神經毒性，疾病復發或進展，及預後。結果：有使用雙胜胺之組別有著較低的神經症狀。經過4次及6次的FOLFOX治療後，雙胜胺組有較低的第一或二級神經症狀發生率。經過6個週期的治療後，雙胜胺組仍可有高達87%病人維持沒有神經症狀。在非神經毒性症狀如噁心、嘔吐、嗜中性白血球低下症或血小板減少症方面，兩組沒有顯著差異。與對照組相比，靜脈注射雙胜胺的患者粘膜炎發生率較低（3.23%, 20.93%, p=0.0382）。在整個化療過程中，靜脈注射雙胜胺組較能完成12次的FOLFOX療程記錄（p=0.0204）。以奧沙利鉑為基礎的化療，補充靜脈注射雙胜胺也不會增加癌症復發率和預後受損。兩組之間的總體存活率、，無疾病存活率和癌症特異性存活率無顯著差異。結論：在接受奧沙利鉑基底輔助化療的第三期結腸癌患者中，補充靜脈注射雙胜胺可以有效降低神經症狀發生率及嚴重程度。