Treatment of Metastatic or Recurrent Gastric Cancer with Weekly 24-hour Infusion of Cisplatin and High-Dose 5-Fluorouracil/Leucovorin in an Outpatient Setting

以門診接受每週一次24小時輸注Cisplatin和高劑量5-Fluorouracil/Leucovorin治療轉移或復發性胃癌病患

王佐輔(Tso-Fu Wang) ； 李啓誠(Chi-Cheng Li) ； 朱崧肇(Sung-Chao Chu) ； 姚朝元(Chao-Yuan Yao) ； 高瑞和(Ruey-Ho Kao)

《慈濟醫學雜誌》 18卷6期 (2006/12) Pp. 432-437

https://doi.org/10.6440/TZUCMJ.200612.0432

摘要

目的：目前針對轉移性胃癌病患尚無標準治療。我們評估以門診每週接受一次24小時輸注Cisplatin和高劑量5-fluorouracil/Leucovorin治療轉移性胃癌病患之療效與毒性。病人與方法：從2001年5月到2005年7月共有21位轉移性胃癌病患接受治療，療程為每週一次24小時輸注Cisplatin(25mg/平方公尺)和5-FU(2000mg/平方公尺)/Leuco-vorin(200mg/平方公尺)，每治療三週後休息一週為一療程，最多進行六個療程。期間規則評估治療效果及毒性。若是病情進展或不可容忍之毒性，則停止治療。結果：21位轉移性胃癌病患中，16位為男性、5位為女性；中位年齡為56歲(21-71)。中位治療週期為4.3個療程。治療整體反應率為33.3%，中位存活期為7.7個月。主要毒性為肝功能指數升高（發生率為52%，其中19%為第三級毒性以上），而消化道及血液毒性皆為輕微。結論：本研究顯示此一門診療程治療轉移性胃癌病患比較以往療程具有相同療效。若考慮治療效果、毒性及方便性來達到增加病患接受度並改善其生活品質，我們認為此療程為一合理的選擇。

關鍵字

胃癌 ； Cisplatin ； 5-fluorouracil ； 化學治療 ； 門診治療

並列摘要

Objective: There is no general agreement over a standard chemotherapy regimen for metastatic or recurrent gastric cancer. We evaluated, retrospectively, the activity and toxicity of weekly 24-hour infusion of cisplatin with high-dose 5-fluorouracil/leucovorin (P-HDFL) in an outpatient setting. Materials and Methods: Patients with metastatic or recurrent gastric cancer, treated in an outpatient setting from May 2001 to July 2005, were analyzed retrospectively. The regimen consisted of continuous infusion cisplatin 25mg/m^2, 5-fluorouracil 2000 mg/m^2 and leucovorin 200mg/m^2 on day 1, 8 and 15 every 4 weeks. The treatment was continued for a maximum of six cycles unless the disease progressed or intolerable toxicities occurred. Results: Twenty-one patients received this regimen: 16 men and 5 women, median age 56 years (range 27-71). A median of 4.3 cycles was administered. Seven of 21 patients (33.3%) achieved an objective partial response. Stable disease was observed in 6 patients (28.6%) and progressive disease in 8 patients (38.1%). The median survival was 7.7 months (95% confidence interval, 6.2-12.8 months). Digestive and hematological toxicities were low and no severe renal insufficiency was observed. The most common toxicity was elevated liver enzymes (11 patients, 52%), of whom three had≥grade 3 toxicity: 1 of them died of hepatic failure. Conclusion: Our results show that outpatient P-HDFL therapy leads to a fairly comparable outcome with various regimens of 5-fluorouracil/cisplatin. This outpatient regimen could be a reasonable alternative that combines advantages in respect of patient activity, mild to moderate toxicity, convenience of dosing and minor expenditure.

並列關鍵字

gastric cancer ； cisplatin ； 5-fluorouracil ； chemotherapy ； outpatient setting