Irinotecan monotherapy as third-line or later treatment in advanced gastric cancer
Irinotecan monotherapy as third-line or later treatment in advanced gastric cancer
复制标题
伊立替康单药作为晚期胃癌的三线或三线以上治疗
DOI：
10.1007/s10120-017-0759-9
复制
发表时间：
2018-05-01
期刊：
影响因子：
7.4
通讯作者：
Baba, Eishi
中科院分区：
文献类型：
--
作者：
Makiyama, Akitaka;Arimizu, Kohei;Baba, Eishi
背景：晚期胃癌（AGC）患者通常采用伊立替康单药治疗作为挽救线治疗。方法回顾2007年至2014年6家机构接受伊立替康单药治疗作为挽救线治疗的AGC患者的病历。结果共有146例患者既往接受过氟尿嘧啶和紫杉烷类药物治疗，75.3%既往接受过铂类药物治疗。中位年龄为66岁（范围27-81），包括102名男性（69.9%）。53/70/19/4例患者的体能状态（PS）为0/1/2/3。89例患者（61.0%）有两个或两个以上的转移部位。135/11例患者（92.5%/7.5%）接受伊立替康单药治疗作为三线/四线治疗。中位给药次数为4次（范围1-62）。46例患者（31.5%）需要根据医生的判断降低初始剂量。总有效率为6.8%，疾病控制率为43.1%。中位PFS为3.19个月[95%置信区间（CI）2.30-4.08个月]，中位OS为6.61个月（95% CI 5.94-7.28个月）。3/4级不良事件为血液学毒性（46例，31.5%）和非血液学毒性（50例，34.2%）。31例患者（21.2%）因不良事件需要住院治疗。相对剂量强度（RDI）小于80%的患者表现出类似的生存RDI 80%或higher.Conclusions伊立替康单药治疗相对安全地进行作为挽救线治疗AGC在日本的临床实践。仔细的患者选择和伊立替康剂量的强化调整可能与有利的生存率相关。
Background Patients with advanced gastric cancer (AGC) are often treated with irinotecan monotherapy as salvage-line therapy. However, the survival benefit of this therapy remains to be elucidated.Methods Medical records of AGC patients who were treated with irinotecan monotherapy as salvage-line treatment in six institutions from 2007 to 2014 were reviewed.Results A total of 146 patients had prior fluoropyrimidine and taxane therapies, and 75.3% had prior platinum therapy. The median age was 66 (range 27-81) years, and 102 males (69.9%) were included. Performance status (PS) was 0/1/2/3 in 53/70/19/4 patients. Eighty-nine patients (61.0%) had two or more metastatic sites. Irinotecan monotherapy as 3rd-/4th-line therapy was performed in 135/11 (92.5%/7.5%). The median number of administrations was 4 (range 1-62). Forty-six patients (31.5%) required initial dose reduction at the physician's discretion. The overall response rate was 6.8%, and the disease control rate was 43.1%. The median PFS was 3.19 months [95% confidence interval (CI) 2.30-4.08 months], and the median OS was 6.61 months (95% CI 5.94-7.28 months). Grade 3/4 adverse events were hematological toxicity (46 patients, 31.5%) and non-hematological toxicity (50 patients, 34.2%). Hospitalization due to adverse events was required in 31 patients (21.2%). Patients with relative dose intensity (RDI) less than 80% showed similar survival to those with RDI 80% or higher.Conclusions Irinotecan monotherapy was relatively safely performed as salvage-line treatment for AGC in Japanese clinical practice. Careful patient selection and intensive modification of the dose of irinotecan might possibly be associated with favorable survival.