Neoadjuvant PFL augmented by methotrexate and piritrexim followed by concomitant chemoradiotherapy for advanced head and neck cancer: a feasible and active approach.
Neoadjuvant PFL augmented by methotrexate and piritrexim followed by concomitant chemoradiotherapy for advanced head and neck cancer: a feasible and active approach.
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对于晚期头颈癌，采用甲氨蝶呤和吡曲辛增强新辅助 PFL，然后同时进行放化疗：一种可行且积极的方法。
DOI：
10.1093/oxfordjournals.annonc.a058079
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
W. Panje
中科院分区：
文献类型：
--
作者：
E. Vokes;D. Haraf;J. McEvilly;R. Mick;M. Kozloff;M. Goldman;W. Moran;N. Clendeninn;M. Collier;R. R. W. selbaum;W. Panje
为了提高顺铂、连续输注氟尿嘧啶 (5-FU) 和口服亚叶酸 (PFL) 两个周期所达到的完全缓解 (CR) 率，我们在联合用药 (PFL-MP) 中添加了两种抗叶酸药物：甲氨蝶呤 (MTX) 和亲脂性吡曲辛 (PTX)。 28 名先前未经治疗的头颈部 IV 期鳞状细胞癌患者在第 1 天接受 2 个周期的顺铂 100 mg/m2，随后以 800 mg/m2/天连续输注 5-FU 5 天，并每 4 小时口服 100 mg 亚叶酸。第 15 天以 40 mg/m2 静脉注射给予 MTX，第 22 至 26 天以 75 mg 口服，每日两次，第 2 个周期从第 36 天开始。在前 5 名患者中的 2 名在第 15 至 35 天期间出现肿瘤进展后，方案强化至 MTX 50 mg/m2、PTX 100 mg 每日两次，周期持续时间为 28 天。局部治疗包括手术和/或放射治疗，同时每隔一周给予 5-FU 和羟基脲 (FHX)。 11 名患者（39%，95% 置信区间 21-57%）获得 CR，9 名患者（32%）获得 PR，4 名患者没有缓解。 4 名患者对 PFL-MP 的反应无法评估。体能状态不佳或 N3 疾病的患者获得 CR 的可能性较小。 PFL 后的粘膜炎是剂量限制性毒性。局部治疗包括 15 名患者的手术和 19 名患者的 FHX 放化疗。在这种情况下使用 FHX 被证明是可行的，并且大多数患者的治疗方案接近预期剂量强度。（摘要截断为 250 字）
To increase the complete remission (CR) rate achieved with two cycles of cisplatin, continuous infusion fluorouracil (5-FU) and oral leucovorin (PFL) we added two antifolate drugs, methotrexate (MTX) and the lipophilic piritrexim (PTX), to the combination (PFL-MP). Twenty-eight patients with previously untreated Stage IV squamous cell carcinoma of the head and neck received 2 cycles of cisplatin 100 mg/m2 on day 1 followed by a 5-day continuous infusion of 5-FU at 800 mg/m2/day and 100 mg of leucovorin administered orally every 4 hours. MTX was administered at 40 mg/m2 IV on day 15 and PTX at 75 mg orally twice daily on days 22 to 26, with cycle 2 starting on day 36. After 2 of the first 5 patients had tumor progression between days 15 and 35, the regimen was intensified to MTX 50 mg/m2, PTX 100 mg twice daily and a cycle duration of 28 days. Local therapy consisted of surgery and/or radiotherapy with concomitant 5-FU and hydroxyurea (FHX) administered every other week. Eleven patients (39%, 95% confidence intervals 21-57%) had a CR, 9 (32%) had a PR, and four patients had no response. Four patients were unevaluable for response to PFL-MP. Patients with poor performance status or N3 disease were less likely to achieve a CR. Mucositis following PFL was the dose-limiting toxicity. Local therapy included surgery in 15 patients and FHX chemoradiotherapy in 19 patients. The administration of FHX in this setting proved feasible and the regimen was given near the intended dose intensity in the majority of patients.(ABSTRACT TRUNCATED AT 250 WORDS)