Modified FOLFIRI as Second-Line Chemotherapy after Failure of Modified FOLFOX-4 in Advanced Gastric Cancer
Modified FOLFIRI as Second-Line Chemotherapy after Failure of Modified FOLFOX-4 in Advanced Gastric Cancer
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DOI：
10.4143/crt.2011.43.3.148
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发表时间：
2011-09-01
影响因子：
4.6
通讯作者：
Hong, Young Seon
中科院分区：
文献类型：
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作者：
Jeon, Eun Kyoung;Hong, Sook Hee;Hong, Young Seon
目的评价奥沙利铂、亚叶酸钙和5-氟尿嘧啶（FOLFOX）治疗晚期胃癌失败后，伊立替康、亚叶酸钙和5-氟尿嘧啶（FOLFIRI）作为二线治疗的疗效和毒性。改良FOLFIRI方案包括第1天伊立替康150 mg/m2静脉输注90分钟，第1天和第2天，亚叶酸（LV）20 mg/m（2）和5-氟尿嘧啶（5-FU）400 mg/m（2）推注，随后600 mg/m（2）22小时输注，与相同剂量的5-FU/LV改良FOLFOX-结果32例患者共接受FOLFIRI方案化疗126个疗程。未达到完全缓解。3例患者（9.4%; 95%置信区间[CI]，0 - 20.1%）达到部分缓解，而11例（34.4%; 95% CI，17.0 - 51.8%）患者显示疾病稳定。疾病控制率（完全缓解、部分缓解和疾病稳定）为43. 8%（95% CI，25. 6 - 61. 9%），中位随访时间为11. 3个月（范围，2. 23 - 37. 9个月）。中位至进展时间为2个月（95% CI，1.49 - 2.51个月），从FOLFIRI开始的中位总生存期为5.84个月（95% CI，4.34 - 7.34个月）。结论晚期胃癌改良FOLFOX-4方案化疗失败后，以改良FOLFIRI方案作为二线化疗方案，患者可以耐受，但有效率较低。对5-FU/LV联合方案治疗晚期胃癌失败后重新尝试5-FU/LV联合伊立替康治疗的研究值得进一步探讨。
PurposeThe purpose of this study was to evaluate efficacy and toxicity of irinotecan, leucovorin and 5-fluorouracil (FOLFIRI) as second-line treatment after failure of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) for advanced gastric cancer.Materials and MethodsPatients who received modified FOLFOX-4 as first-line treatment and then received sequential modified FOLFIRI for disease progression were included in this study. The modified FOLFIRI regimen consisted of irinotecan 150 mg/m(2) in a 90-minute intravenous infusion on day 1, leucovorin (LV) 20 mg/m(2) and 5-fluorouracil (5-FU) 400 mg/m(2) as a bolus followed by 600 mg/m(2) as a 22-hour infusion on days 1 and 2 with the same dose of 5-FU/LV of modified FOLFOX-4 every 2 weeks.ResultsA total of 32 patients received 126 courses of FOLFIRI chemotherapy. No complete response was achieved. Three patients (9.4%; 95% confidence interval [CI], 0 to 20.1%) achieved partial response, whereas 11 (34.4%; 95% CI, 17.0 to 51.8%) patients showed stable disease. Disease control rate (complete response, partial responses and stable diseases) was 43.8% (95% CI, 25.6 to 61.9%) and median follow up duration was 11.3 months (range, 2.23 to 37.9 months). Median time to progression was 2 months (95% CI, 1.49 to 2.51 months), and median overall survival from the start of FOLFIRI was 5.84 months (95% CI, 4.34 to 7.34 months). Toxicities were tolerable.ConclusionModified FOLFIRI as second-line chemotherapy after failure of the modified FOLFOX-4 in advanced gastric cancer was tolerable but showed a lower response rate. Further study about retrying 5-FU/LV with irinotecan after failure of the 5-FU/LV combined regimen is necessary in advanced gastric cancer.