Dose and dose-intensity of chemotherapy, studies in small cell lung cancer
Dose and dose-intensity of chemotherapy, studies in small cell lung cancer
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化疗的剂量和剂量强度，小细胞肺癌的研究
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
V. Tjan
中科院分区：
文献类型：
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作者：
V. Tjan
如果不进行治疗，小细胞肺癌（SCLC）患者的生存期不到3个月。虽然联合化疗改善了预后，但长期生存率仍然很差。为了评估化疗剂量强化对生存率的影响，244例SCLC患者被随机分配至标准CDE（环磷酰胺1000 mg/m2，多柔比星45 mg/m2，依托泊苷100 mg/m2 x3，每3周一次，共5个周期）或强化CDE（125%剂量，G-CSF 5 g/kg/天，第4-13天，每2周一次，共4个周期）。中位随访4u年后，生存率没有差异：中位生存期为54周和52周，2年生存率分别为15%和18%（P=0.885）。上述试验中的前163例患者也随机（2x2析因设计）接受预防性抗生素或安慰剂，以评估其对发热性白细胞减少症（FL）的影响。预防性环丙沙星加罗红霉素可使FL的发生率、感染数量、治疗性抗生素的使用和因FL住院的人数减少约50%，感染性死亡人数减少。研究表明，给接受化疗的小细胞肺癌患者预防性使用抗生素可以节省成本。敏感性分析表明，预防的有效性为50%，抗生素预防的预期成本为500欧元或更低，成本节约将导致广泛的基线FL风险，即每个周期FL的风险高于10%至20%。此外，在一项小型初步研究中证实，在下一个化疗周期前48小时给予G-CSF会增加化疗相关的白细胞减少症和血小板减少症。最后，对20项随机研究进行了分析，其中SCLC化疗的剂量或DI是唯一的变量。从该分析中可以看出，周期数、剂量水平、剂量密度和累积剂量都是改善生存率的重要因素。
Without treatment, survival of patients with small cell lung cancer (SCLC) is less than 3 months. Although combination chemotherapy has improved the prognosis, long-term survival remains poor. To assess the impact of chemotherapy dose intensification on survival, 244 SCLC patients were randomised to standard CDE (cyclophosphamide 1000mg/m2, doxorubicin 45mg/m2, etoposide 100mg/m2 x3, every 3 weeks for 5 cycles) or intensified CDE (125% dose with G-CSF 5 g/kg/day days 4-13, every 2 weeks for 4 cycles). After a median follow-up of 4u years there was no survival difference: median survival was 54 weeks versus 52 weeks, with 2-year survival rates of 15% and 18%, respectively (P=0.885). The first 163 pts in the aforementioned trial were also randomised (2x2 factorial design) to prophylactic antibiotics or placebo to assess their impact on febrile leukopenia (FL). Prophylactic ciprofloxacin plus roxithromycin reduced the incidence of FL, the number of infections, the use of therapeutic antibiotics and hospitalisations due to FL by approximately 50%, with reduced number of infectious deaths. It was shown that giving prophylactic antibiotics to SCLC patients undergoing chemotherapy produces cost-savings. Sensitivity analyses indicate that, with an efficacy of prophylaxis of 50%, and with expected costs of antibiotic prophylaxis of 500 Euro or less, cost-savings will incur over a broad range of baseline risks for FL, that is a risk above 10% to 20% for FL per cycle. Further it was demonstrated in a small pilot study, that G-CSF administration until 48 hours before the next chemotherapy cycle increased chemotherapy-associated leukopenia and thrombocytopenia. Finally, 20 randomised studies, in which the dose or DI of chemotherapy for SCLC were the only variables tested, were analysed. From this analysis, it appears that the number of cycles, dose level, dose-density and cumulative dose are all important factors for improving survival.
环丙沙星与甲氧苄啶/磺胺甲恶唑用于预防骨髓移植受者细菌感染：一项随机对照试验。
DOI：
10.1200/jco.1995.13.1.239
发表时间：
1995
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
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作者：
Lew,MA;Kehoe,K;Ritz,J;Antman,KH;Nadler,L;Kalish,LA;Finberg,R
通讯作者：
Finberg,R