Evaluation on efficacy and safety of gemcitabine combined with platinum-based chemotherapy for platinum-resistant recurrent ovarian carcinoma

doi:10.3877/cma.j.issn.1673-5250.2018.05.008

Objective

To investigate the efficacy and safety of gemcitabine (GEM) combined with oxaliplatin (OX) (GEMOX) in treatment of patients with platinum-resistant recurrent ovarian carcinoma.

Methods

A total of 32 cases of platinum-resistant recurrent ovarian carcinoma patients who were hospitalized in West China Second University Hospital, Sichuan University from January 2013 to January 2017, were chosen as research subjects. The GEMOX regimen of GEM at the dose of 1 000 mg/(m²·d) was given on day 1 and day 8 by intravenously guttae every 21 days a treatment cycle, and combined OX at the dose of 100 mg/(m²·d) was delivered after GEM infusion on day 1 in the cycle, and the total treatment cycles were 2-6. The therapeutic effect, survival, progression and adverse reactions of 32 patients were analyzed statistically. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①According to response evaluation criteria in solid tumors (RECIST), after GEMOX chemotherapy, none of the ovarian carcinoma patients in this study had achieved complete remission (CR), while rates of partial remission (PR), stable disease (SD) and progressive disease (PD) were 21.9%(7/32), 28.1%(9/32) and 50.0%(16/32), respectively. The total response rate of platinum-resistant recurrent ovarian carcinoma to GEMOX was 21.9%(7/32), and the clinical objective response rate was 50%(16/32). ②Among the ovarian carcinoma patients in this study, the median overall survival (OS) time was 10.5 months (95%CI: 8.4-12.6 months), median progression free survival (PFS) time was 6.3 months (95%CI: 4.6-7.9 months), one-year OS rate was 34.4%, and one-year PFS rate was 12.5%. ③The hematological adverse reactions of 32 ovarian carcinoma patients showed that 12.5%(4/32) patients had grade 3 neutropenia, 6.3%(2/32) patients had grade 3 leukopenia, and 3.1%(1/32) patients had grade 4 anemia. The non-hematological adverse reactions showed that 3.1%(1/32) patients had grade 3 nausea and (or) vomiting, and hepatotoxicity. Grade 1-2 fatigue was the most common non-hematological adverse reaction among 32 ovarian carcinama patients in this Study, with a total incidence of 65.6%(21/32).

Conclusions

The GEMOX is a regimen with a beneficial therapeutic efficacy and tolerable adverse reactions in platinum-resistant recurrent ovarian carcinoma patients.

Key words: Gemcitabine, Drug resistance, Recurrence, Ovarian neoplasms, Oxaliplatin, Drug therapy, Female

表1 吉西他滨联合奥沙利铂治疗32例铂类耐药复发性卵巢癌的不良反应发生情况[例数(%)]

不良反应类型		不良反应严重程度
不良反应类型		1级	2级	3级	4级
血液性		?	?	?	?
?	贫血	11(34.4)	4(12.5)	2(6.3)	1(3.1)
?	白细胞减少	12(37.5)	5(15.6)	2(6.3)	0(0)
?	中性粒细胞减少	9(28.1)	3(9.4)	4(12.5)	0(0)
非血液性		?	?	?	?
?	恶心、呕吐	9(28.1)	5(15.6)	1(3.1)	0(0)
?	腹泻	8(25.0)	3(9.4)	0(0)	0(0)
?	肝脏毒性	5(15.6)	1(3.1)	1(3.1)	0(0)
?	神经毒性	6(18.7)	5(15.6)	0(0)	0(0)
?	疲乏	9(28.1)	12(37.5)	0(0)	0(0)
?	感染	3(9.4)	2(6.3)	0(0)	0(0)

表1 吉西他滨联合奥沙利铂治疗32例铂类耐药复发性卵巢癌的不良反应发生情况[例数(%)]

不良反应类型		不良反应严重程度
不良反应类型		1级	2级	3级	4级
血液性		?	?	?	?
?	贫血	11(34.4)	4(12.5)	2(6.3)	1(3.1)
?	白细胞减少	12(37.5)	5(15.6)	2(6.3)	0(0)
?	中性粒细胞减少	9(28.1)	3(9.4)	4(12.5)	0(0)
非血液性		?	?	?	?
?	恶心、呕吐	9(28.1)	5(15.6)	1(3.1)	0(0)
?	腹泻	8(25.0)	3(9.4)	0(0)	0(0)
?	肝脏毒性	5(15.6)	1(3.1)	1(3.1)	0(0)
?	神经毒性	6(18.7)	5(15.6)	0(0)	0(0)
?	疲乏	9(28.1)	12(37.5)	0(0)	0(0)
?	感染	3(9.4)	2(6.3)	0(0)	0(0)

[1]	Brun JL,Feyler A,Chêne G, et al. Long-term results and prognostic factors in patients with epithelial ovarian cancer[J]. Gynecol Oncol, 2000, 78(1): 21-27.
[2]	曹泽毅. 中华妇产科学[M]. 3版. 北京：人民卫生出版社，2014: 2415-2420.
[3]	Faivre S,Raymond E,Woynarowski JM, et al. Supraadditive effect of 2′，2′-difluorodeoxycytidine (gemcitabine) in combination with oxaliplatin in human cancer cell lines[J]. Cancer Chemother Pharmacol, 1999, 44(2): 117-123.
[4]	Mavroudis D,Pappas P,Kouroussis C, et al. A dose-escalation and pharmacokinetic study of gemcitabine and oxaliplatin in patients with advanced solid tumors[J]. Ann Oncol, 2003, 14(2): 304-312.
[5]	Therasse P,Arbuck SG,Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst, 2000, 92(3): 205-216.
[6]	National Cancer Institute. Cancer therapy evaluation program: common toxicity criteria, version 2.0[EB/OL]. (1999-04-30)[2018-01-17]. URL
[7]	谷文飞. 复发性卵巢癌不同治疗方案的病例分析[D]. 银川：宁夏医科大学，2013.
[8]	Chen W,Zheng R,Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[9]	张玉霞，王晶. 复发性卵巢癌的治疗进展[J]. 现代肿瘤医学，2016, 24 (11): 1837-1840.
[10]	李克敏，宋亮，尹如铁. 2017年第4版NCCN卵巢癌临床实践指南解读[J]. 华西医学，2018, 33(4): 398-402.
[11]	Fung-Kee-Fung M,Oliver T,Elit L, et al. Optimal chemotherapy treatment for women with recurrent ovarian cancer[J]. Curr Oncol, 2007, 14(5): 195-208.
[12]	Bruchim I,Jarchowsky-Dolberg O,Fishman A. Advanced (>second) line chemotherapy in the treatment of patients with recurrent epithelial ovarian cancer[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 166(1): 94-98.
[13]	Salah-Eldin MA,Wahba HA,Halim AA. Biweekly peglated liposomal doxorubicin/oxaliplatin for ovarian cancer resistant to taxane-platinum treatment: a phase Ⅱ study[J]. Indian J Cancer, 2012, 49(1): 169-175.
[14]	Monnet I,de CH,Soulié P, et al. Oxaliplatin plus vinorelbine in advanced non-small-cell lung cancer: final results of a multicenter phase Ⅱ study[J]. Ann Oncol, 2002, 13(1): 103-107.
[15]	刘睿，曹晓艳，肖颖，等. 奈达铂联合吉西他滨治疗老年复发性卵巢癌的疗效[J]. 中国老年学，2012, 32(15): 670-672.
[16]	陈芳，姜雪秋，许一清，等. 吉西他滨联合奥沙利铂治疗晚期恶性肿瘤的近期疗效和血液学不良反应观察[J]. 肿瘤药学，2013, 3(6): 459-462.
[17]	邱汇，陈悠，范秀霞. 健择联合草酸铂治疗晚期复发性卵巢癌的临床观察[J]. 中国医学创新，2011, 8(21): 152-153.
[18]	Harnett P,Buck M,Beale P, et al. Phase Ⅱ study of gemcitabine and oxaliplatin in patients with recurrent ovarian cancer: an Australian and New Zealand Gynaecological Oncology Group study[J]. Int J Gynecol Cancer, 2007, 17(2): 359-366.

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