Objective To systematically evaluate the safety and efficacy of trastuzumab combined with chemotherapy for HER-2 positive patients with advanced gastric cancer. Methods We searched ClinicalTrails.gov, PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), CNKI, CBM, WanFang Data, VIP and major meeting proceeding databases (ASCO and ESMO) from inception to May 2016, to collect randomized controlled trials (RCTs) or non-RCTs about trastuzumab combined with chemotherapy versus chemotherapy alone for advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by using RevMan 5.3 software. Results Nine studies involving 1 034 HER-2 positive patients were included, of which three were RCTs and the other six were non-RCTs. Meta-analysis results indicated that the trastuzumab combined with chemotherapy group (the trial group) was superior to the chemotherapy alone group (the control group) in complete remission (OR=2.76, 95%CI 1.40 to 5.44,P=0.003), partial remission (OR=1.81, 95%CI 1.40 to 2.33,P<0.000 01), overall response rate (OR=2.09, 95%CI 1.63 to 2.68,P<0.000 01) and disease control rate (OR=2.20, 95%CI 1.63 to 2.98,P<0.000 1), while there was no statistical significances in stable disease (OR=0.87, 95%CI 0.66 to 1.14,P=0.31). In terms of safety, the incidence of diarrhea (OR=1.51, 95%CI 1.10 to 2.06,P=0.01) and erythra (OR=4.35, 95%CI 1.25 to 15.10,P=0.02) in the trial group were higher than the control group. However, other adverse reactions were no significant differences in two groups. Conclusion Compared with chemotherapy alone, trastuzumab combined with chemotherapy in the treatment of HER-2 positive patients with advanced gastric cancer can significantly improve response rate, but it may increase the incidence of diarrhea and erythra. Because of the limited quality and quantity of the included studies, the above conclusion needs to be verified by conducting more high quality studies.
ObjectiveTo summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in the judgment of N stage and lymph node metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.MethodsClinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy, form July 2017 to July 2019 in Affiliated Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively, and all of patients underwent SOX regimen transformation therapy. The MSCT enhanced scan was performed before operation, and the postoperative pathology was used as the gold standard. The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results Before the operation, MSCT was used to evaluate the lymph node metastasis of the patients with advanced gastric cancer after transformation therapy, and compared with the lymph nodes metastasis of the corresponding pathological results, the accuracy rates of lymph node groups in No.1, No.3, No.5, No.6, No.7, No.8, and No.16 were 77.78% (21/27), 81.48% (22/27), 85.19% (23/27), 88.89% (24/27), 85.19% (23/27), 74.07% (20/27), and 96.30% (26/27), respectively. Compared with pathological results, the total accuracy of N stage after transformation therapy that evaluated by MSCT was 62.96% (17/27), with the Kappa coefficient was 0.419 (P=0.003).ConclusionsMSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy. Besides, MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1, No.3, No.5, No.6, No.7, No.8, and No.16.
Objective To evaluate the effectiveness and safety of lentinan on immune function in patients with advanced gastric cancer. Methods We searched MEDLINE (1969-2006), EMBASE (1984-2006), OVID (1969-2006), CENTRAL (Cochrane Central Register of Controlled Trials in The Cochrane Library) (Issue 4, 2006), the Chinese Biomedicine Database (1978-2006) and CNKI (1978-2006). We also handsearched relevant journals. Pharmaceutical companies were contacted to identify additional randomized controlled trials. We assessed the identified studies in order to include high quality studies. Results Ten studies (containing 786 patients) met the inclusion criteria. Six trials shown that lentinan+FAM had significant efficacy upon patients with advanced gastric cancer compared with FAM in overall response [Plt;0.01, RR1.70, 95%CI (1.39,2.09)]. In three trials, a significant effect of lentinan+FAM group compared with FAM group in quantity of CD3+ T, T4/T8, NK was found, but lower than FAM group in side- effect of digestive system [RR0.71, 95%CI (0.55,0.91)]. The other trail identified there were fewer side effects in lentinan+FAM group compared with FAM group, though did not discribe the overall response. In case the significant heterogeneity, meta-analysis could not be used for the other three trails included, since the components of chemotherapeutic agents (ATP+Co-A+Vc; DDP+ Epirubicin+5FU; 5FU+CF+VP16) were not the same. In the three trials, overall response was statistically significant better in the lentinan group than in the control group, and lentinan group could significantly increase the quantity of CD3+ T, T4/T8, NK compared with control group. Conclusions The present meta-analysis suggested that addition of lentinan to standard chemotherapy provided a significant advantage over chemotherapy alone in terms of efficacy for patients with advanced gastric cancer. However, most of trials included in the review were of low quality, therefore, it is of necessity to conduct multi-center randomized-controlled trials of high quality.
ObjectiveTo understand the latest research progress in the treatment of advanced gastric cancer (AGC) and explore the optimal treatment strategy. Method The latest literature on the treatment of AGC was retrieved and reviewed. Results For patients with AGC, chemotherapy, radiotherapy, targeted therapy, immunotherapy, palliative therapy, nutritional support, and traditional Chinese medicine therapy were currently adopted in clinic, the combination of them were used usually. Some patients obtained good therapeutic effects by new chemotherapy drugs and antibody conjugated drugs. In the era of first-line immunotherapy or targeted therapy, first-line immunotherapy alone, immunotherapy in combination with chemotherapy, double immunotherapy, and immunotherapy combined with anti-angiogenesis targeted drugs for AGC had represented some survival benefits. ConclusionsThe research, development, and widespread application of new anti-tumor drugs have continuously expanded the treatment methods for AGC. The development of tumor molecular biology provides an opportunity for the treatment of AGC, and the precise diagnosis and treatment pattern guided by molecular typing is gradually maturing. However, the treatment of AGC is still facing challenges. In the era of precision medicine, facing the higher heterogeneity of gastric cancer, the dilemma of precise treatment of drugs for AGC, and the research and development of new anti-tumor drugs, the optimal treatment mode of AGC still needs more clinical exploration. It is necessary to comprehensively consider various aspects such as the patient’s physical condition, previous treatment status, and drug accessibility.
ObjectiveTo compare the clinical effects of continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) and intravenous chemotherapy for advanced gastric cancer patients, and find better nursing methods. MethodsSixty advanced gastric cancer patients who underwent chemotherapy between June 2013 and June 2014 were divided into CHPPC group (group C, n=30) and intravenous chemotherapy group (group V, n=30). We recorded the nursing methods for both the two groups, patients' satisfaction to the nursing and treatment, peritoneal metastasis rate and quality of life during the chemotherapy. ResultsThe life quality in group V was lower than that in group C (P<0.05). The differences in patients' satisfaction rate, peritoneal metastasis rate, and one-year survival rate were not significantly different between the two groups (P>0.05). ConclusionFor patients with advanced gastric cancer requiring chemotherapy, in spite of higher cost and more complicated operations, CHPPC is superior in lower adverse events rate, better quality of life during chemotherapy and doesn't decrease patients' satisfaction to the nursing and treatment.
【摘要】 目的 探討替吉奧膠囊聯合奧沙利鉑治療晚期胃癌的近期療效和毒性反應。 方法 2010年1-7月，16例晚期胃癌患者根據體表面積來確定初始劑量，體表面積lt;1.25 m2，替吉奧膠囊40 mg/次，2次/d；體表面積1.25~1.5 m2，替吉奧膠囊50 mg/次，2次/d；體表面積gt;1.5 m2，替吉奧膠囊60 mg/次，2次/d，早、晚飯后分別口服1次，連續服用28 d，停藥14 d。奧沙利鉑注射液130 mg/m2加入5%葡萄糖注射液500 mL避光緩慢靜gt;2 h，第1、21天重復，連用2周期。按RECIST 1.1標準評價客觀療效和不良反應。 結果 16例患者中PR 9例（56.3%），SD3例（18.8%），PD 4例（25%），總有效率為69.0%。不良反應主要是血液學毒性、胃腸道反應及外周神經毒性，且均在Ⅰ~Ⅱ。 結論 替吉奧膠囊聯合奧沙利鉑方案治療晚期胃癌的近期療效較好，不良反應可以耐受，值得進一步研究應用。【Abstract】 Objective To explore the early efficacy of Oxaliplatin combined with S1 capsule on advanced gastric cancer and observe the toxicity. Methods A total of 16 patients with advanced gastric cancer from January to July 2010 were treated with chemotherapy: oxaliplatin 130 mg/m2 mixed with 5% glucose injection 500 mL in the first day and repeated in the 21st day; Po after breakfast and dinner: S1 capsule with an initial dose according to the body surface area. Body surface lt;1.25 m2, 40 mg once, twice per day; body surface:1.25-1.5 m2,50 mg once, twice per day; body surface gt;1.5 m2, 60 mg once, twice per day. The medication lasted for 28 days, withdrew for 14 days. All of the patients underwent the treatment for two cycles. Efficacy and toxicities were evaluated according to the RECIST 1.1 standard. Results Of the 16 patients, partial remission (PR) was in nine (56.3%), stable disease was in three (18.8%) (SD), and progression disease was in four (PD). The total response rate was 69.0%. The major toxicities included leucopenia, nausea, vomiting and neurosensory abnormity. Conclusion Oxaliplatin combined with S1 capsule is effective on advanced gastric cancer, and the adverse effects are tolerable.
Objectives To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Methods We searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to March 2017, to collect randomized controlled trials (RCTs) on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 984 advanced gastric cancer patients were included. The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in ORR (RR=1.21, 95%CI 1.02 to 1.43, P=0.03), DCR (RR=1.13, 95%CI 1.01 to 1.26, P=0.03), 1-year survival rate (RR=1.26, 95%CI 1.01 to 1.56, P=0.04) and 2-year survival rate (RR=3.03, 95%CI 1.59 to 5.75, P=0.000 7), while there was no statistical difference between two groups in the incidence of grade Ⅲ to Ⅳ adverse events. The results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate (RR=2.56, 95%CI 1.06 to 6.19, P=0.04), but there were no statistical differences in ORR (RR=1.13, 95%CI 0.88 to 1.45, P=0.34), DCR (RR=1.02, 95%CI 0.85 to 1.21, P=0.84) and 1-year survival rate (RR=1.29, 95%CI 0.92 to 1.80, P=0.14). The results of sensitivity analysis indicated that the overall outcomes might be affected by the risk bias of included studies. The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade Ⅲ to Ⅳ adverse events. Conclusions Compared with epirubicin based regimens, docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
摘要:目的：觀察復方苦參注射液配合化療治療晚期胃癌的臨床療效。方法：將60例晚期胃癌患者分為兩組,兩組均采用FOLFOX方案化療,21天為1個周期；2個周期評價效療。治療組30例加用復方苦參注射液治療,14天為1療程,2個療程評價療效。觀察近期療效及臨床證候變化、生存質量及毒副反應變化。結果:兩組近期療效比較,治療組與對照組總緩解率分別為433%和400%（P＞005）；兩組臨床證候變化比較,治療組與對照組總改善率分別為800%和600%（P＜005）；兩組生存質量變化比較,治療組與對照組提高穩定率分別為867%和567%（P＜005）；中位生存期分別為8個月和5個月；兩組毒副反應比較,治療組毒副反應明顯低于對照組（P＜005）。結論:復方苦參注射液配合化療治療晚期胃癌具有一定抗腫瘤作用,能緩解疼痛癥狀及臨床癥狀,減輕化療毒副反應,提高生活質量,延長生存期。Abstract: Objective: To study the effect of combination FuFang Ku Shen Zhusheye and chemotherapy for treatment of advanced gastric cancer. Methods: Sixty patientswith advanced gastric cancer were divided into two groups, all used with FOLFOXregimen, 21 days a cycle; twocycle assessment of treatment effect. The treatment group were treated with the FuFang Ku Shen Zhusheye plus treatment, a course of treatment for 14 days, the effect were evaluated after two courses. The clinical symptoms and living quality, toxicity were dynamically observed. Results: Both shortterm effect of comparison, the overall response rates of the treatment group and the control group were 433% and 400% (P＞005); The rates of clinical symptoms of the treatment group and the controlgroup were 800% and 600% respectively (P＜005); the rates of increasing of living quality were respectively 867% and 567% (P＜005); the median survival time was 8 months and 5 months; the toxicity of the treatment group was significantly lower than that of the control group (P ＜005).Conclusion: Treating advanced gastric cancer by use of FuFang Ku Shen Zhusheye combination with chemotherapy is helpful to reducing the pain symptoms, promoting the clinical symptoms, reducing the chemotherapy side effects, improving quality of life and prolonging the survival time.