关键词: 白蛋白结合型紫杉醇, 胃肿瘤, 姑息疗法, 药物疗法

Abstract: Objective：To evaluate the safety and efficacy of albumin-bound paclitaxel in patients with advanced gastric cancer (AGC).Methods: The patients with histopathologic or cytopathologic diagnosed advanced gastric cancer (AGC), Karnofsky performance status≥60, and life expectancy＞12 weeks, and with adequate organ functions of the bone marrow, liver, kidney and heart were recuited in our study. Albuminbound paclitaxel was administered alone or combined with capecitabine, TS1, trastuzumab or cetuxizumb. The total doses of albumin-bound paclitaxel were 200-400 mg （130-260 mg/m2）, divided on days 1, 8 or days 1,8, and 15, given intravenously during 30 minutes of a 21-day cycle. Tumor response was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.0. The adverse events (AE) were graded according to National Cancer Institute-Common Toxicity Criteria (NCI-CTC) 3.0 version. Results: From July 2009 to Octobor 2012, the total of 25 patients were treated and completed 65 cycles of chemotherapy (median: 2 cycles, and range: 0.5-7). The median age was 57 years (range: 38-79). The majority of the patients were with nongastroesophageal junction cancers and had metastasic disease with lymph nodes and peritoneum. Eleven patients were chemotherapy naive and the others had accepted previous systemic therapy for advanced disease. 16 patients were evaluable for clinical response. No complete response was observed and partial response （PR） was achieved in 5 patients. Five patients had stable disease and 6 patients progressed. Among the chemotherapy naive patients, 8 patients were evaluable for response, 3 patients had partial response (37.5%) and 1 patient had stable disease (tumor shrink). The clinical response rate was 50%. Time to treatment failure (TTF）was 3.7 months（95% CI 2.32-5.08） and time to death (TTD）was 7.9 months （95% CI 5.17-10.63）. No statistical differences in TTF and TTD were observed between the untreated and the retreated patients or the monotherapy and the combination therapy groups. All the patients were suitable for safety assessment. Most toxicities were mild with grades 1/2. Hematologic AEs were more common with leucopenia and neutropenia. Meanwhile, nausea/vomiting, fatigue, peripheral neuropathy were the most common non hematologic AEs. No allergic reaction or treatment-related deaths were recorded.Conclusion:AGC patients could benefit from albumin-bound paclitaxel with lower dose level than breast cancer patients. Additional phase Ⅰ/Ⅱ studies of albumin-bound paclitaxel in gastric cancer are warranted.

Key words: Albumin-bound paclitaxel, Stomach neoplasms, Palliative care, Drug therapy