The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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FOLFOX-4 Combination Chemotherapy as a First-line Treatment in Patients with Advanced Gastric Cancer

진행성 위암 환자에서 1차 요법으로 FOLFOX-4 병합화학 약물치료의 효과와 안정성

  • Lee, Cheon-Woo (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Park, Moo-In (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Park, Seun-Ja (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Moon, Won (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Kim, Hyung-Hun (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Lee, Hae-Won (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Ku, Ki-Hwan (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Kim, Bu-Kyung (Department of Internal Medicine, Kosin University College of Medicine)
  • 이천우 (고신대학교 의과대학 내과학교실) ;
  • 박무인 (고신대학교 의과대학 내과학교실) ;
  • 박선자 (고신대학교 의과대학 내과학교실) ;
  • 문원 (고신대학교 의과대학 내과학교실) ;
  • 김형훈 (고신대학교 의과대학 내과학교실) ;
  • 이혜원 (고신대학교 의과대학 내과학교실) ;
  • 구기환 (고신대학교 의과대학 내과학교실) ;
  • 김부경 (고신대학교 의과대학 내과학교실)
  • Published : 2012.01.01
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Abstract

Background/Aims: This study examined the efficacy and safety of oxaliplatin-5-fluorouracil-leucovorin (FOLFOX-4) combination chemotherapy as first-line treatment in patients with advanced gastric cancer. Methods: This retrospective study enrolled 35 patients diagnosed with pathologically proven surgically unresectable gastric cancer who received FOLFOX-4 combination chemotherapy between August 2006 and February 2009, using medical records. The administered dose of oxaliplatin was $85\;mg/m^2$ for 2 hrs and leucovorin $200\;mg/m^2$ for 2 hrs on day 1, 5-fluorouracil $400\;mg/m^2$ as a bolus and 5-fluorouracil $600\;mg/m^2$ for 22 hrs on days 1 and 2, every 2 weeks. The response was assessed every three cycles. Toxicity was evaluated for every course of chemotherapy according to the NCI toxicity criteria ver. 2.0. Results: The median patient age was 61 (range 27-77) years. The median overall survival was 8.50 (6.23-10.90) months and the median time to progression was 4.50 (0.38-9.75) months. With FOLFOX-4, there was no complete remission and 19 partial responses, for a response rate of 54.3%. Over 298 cycles, anemia worse than NCI toxicity grade 3 occurred in 1.3%, leukopenia in 1.6%, neutropenia in 9%, and thrombocytopenia in 3.2%. Grade 1-2 neuropathy occurred in 14.7% of the cycles. Neutropenic fever occurred in two cycles and the regimen was changed because of side effects in one cycle. Conclusions: FOLFOX-4 has a very high response rate with mild toxicity in patients with advanced gastric cancer as a first-line treatment.

목적: 전이성 위암 환자들에서 1차 치료로서 투여된 oxaliplatin, 5-FU, leucovorin (FOLFOX-4) 병합화학요법의 효과와 안정성에 대하여 분석하였다. 방법: 2006년 8월부터 2009년 2월까지 조직학적으로 확진하고 절제가 불가능한 진행, 전이성 위암 환자 35명을 대상으로 의무기록을 통하여 후향적으로 조사하였다. Oxaliplatin $85\;mg/m^2$과 leucovorin $200\;mg/m^2$을 제1일에 2시간 동안 정주하였으며, 5-FU는 $400\;mg/m^2$을 bolus로, $600\;mg/m^2$을 22시간 동안 지속 주입하는 방법으로 제1일과 2일에 투여하였다. 이상을 2주 간격으로 시행하였다. 반응률은 2 내지 3주기의 항암요법 시행 후 평가하였고, 부작용은 NCI CTC ver. 2.0을 기준으로 평가하였다. 결과: 총 35명 환자들의 총 생존기간 중앙값은 8.5개월 (6.23-10.90개월)이었고, 반응지속기간은 4.5개월(0.38-9.75개월)이었다. 치료반응에서 완전관해는 없었고, 부분관해 19예(54.3%), 불변 13예(37.1%), 진행 3예(8.6%)였다. 전체 항암요법 298회 중 grade 3 이상의 백혈구 감소증은 5회(1.6%)였고, 호중구 감소증은 총 27회(9%)였다. Grade 3 이상의 빈혈은 4회(1.3%)였고, 혈소판 감소증은 10회(3.2%)였다. 호중구 감소증에 의한 감염이 있어 1명의 환자가 사망하였다. Grade 1-2 신경병증이 44회(14.7%)에서 나타났다. 결론: FOLFOX-4의 병합화학요법은 수술을 할 수 없는 진행성 위암 환자들에 대한 1차 요법으로 높은 반응률을 보이면서 독성이 약한 비교적 안전한 치료법이다.

Keywords

References

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