吡柔比星辅助化疗治疗乳腺癌临床分析

目的：探讨吡柔比星辅助化疗治疗乳腺癌的临床疗效。方法：选取我院2012年1月～2014年12月接收的乳腺癌女性患者42例,根据医生制定的吡柔比星辅助化疗方案,随机分为治疗组和对照组两组,观察并对比两组的治疗效果。结果：对照组的总有效率为61.90%,治疗组的总有效率为80.96%。治疗组的总有效率明显高于对照组,差异具有统计学意义（P<0.05）。两组在化疗后,均有白细胞减少或伴有恶心呕吐、脱发等不良反应,程度均不严重可以耐受。结论：对乳腺癌采用吡柔比星辅助化疗,有明显的辅助疗效,不良反应均可耐受,将吡柔比星与多西他赛联合用于化疗,疗效显著,值得临床推广。     

观察紫杉醇类药物新辅助治疗老年乳腺癌患者的疗效及不良反应

目的观察紫杉醇类药物新辅助治疗老年乳腺癌患者的疗效及不良反应。方法选取老年乳腺癌患者88例,按照随机数字表法,分为对照组和观察组,各44例。对照组采用普通紫杉醇单药化疗法开展治疗,观察组采用多西紫杉醇脂质体新辅助化疗法开展治疗,比较两组临床疗效和不良反应发生情况,结果对照组治疗总有效率为77.27%,观察组治疗总有效率为79.54%,两组差异无统计学意义(P>0.05);观察组不良反应发生少于对照组,差异具有统计学意义(P<0.05)。结论紫杉醇药物新辅助化疗治疗老年乳腺癌的效果明显,同时不良反应发生少,值得在临床上推广应用。     

药学服务与乳腺癌辅助内分泌治疗的作用

目的分析药学服务与乳腺癌辅助内分泌治疗的效果,为临床提供指导。方法抽取来我院住院部治疗的30例乳腺癌患者(2012年6月至2015年6月)作为本次实验的目标对象,对30例乳腺癌患者实施随机分组(对照组和实验组)。对照组15例乳腺癌患者实施辅助内分泌治疗,实验组15例乳腺癌患者在对照组的基础上实施药学服务干预,分析比较两组乳腺癌患者的不良反应发生率、用药依从性以及满意度评分。结果两组乳腺癌患者比较可得,组间用药依从性以及满意度评分的结果存在差异,P<0.05;但组间不良反应发生率的结果无显著差异,P>0.05。结论在辅助内分泌治疗过程中,对乳腺癌患者实施药学服务干预,能显著提高患者的用药依从性及满意度,改善医患关系。     

表阿霉素联合紫杉醇在局部晚期乳腺癌新辅助化疗中的应用观察

目的：分析局部晚期乳腺癌新辅助化疗中应用表阿霉素联合紫杉醇治疗的临床疗效。方法局部晚期乳腺癌新辅助化疗患者95例,随机分为两组,对照组47例采取表柔比星、氟尿嘧啶联合环磷酰胺治疗,观察组48例采取表阿霉素联合紫杉醇治疗,对比两组临床疗效及不良反应。结果观察组治疗总有效率89.6%显著高于对照组68.1%,差异有统计学意义（P〈0.05）,不良反应发生率14.6%显著低于对照组29.8%,差异有统计学意义（P〈0.05）。结论表阿霉素联合紫杉醇在局部晚期乳腺癌新辅助化疗中具有较高临床应用价值,可有效改善患者临床症状,大幅提高其生存质量,治疗安全性高且患者耐受性良好,值得在临床中推广。     

探讨白蛋白结合型紫杉醇联合表柔比星和环磷酰胺在乳腺癌新辅助化疗中的有效性和安全性

目的：探讨白蛋白结合型紫杉醇联合表柔比星和环磷酰胺在乳腺癌新辅助化疗中有效性和安全性。方法：以2020年1月—2022年12月我院收治的180例需术前新辅助化疗乳腺癌患者为研究对象,将其按化疗方案不同分为对照组和观察组,各90例。对照组给予表柔比星、环磷酰胺和紫杉醇注射液治疗。观察组表柔比星、环磷酰胺联合白蛋白紫杉醇治疗。比较两组患者在治疗前、后细胞增殖核抗原(Ki-67)、生活质量,治疗效果及不良反应。结果：治疗后两组Ki-67指标较治疗前下降,观察组下降程度更明显(P<0.05)。治疗后两组生活质量较治疗前提升,观察组提升程度更明显(P<0.05)。观察组疾病控制率、客观缓解率更高,药物不良反应发生率低于对照组(P<0.05)。结论：乳腺癌新辅助化疗采用白蛋白结合型紫杉醇联合表柔比星和环磷酰胺化疗,可降低患者Ki-67水平,提升化疗治疗效果与生活质量,减少并发症的发生,治疗安全有效。     

对于乳腺癌辅助内分泌治疗的药学服务研究

目的对乳腺癌辅助内分泌治疗的药学服务进行分析与研究。方法乳腺癌患者82例,均辅助内分泌治疗,并将临床药师提供药学服务前的35例患者作为对照组,提供药学服务后的47例患者作为研究组,统计分析辅助内分泌治疗的合理性及药学服务的作用。结果提供药学服务进行辅助内分泌治疗的研究组患者在内分泌治疗知识知晓率、对临床药师工作满意率、用药依从性良好率以及不良反应发生率等方面,均明显优于未给予药学服务进行治疗的对照组,组间比较差异具有统计学意义（P〈0.05）。结论内分泌治疗作为乳腺癌辅助治疗的有效模式,若在内分泌治疗的同时加强药学服务工作,可大幅提高治疗效果,降低不良反应发生率,为进一步提升患者的生存率打好基础。     

紫衫类药物用于老年乳腺癌患者新辅助化疗疗效及不良反应分析

目的 探讨紫衫类药物用于老年乳腺癌患者新辅助化疗的疗效及不良反应。方法 70例老年乳腺癌患者随机分为观察组35例和对照组35例,其中观察组使用多西紫杉醇脂质体新辅助化疗法进行治疗,对照组使用普通紫杉醇单药化疗法进行治疗,统计比较两组患者的治疗疗效和不良反应。结果 观察组化疗后的有效率是84.3%,完全缓解率是13.0%;对照组化疗后的有效率是81.5%,完全缓解率是12.2%。两组比较差异无统计学意义(P>0.05)。两组患者的不良反应发生率的比较,差异具有统计学的意义(P<0.05)。结论 多西紫衫类药物对于治疗老年乳腺癌患者新辅助化疗的疗效较好,患者的不良反应较低,患者的耐受性良好,值得临床推广。     

紫杉醇在乳腺癌化疗中的临床评价

目的：研究分析紫杉醇对乳腺癌化疗治疗中的应用效果。方法：选取在上饶市人民医院治疗期间接受化疗的54例乳腺癌患者,均在常规化疗基础上加用紫杉醇,分析紫杉醇治疗乳腺癌的疗效。结果：用紫杉醇治疗的54例乳腺癌患者,其总有效率为81.48%（44/54）,不良反应较小。结论：紫杉醇对乳腺癌的疗效确切,耐受性较好,不良反应的发生率较少。     

多西紫杉醇联合表阿霉素辅助治疗乳腺癌28例

目的观察多西紫杉醇联合表阿霉素辅助治疗乳腺癌的疗效与不良反应。方法临床确诊的28例乳腺癌患者第1天均给予表阿霉素快速静脉滴注,100 mg.(m2)-1;第2天给予多西紫杉醇缓慢静脉滴注,75 mg.(m2)-1;每3周为1个周期,常规治疗4个周期,有严重不良反应者减量或对症处理。结果肿瘤完全缓解3例(10.7%),部分缓解22例(78.6%),稳定3例(10.7%)。主要不良反应为骨髓抑制。结论多西紫杉醇联合表阿霉素辅助化疗方案治疗乳腺癌疗效确切,安全性较高,是治疗乳腺癌可行的方法。     

^99Tc-MDP缓解乳腺癌芳香化酶抑制剂辅助内分泌治疗后骨关节、肌肉痛的疗效分析

目的应用^99Tc-MDP治疗乳腺癌芳香化酶抑制剂（AI）辅助内分泌治疗后骨关节、肌肉痛，探讨其临床价值。方法收集2003年1月至2007年3月间乳腺癌AI辅助内分泌治疗后骨关节、肌肉痛患者74例，随机分为二组：^99Tc-MDP加服钙尔奇D组（A组）34例，单服钙尔奇D组（B组）40例。比较两组对疼痛的缓解效果。结果骨关节、肌肉痛症状缓解情况：A组总有效率为94．1％，B组为52．5％，两组差异有统计学意义（P〈0．001）。结论^99Tc-MDP使用简便、安全、疗效满意、不良反应少，值得临床推广应用于缓解绝经后乳腺癌AI辅助内分泌治疗后的骨关节、肌肉痛。     

Gene-expression assays: new tools to individualize treatment of early-stage breast cancer.

PURPOSE: The clinical and economic data for the two currently available gene-expression assays are reviewed. SUMMARY: Two gene-expression assays, used to determine the risk of breast cancer recurrence in patients with stage I or II node-negative breast cancer, are currently available. Oncotype DX is an assay performed on RNA extracted from paraffin-embedded tumor tissue. It analyzes the expression of 21 genes: 16 cancer-related genes and 5 reference genes. The results are used to calculate a recurrence score to identify the likelihood of cancer recurrence in patients treated with tamoxifen. The results of two studies evaluating the ability of Oncotype DX to predict the risk of breast cancer recurrence suggest that patients with ER-positive, node-negative breast cancer and a low recurrence score may need only adjuvant treatment with tamoxifen, while intermediate- and high-risk patients may require additional treatment with adjuvant chemotherapy. MammaPrint, an oligonucleotide microassay performed on fresh-frozen tumor samples, analyzes the expression of 70 genes. Studies have found that MammaPrint allows young patients (<61 years) with early-stage breast cancer to be categorized as having a high or low risk of distant metastasis. High-risk patients may then be managed with more aggressive therapy. CONCLUSION: Two gene-expression assays, Oncotype DX and MammaPrint, have been developed to determine the risk of breast cancer recurrence in patients with stage I or II node-negative breast cancer. In the future, these tests may be useful in determining the need for systemic adjuvant therapy in such patients.     

Inhibition of receptor tyrosine kinases in combination with chemotherapy for the treatment of breast cancer

Although significant advances have been made in the treatment of breast cancer using chemotherapy, less than half of the patients treated for localized breast cancer benefit from adjuvant chemotherapy and most patients with metastatic cancer eventually develop disease that is chemotherapy resistant. Targeted agents, such as inhibitors of tyrosine kinases, offer the opportunity to reverse chemotherapy resistance and enhance response in patients with localized and advanced breast cancer. Such combined approaches have been established for the treatment of advanced breast cancer and are now demonstrating benefit in the adjuvant arena. This review summarizes the results of several trials involving the use of tyrosine kinase inhibition in combination with chemotherapy for the treatment of breast cancer and discusses future directions for breast cancer biotherapy.     

An update on adjuvant systemic therapy for elderly patients with early breast cancer

Introduction: Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients.

Areas covered: In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting.

Expert opinion: The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.     

Anastrozole: a review of its use in postmenopausal women with early-stage breast cancer

Anastrozole (Arimidex) is an aromatase inhibitor approved in the EU, the US and in other countries worldwide for use as an adjuvant treatment in postmenopausal women with early-stage, hormone receptor-positive breast cancer. It is also approved in the EU and other countries worldwide for continuing adjuvant treatment in women who have already had 2-3 years of adjuvant tamoxifen treatment for breast cancer.Anastrozole is an effective primary adjuvant treatment for postmenopausal women with early-stage breast cancer. In patients with hormone receptor-positive tumours, 5 years of anastrozole treatment was more efficacious in reducing breast cancer recurrence than 5 years of tamoxifen, both in a head-to-head comparison and in switching trials when given after 2-3 years of tamoxifen treatment. The treatment benefits have now been shown to extend to 100 months following breast surgery. To date, overall survival was better in anastrozole than tamoxifen recipients in one switching trial and in a meta-analysis of three switching trials. There was no increased benefit in health-related quality of life with anastrozole over tamoxifen. In women who had received 5 years of tamoxifen treatment, continuation of treatment with anastrozole further reduced the risk of breast cancer recurrence. Ongoing head-to-head trials against other third-generation aromatase inhibitors will provide data as to its relative efficacy against these agents. Anastrozole is a generally well tolerated treatment for early-stage breast cancer. Like other aromatase inhibitors, its most important adverse effect was an increased risk of bone fractures, which for anastrozole was restricted to the treatment period. It is still unclear whether primary adjuvant treatment extended beyond 5 years is of benefit and whether primary adjuvant treatment with anastrozole for 5 years is preferable to switching to anastrozole after 2-3 years of tamoxifen treatment. However, the evidence to date establishes anastrozole as a valuable adjuvant and extended adjuvant treatment for postmenopausal women with hormone receptor-positive, early-stage breast cancer.     

105例乳腺癌辅助内分泌治疗依从性分析

目的 了解乳腺癌辅助内分泌治疗的依从性,分析影响因素,提出对策.方法 回顾性分析2007年1月至12月在汕头市中心医院诊治的105例受体ER和（或）PR阳性的乳腺癌患者随访数据（包括门诊随访、住院随访和电话随访）,运用药物占用比（MPR）及白行设计调查问卷方法,了解辅助内分泌治疗依从性及影响原因.结果 成功随访102例,占97.14％,根据MPR将102例乳腺癌患者分为依从性良好组和依从性不良组,发现疾病认知程度、复查情况、就医环境和经济状况与乳腺癌患者术后内分泌治疗依从性相关.结论 本研究乳腺癌患者辅助内分泌治疗总体依从性偏低.可从加强患者健康教育、定期门诊复查、减轻患者经济负担、定期随访四方面来提高内分泌治疗依从性.     

Is long-term adjuvant treatment of breast cancer with anastrozole indicated?

Background: Tamoxifen is the established adjuvant treatment for postmenopausal women with hormone-sensitive breast cancer. Objective: To determine whether the aromatase inhibitor anastrozole should replace tamoxifen as the adjuvant treatment in this cancer. Methods: Two recent trials of anastrozole and tamoxifen as adjuvant treatment were evaluated. Results/conclusion: The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial showed that 5 years of adjuvant therapy with anastrozole reduced recurrence of breast cancer to a greater extent than did tamoxifen. The Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 6a showed that after 5 years of adjuvant treatment with tamoxifen more benefit was achieved by continuing with adjuvant anastrozole for 3 years than no further treatment. Although the long-term adjuvant treatment of hormone receptor positive breast cancer with anastrozole is indicated, questions remain as to how long the adjuvant treatment with anastrozole should continue.     

Assessing the risk of bone fracture among postmenopausal women who are receiving adjuvant hormonal therapy for breast cancer

ABSTRACT

Objective: To understand better the true impact of wide­spread adoption of adjuvant aromatase inhibitor (AI) therapy on postmenopausal breast cancer patients’ risk of bone fracture.

Methods: Data from three different studies were used to estimate the relative risk of bone fracture for each of the following groups of women (i.e., versus a control group of healthy postmenopausal women): (a) healthy postmenopausal women receiving tamoxifen; (b) post­menopausal women who had received treatment for early breast cancer; (c) postmenopausal breast cancer patients on adjuvant tamoxifen therapy; (d) postmenopausal breast cancer patients on adjuvant anastrozole therapy. The results of these analyses were then used to estimate the likely incidence of clinical fracture among such popula­tions in ‘real-life’ clinical practice.

Results: Breast cancer survivors were calculated to be at increased risk of clinical bone fracture (i.e., RR 1.15 vs. control group over 5 years). Breast cancer patients initiated on adjuvant anastrozole were also calculated to be at increased risk of bone fracture (RR = 1.36 vs. control group over 5 years), while the calculated risk of fracture among tamoxifen-treated breast cancer patients was similar to that observed in the control population (RR = 0.91).

Conclusion: Breast cancer patients are at increased risk of clinical bone fracture (compared with the general postmenopausal population) and adjuvant anastrozole therapy slightly adds to this risk. Importantly, however, the absolute risk of bone fracture appears to remain low in each of the evaluated patient populations, suggesting that fear of fracture should not prevent the initiation of adjuvant aromatase inhibitor therapy.     

Letrozole in the treatment of breast cancer

Endocrine therapy, predominantly using the antioestrogen tamoxifen, has long been a key treatment strategy for oestrogen receptor-positive breast cancer. An alternative approach is to treat patients with aromatase inhibitors, which suppress oestrogen biosynthesis. Letrozole, and other third-generation aromatase inhibitors, are highly specific and potent inhibitors of oestrogen production, which markedly reduce circulating oestrogen levels and whole-body aromatisation of androgen precursors after menopause. In postmenopausal women with hormone receptor-positive or receptor-unknown breast cancer, letrozole has been shown to be superior to megestrol acetate and aminoglutethimide in second-line treatment for advanced breast cancer. Letrozole was also superior to tamoxifen in first-line treatment for advanced breast cancer, as well as in systemic preoperative (neoadjuvant) treatment of locally advanced breast cancer. A recent adjuvant trial demonstrated significant superiority of letrozole over tamoxifen in disease-free survival, and another trial demonstrated that treatment for early breast cancer with letrozole, following 5 years of adjuvant tamoxifen (extended adjuvant therapy), significantly improved disease-free survival compared with placebo, irrespective of nodal status. Ongoing trials will determine whether the optimal use of letrozole in the adjuvant therapy of early breast cancer is as a replacement for tamoxifen, or sequenced additionally before or after tamoxifen.     

Letrozole in the treatment of breast cancer

Endocrine therapy, predominantly using the antioestrogen tamoxifen, has long been a key treatment strategy for oestrogen receptor-positive breast cancer. An alternative approach is to treat patients with aromatase inhibitors, which suppress oestrogen biosynthesis. Letrozole, and other third-generation aromatase inhibitors, are highly specific and potent inhibitors of oestrogen production, which markedly reduce circulating oestrogen levels and whole-body aromatisation of androgen precursors after menopause. In postmenopausal women with hormone receptor-positive or receptor-unknown breast cancer, letrozole has been shown to be superior to megestrol acetate and aminoglutethimide in second-line treatment for advanced breast cancer. Letrozole was also superior to tamoxifen in first-line treatment for advanced breast cancer, as well as in systemic preoperative (neoadjuvant) treatment of locally advanced breast cancer. A recent adjuvant trial demonstrated significant superiority of letrozole over tamoxifen in disease-free survival, and another trial demonstrated that treatment for early breast cancer with letrozole, following 5 years of adjuvant tamoxifen (extended adjuvant therapy), significantly improved disease-free survival compared with placebo, irrespective of nodal status. Ongoing trials will determine whether the optimal use of letrozole in the adjuvant therapy of early breast cancer is as a replacement for tamoxifen, or sequenced additionally before or after tamoxifen.     

辅助化疗联合曲妥珠单抗治疗人表皮生长因子受体-2阳性晚期或转移性乳腺癌的系统评价

目的：系统评价辅助化疗联合曲妥珠单抗治疗人表皮生长因子受体-2（HER2）阳性晚期或转移性乳腺癌的临床效果。方法：检索国内外公开发表的关于辅助化疗联合曲妥珠单抗治疗HER2阳性晚期或转移性乳腺癌的中英文文献,对纳入的研究进行比较。结果：共纳入6篇随机对照试验（RCT）研究。辅助化疗联合曲妥珠单抗治疗HER2阳性晚期或转移性乳腺癌的反应率和病理完全缓解率的风险比（RR）分别为1.46（P=0.02）和0.98（P=0.91）。结论：尽管研究存在一定的局限性,但在不考虑治疗成本的情况下,辅助化疗联合曲妥珠单抗治疗要优于标准治疗,临床上具有较强的可替代性。