乳腺癌应用电化学合并三苯氧胺治疗（附37例报告）

目的 对乳腺恶性肿瘤不论是原发或复发转移失去手术机会，年老体弱不易手术或不愿接受手术的患者均可采用电化学治疗（ECT）。方法 应用北京原子能科学院研制的WL－A型电化学治疗仪，在肿瘤部位插入阴，阳电极针分别连接到治疗仪通电治疗；11例原发乳腺癌自电化学治疗开口服服三苯氧胺（TAM）三年。结果 本组ECT治疗乳腺恶性肿瘤37例，按国际ECT协会评定疗效的标准；CR26例，PR6例，总有效率为86．3％（CR＋PR32／37）。结论 乳腺癌应用电化学合并三苯氧胺治疗创伤小，操作简单，疗效满意。     

戈舍瑞林联合三苯氧胺治疗绝经前ER+PR+及ER+PR-复发转移性乳腺癌疗效观察

目的:探讨戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前雌激素(ER)、孕激素(PR)双阳性及ER+/PR-两种复发转移乳腺癌的临床疗效,对比两种乳腺癌的治疗效果.方法:将104例绝经前、原癌基因(c-erbB-2)均为(+)、淋巴结1-3个阳性的复发转移乳腺癌患者分成两组,52例ER+/PR+,52例为ER+/PR-.两组患者均为手术后和辅助化疗后发现复发转移的乳腺癌接受戈舍瑞林3.6mg皮下注射,每28天1次,连续6个月以上;联合三苯氧胺口服,10mg/次,每日2次,连用6个月以上.结果:104例患者完全缓解(CR)3例,部分缓解(PR)31例,稳定(SD)31例,进展(PD)39例,总有效率(OR=CR+PR)为32.7%,临床获益率(CBR=CR+PR+SD≥6个月)62.5%;其中ER+、PR-组,CR 2例,PR 21例,SD 16例,PD 13例,OR为44.1%,CBR 74.9%;ER+、PR-组CR 1例,PR 10例,SD 15例,PD 26例,OR 21.1%,CBR 49.9%.结论:戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前ER阳性、淋巴结1-3阳性、复发转移性的乳腺癌患者临床疗效显著,而ER+/PR+组患者效果明显优于ER+、PR-组患者,临床治疗效果更佳.对于在辅助内分泌治疗期间发生PD,应立即中止辅助内分泌治疗,进行手术、解救化疗、放疗或分子靶向等治疗后再序贯内分泌治疗.     

戈舍瑞林联合三苯氧胺治疗绝经前ER~＋PR~＋及ER~＋PR~-复发转移性乳腺癌疗效观察

目的：探讨戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前雌激素（ER）、孕激素（PR）双阳性及ER＋/PR-两种复发转移乳腺癌的临床疗效,对比两种乳腺癌的治疗效果。方法：将104例绝经前、原癌基因（c-erbB-2）均为（＋）、淋巴结1-3个阳性的复发转移乳腺癌患者分成两组,52例ER＋/PR＋,52例为ER＋/PR-。两组患者均为手术后和辅助化疗后发现复发转移的乳腺癌接受戈舍瑞林3.6mg皮下注射,每28天1次,连续6个月以上;联合三苯氧胺口服,10mg/次,每日2次,连用6个月以上。结果：104例患者完全缓解（CR）3例,部分缓解（PR）31例,稳定（SD）31例,进展（PD）39例,总有效率（OR=CR＋PR）为32.7%,临床获益率（CBR=CR＋PR＋SD≥6个月）62.5%;其中ER＋、PR-组,CR 2例,PR 21例,SD 16例,PD 13例,OR为44.1%,CBR 74.9%;ER＋、PR-组CR 1例,PR 10例,SD 15例,PD 26例,OR 21.1%,CBR 49.9%。结论：戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前ER阳性、淋巴结1-3阳性、复发转移性的乳腺癌患者临床疗效显著,而ER＋/PR＋组患者效果明显优于ER＋、PR-组患者,临床治疗效果更佳。对于在辅助内分泌治疗期间发生PD,应立即中止辅助内分泌治疗,进行手术、解救化疗、放疗或分子靶向等治疗后再序贯内分泌治疗。     

CAF+TAM方案治疗中晚期乳腺癌临床观察

目的探讨CAF+TAM(三苯氧胺)治疗中、晚期乳腺癌的疗效和安全性.方法应用CAF+TAM方案治疗中、晚期乳腺癌42例.初治16例,复治26例.结果全组完全缓解(CR)12例(28.6%),部分缓解(PR)21例(50.0%),总有效率(CR+PR)78.6%,初治者及复治者有效率分别为81.3%及76.8%.其毒副反应主要是恶心、呕吐(65.4%);白细胞减少(50.5%)及大量脱发现象.结论CAF+TAM方案治疗中、晚期乳腺癌有效而安全,对复治患者也有疗效.     

肝动脉插管化疗栓塞配合电化学治疗中晚期肝癌

目的　研究肝动脉插管化疗栓塞(TACE)结合电化学治疗(ECT)在中晚期肝癌治疗中的作用。　方法　对17例失去手术机会的中晚期肝癌在TACE间期结合ECT。　结果　3例完全缓解(CR),11例部分缓解(PR),CR PR为824%。有6例获得切除,一年生存率647%。甲胎蛋白(AFP)从治疗前的(73512±41439)μg/L降至(21039±19901)μg/L。　结论　TACE配合ECT治疗不能手术的中晚期肝癌疗效确切,值得推广     

化疗结合三苯氧胺治疗非小细胞肺癌疗效分析

目的：探讨全身化疗加或不加三苯氧胺对非小细胞肺癌（NSCLC）的疗效及毒性变化。方法：将90例NSCLC患者随机分为治疗组和对照组，分别接受EP方案（顺铂，足叶乙甙）加三苯氧胺或单纯EP方案化疗。结果：治疗组（EP＋TAM）总有效率（CR＋PR）为60％（27／45），对照组（EP regimen)，为37．78％（17／45）（P＜0．05），中位缓解期分别为5．8个月和3．2个月，除三苯氧胺引起阴道出血或白带增多外，其余毒性与对照组基本相同。结论：全身化疗同时应用三苯氧胺治疗NSCLC，其疗效有所提高，且毒性未见增加。     

大剂量甲地孕酮治疗晚期乳腺癌临床观察

晚期和复发乳腺癌目前主要采用化疗和内分泌治疗，三苯氧胺因其疗效高而副作用低被作为乳腺癌内分泌治疗的首选药物。然而，随着近年来三苯氧胺的广泛应用．使得治疗后复发且对三本氧肢无效或耐药的乳癌数量逐渐增多；相反，孕酮由于作用机制和三苯氧胺不同，加大剂量时疗效有提高，已成为进展期乳腺癌的第二线内分泌治疗药物「门。本组观察了经大剂量甲地孕酮治疗晚期乳腺癌的临床疗效。临床资料晚期乳腺癌（女性）共24例，其中2例原发，22例术后复发，均无手术和放疗指证，平均年龄61.9（40～89）岁，生活质量指数（KPS）≥40，预期生存…     

小剂量MDR逆转剂联合应用加化疗治疗晚期食管癌

目的 :研究小剂量多药耐药 (MultidrugresistanceMDR)逆转剂联合化疗治疗晚期食管癌的可行性。方法 :三苯氧胺 10mgBid× 30天 ,倍恩胶囊 ,Tid× 30天 ,同时进行PF方案化疗 ,连用 2周期评价疗效。结果 :32例晚期食管癌中CR 3例 ,PR 14例 ,PD 6例 ,NC 9例 ,有效率 (CR +PR)为 5 3 13%。结论 :小剂量MDR逆转剂联合应用加PF方案化疗治疗晚期食管癌效果好 ,副反应轻     

新辅助内分泌治疗在绝经后乳腺癌中的应用

目的 探讨新辅助内分泌治疗在绝经后激素受体阳性的乳腺癌患者的应用.方法 回顾性分析40例绝经后ER和/或PR阳性的乳腺癌患者新辅助内分泌治疗的临床资料.结果 40例患者中完全缓解2例,部分缓解27例,稳定8例,进展3例,总有效率为72.5%;来曲唑的疗效明显高于三苯氧胺,起效时间更短且不受CerbB-2的影响.结论 绝经后激素受体阳性的乳腺癌患者应用新辅助内分泌治疗具有显著疗效,来曲唑疗效优于三苯氧胺.     

肝动脉插管化疗栓塞与联合电化学治疗肝癌的疗效比较

目的:对肝动脉插管化疗栓塞(TACE)联合电化学治疗(ECT)与单纯采用TACE治疗中晚期肝癌的疗效进行比较.方法:将40例失去手术机会的中晚期肝癌患者随机分成A、B两组.A组在TACE间期配合ECT治疗,B组单纯接受TACE治疗.结果:A组有4例完全缓解(CR),12例部分缓解(PR),CR PR为80%.有7例获得二期手术切除,1年存活率65%.甲胎蛋白(AFP)从治疗前的752.18±423.39μg/L降至206.28±189.24μg/L.B组有1例CR,9例PR,CR PR 50%.有3例获得切除,1年存活率 40%.AFP从治疗前的782.61±491.23μg/L降至411.26±325.17μg/L.两组有效率(PR CR)及切除率有显著差异(P<0.05).结论:TACE联合ECT治疗中晚期肝癌的疗效优于单纯的TACE治疗.     

电化学治疗中晚期乳腺癌

目的：探讨电化学治疗中晚期乳腺癌的临床效果。方法：采用特制的ＢＫ９２型治疗仪和铂金针，在局麻下将铂金针插入肿瘤内，再连接在治疗仪上进行通电治疗。结果：接受电化学治疗的１０５例中晚期乳腺癌中７４例为原发性乳腺癌，３１例是乳癌术后局部复发癌。１年内疗效为ＣＲ３５２％；ＰＲ４３８％；ＮＣ１３３％；ＰＤ７６％。将ＣＲ＋ＰＲ评为有效，占７９０％。经５年随访：１年生存率８９５％；２年生存率为６９５％，５年生存率为５０４％。结论：电化学可治疗中晚期乳腺癌，尤其是对术后复发癌有较好疗效。     

Phase II study of 5'-DFUR in gastrointestinal and breast cancer

Clinical effects of daily oral administration of 5'-DFUR were studied in patients with advanced or recurrent gastrointestinal cancer and breast cancer. Cases included 5 gastric cancer, 18 colorectal cancer, 27 breast cancer and 1 malignant melanoma. Out of 38 cases who completed the treatment, CR was observed in 2 and PR in 7, the response rate being 23.7%. Out of 23 cases with breast cancer who completed the treatment, CR was observed in 2 and PR in 6, the response rate being 34.8%. Safety was evaluated in 42 cases and diarrhea was found in 17.1% of cases; however, it was easily reduced by decreasing the dosage or discontinuing administration of the drug.     

Role and mechanism of action of tamoxifen in premenopausal women with metastatic breast carcinoma

Tamoxifen was evaluated as initial hormone therapy for metastatic breast cancer in 85 premenopausal patients. Tamoxifen responders continued on tamoxifen, while tamoxifen failures and initial responders who later progressed were to receive ovarian ablation next. Of 74 evaluable patients, 5 had complete responses (CR) and 15 had partial responses (PR) while 12 remained stable (ST), giving response rates of 27% (CR + PR) or 43% (CR + PR + ST). Of the 23 patients who initially responded (CR + PR + ST) to tamoxifen but then progressed and received ovarian ablation alone, 15 are assessable. Nine (60%) responded (CR + PR + ST) to ovarian ablation. Sixteen patients who failed tamoxifen had ovarian ablation alone, and of 14 assessable patients 2 had ST while 12 progressed. Thus response to tamoxifen strongly predicted response to ovarian ablation (P = 0.021). Serial follicle stimulating hormone, prolactin, and estradiol levels suggested that tamoxifen does not act by induction of a "medical ovariectomy" or by alteration of prolactin levels in premenopausal patients.     

A randomised study of CGS 16949A (fadrozole) versus tamoxifen in previously untreated postmenopausal patients with metastatic breast cancer

BACKGROUND:: Fadrozole, a potent, highly specific inhibitor of aromataseactivity, has only been used as second-line therapy in treatmentof post-menopausal women with advanced breast cancer. A prospectivelyrandomised study was therefore undertaken to compare relativeclinical efficacy of fadrozole as first-line treatment to thatof tarnoxifen. PATIENTS AND METHODS:: Eighty postmenopausal women who had not received prior treatmentfor advanced/metastatic breast cancer were randomised to receiveeither fadrozole, 1 mg twice daily, or tamoxifen, 20 mg daily. RESULTS:: Toxicity was not statistically different on the two treatmentarms. Only mild to moderate toxicity was documented: hot flashesin 37%, headaches in 6.5%, mild fatigue in 2.6%. There werealso no statistically significant differences in objective responserates, survival or time to treatment failure (TTF). Objectiveresponse rate on fadrozole was 50% (complete response (CR) 8.3%and partial response (PR) 42%). On tamoxifen objective responsewas 44.7% (CR 21% and PR 24%). Median TTF was 4.9 months onfadrozole and 5 months on tamoxifen. Median survival was 22.7months on fadrozole and 27.5 months on tamoxifen. CONCLUSION:: While response rates, survival and TTF were not statisticallysignificantly different, there were more complete responseson tamoxifen and duration of objective response (CR + PR) wassignificantly longer in the patients treated with tamoxifen. breast cancer, fadrozole, postmenopausal, tamoxifen     

他莫昔芬治疗芳香化酶抑制剂耐药的激素受体阳性绝经后转移性乳腺癌患者的临床研究

目的:探讨他莫昔芬治疗芳香化酶抑制剂（AIs）耐药的激素受体阳性（HR+）绝经后转移性乳腺癌（MBC）患者的疗效和安全性。方法:回顾性分析他莫昔芬治疗AIs耐药的30例HR+绝经后MBC患者的临床资料,观察终点为缓解率（RR）、临床获益率（CBR）、疾病进展时间（TTP）和安全性。结果:30例患者中,CR 1例,PR 9例,SD 15例,RR为33.3%,CBR 为50%,中位TTP 6.1个月。23例骨和/或软组织转移患者中,RR为34.8%,CBR为52.2%,中位TTP 7.3个月;7例肝脏和/或肺部转移患者中,RR为28.6%,CBR为42.8%,中位TTP 4.8个月（P=0.019）。不良反应多为面部潮红、阴道干燥、白带增多、阴道出血、恶心、呕吐、腹泻等,均为I、II级。结论:他莫昔芬治疗AIs耐药的HR+绝经后MBC患者安全有效,可改善患者预后。     

Phase II study of 5'-DFUR (5'-deoxy-5-fluorouridine) by the Cooperative Study Group

Phase II study of 5'-DFUR was conducted in 195 patients with malignant tumors by the Osaka Chemotherapy Cooperative Study Group. Five CR and 20 PR cases were obtained out 133 evaluable cases and the total response rate was 18.8% (15.8% in gastric, 38.1% in breast) One PR was observed for each of head & neck and esophageal cancer. It was noteworthy that four CR were observed in breast cancer. Adverse reaction was observed in 61 out of 151 cases (40.4%), and major side effects were digestive symptoms such as diarrhea (22.5%), nausea-vomiting (11.9%) and anorexia (10.6%). These results suggest that 5'-DFUR can be useful for the treatment of malignant tumors.     

Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group.

PURPOSE: The efficacy and tolerability of anastrozole (Arimidex; AstraZeneca, Wilmington, DE, and Macclesfield, United Kingdom) and tamoxifen were compared as first-line therapy for advanced breast cancer in 353 postmenopausal women. PATIENTS AND METHODS: The randomized, double-blind, multicenter study was designed to evaluate anastrozole 1 mg once daily relative to tamoxifen 20 mg once daily in patients with hormone receptor-positive tumors or tumors of unknown receptor status who were eligible for endocrine therapy. Primary end points were objective response (OR), defined as complete (CR) or partial (PR) response, time to progression (TTP), and tolerability. RESULTS: Anastrozole was as effective as tamoxifen in terms of OR (21% v 17% of patients, respectively), with clinical benefit (CR + PR + stabilization > or = 24 weeks) observed in 59% of patients on anastrozole and 46% on tamoxifen (two-sided P =.0098, retrospective analysis). Anastrozole had a significant advantage over tamoxifen in terms of TTP (median TTP of 11.1 and 5.6 months for anastrozole and tamoxifen, respectively; two-sided P =.005). The tamoxifen:anastrozole hazards ratio was 1.44 (lower one-sided 95% confidence limit, 1.16). Both treatments were well tolerated. However, thromboembolic events and vaginal bleeding were reported in fewer patients who received anastrozole compared with those who received tamoxifen (4.1% v 8.2% [thromboembolic events] and 1.2% v 3.8% [vaginal bleeding], respectively). CONCLUSION: Anastrozole satisfied the predefined criteria for equivalence to tamoxifen. Furthermore, we observed both a significant increase in TTP and a lower incidence of thromboembolic events and vaginal bleeding with anastrozole. These findings indicate that anastrozole should be considered as first-line therapy for postmenopausal women with advanced breast cancer.     

A 10-year experience of tamoxifen as primary treatment of breast cancer in 100 elderly and frail patients

Between 1977 and 1983 100 elderly women (median 76.3 years) with breast cancer were treated with tamoxifen as primary therapy. The median follow-up is 59 months. Sixty-eight responded (40 CR and 28 PR) with median response durations of 47 months and 26 months respectively. Twenty-two patients had disease stabilization for a median of 15.5 months and 10 had progressive disease. The median time to best response was 13.5 weeks for patients achieving CR and 14 weeks for those with PR. Oestrogen receptor values were obtained in 37 patients of which two patients had no ER detectable. Sixty-seven per cent of ER-unknown patients responded compared with 74% of ER-rich. Likelihood of response did not appear to depend upon T-stage or age. Survival was better than that of an unmatched historical group treated with surgery/radiotherapy and compares favourably with recent reports. Although 35% have died of breast cancer, 25% died of other causes and 22% remained free of recurrence at the time of reporting or at death. Only 11% underwent subsequent mastectomy/lumpectomy and the most frequent subsequent treatments were radiotherapy to the breast (32%) and further hormonal therapies (40%). Tamoxifen is a practical primary therapy of breast cancer in elderly and frail women obviating the need for surgery in a high proportion of cases.