晚期三阴性乳腺癌的临床特征及生存分析

Objective To characterize the sites of distant recurrence and clinical outcomes in a cohort of Chinese patients with metastatic triple-negative breast cancer (TNBC ). Methods One hundred and thirty-four patients with metastatic TNBC treated at Cancer Hospital of CAMS from January 1999 to December 2007 were included in this study. Hie clinicopathological features and long-term survival of the patients were retrospectively analyzed. Results The median age of the patients was 45 years. Most patients (72.7% ) had a higher predilection for visceral metastasis and early recurrence within the first two years of follow-up. Six patients (4.5%) presented with stage Ⅳ disease, 14 patients were diagnosed with locoregional recurrence after mastectomy, 75 patients with distant metastases, and 45 patients with both locoregional recurrence and distant metastasis. The most common site of first recurrence was the lung, and 62(51.7% )of the patients had more than two sites of metastasis. By July 30, 2009, 75 patients died of breast cancer (56.0%). The median overall survival (OS) was 26. 5 months [95% confidence interval (CI), 20. 5-32. 6 months]. The l-,3- and 5-year overall survivals ( OS) were 80. 9% ,37. 1% and 30.1% , respectively. The median overall survival time of 58 patients with single site of metastasis was 28.5 months, longer than that of patients with more than two sites of metastases. Patients whose initial distant recurrence was bone metastasis only (7 patients) had better prognosis, with a median OS of 84.2 months. The median OS (28.5 vs. 12.6 months, P =0.0001) differed significantly between patients who received first-line chemotherapy and those who did not. Forty-five of the 96 patients with measurable disease achieved complete/partial response (CR/PR), 39 patients had stable disease (SD), and 12 patients had disease progression (PD). The median OS was 36.1 months in patients with CR/PR, 20. 8 months with SD, and 14 months with PD, respectively. The median OS of patients with CR/PR was significantly longer than that of patients with SD/PD (P =0. 0106). Distant metastasis, first-line chemotherapy and clinical response were significantly related with OS by univariate analysis. Furthermore, first-line chemotherapy and the clinical response were demonstrated to be an independent prognostic factor by multivariate analysis. Conclusions Recurrence risk and mortality are considerably higher in TNBC patients within the early years of follow-up. TNBC patients have a higher risk of multiple and visceral metastases, and poorer survival, which might attribute to its aggressive clinical behavior and lack of effective regimens. Our findings also suggest that chemotherapy can effectively improve the clinical outcome of those patients.     

长春瑞滨单药周疗方案治疗既往应用过蒽环类和紫杉类药物的晚期乳腺癌临床观察

目的 观察长春瑞滨(NVB)单药治疗对既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌的疗效和安全性.方法 我院从2008年1月至2011年7月共有31例既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌患接受了NVB单药周疗方案治疗.结果 全组化疗共113个周期,中位化疗周期数为4个(2～6个周期).完全缓解(CR)1例(3%),部分缓解(PR)7例(22%),稳定(SD)4例(13%),进展(PD)19例(61%),总有效率(RR＝CR+PR)为26%,临床获益率(CR+PR+SD＞6个月)为32%,中位疾病进展时间(TTP)4.0个月,中位生存期为13个月.主要不良反应为骨髓抑制及胃肠道反应,无化疗相关死亡病例.结论 长春瑞滨单药治疗既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌有一定疗效,且耐受性好.     

替吉奥单药治疗转移性乳腺癌获部分缓解1例并文献复习

0 引言 替吉奥胶囊含有吉美司特和奥替拉西钾两种增效、减毒成分,日本于2005年批准用于晚期乳腺癌的治疗,我们收洛1例晚期乳腺癌经替吉奥单药治疗获部分缓解并已维持6月的病例显示出较好的疗效和耐受性,现报告如下. 1病例资料 患者,55岁,为绝经后女性,2010年7月偶然发现左乳内下象限肿物,无痛,无乳头溢液,无局部皮肤改变,无乳头凹陷;未予重视.至2011年1月肿物增大,行超声引导下穿刺,经病理诊断为"左乳浸润性导管癌Ⅲ级,非特殊型,ER、pR阴性,HER-2(+++)",胸腹部CT提示:肝脏多发转移瘤.行紫杉醇+卡铂方案化疗5周期,治疗中出现Ⅱ度恶心呕吐,Ⅲ度粒细胞减少.     

抗肿瘤新药pemetrexed治疗乳腺癌的研究

pemetrexed是一种新型抗叶酸药,能够抑制叶酸代谢途径中的多种酶,从而抑制嘧啶和嘌呤生物的合成,达到抑制肿瘤的作用.Ⅱ期临床结果显示,pemetrexed单药对于初治和复治的进展期乳腺癌均有较高的疗效.毒副作用主要为中性粒细胞减少、食欲减退、乏力和皮疹.补充叶酸和Vit B12可显著减少pemetrexed的血液学毒性,预防性给予皮质激素可减轻皮疹的发生.     

表皮生长因子受体抑制剂在乳腺癌治疗中的研究

表皮生长因子受体(EGFR)抑制剂在非小细胞肺癌、头颈部肿瘤的治疗方面取得了较好的疗效.在乳腺癌方面,人们最初认为,EGFR的高表达也可能是乳腺癌病人接受EGFR抑制剂的重要条件,而EGFR抑制剂可能对ER阴性、内分泌治疗不敏感的乳腺癌有效.但临床研究结果并不支持上述观点.本文着重讨论EGFR抑制剂在乳腺癌治疗中的现状及前景.     

以吉西他滨为主的联合化疗方案治疗难治性乳腺癌的临床观察

目的观察以吉西他滨为主的联合化疗方案治疗对葸环类和紫杉类均耐药的转移性乳腺癌的疗效和不良反应。方法我院从2006年1月～2008年12月分别采用吉西他滨联合顺铂（GP）、异环磷酰胺（GI）或希罗达（GX）方案治疗蒽环类和紫杉类均耐药的转移性乳腺癌74例,21天为1个周期,中位化疗周期数为4个。结果本组完全缓解（CR）1例（1％）,部分缓解（PR）21例（30％）,稳定（SD）35例（50％）,进展（PD）13例（19％）,总有效率（RR=CR＋PR）为31％,临床获益率（CR＋PR＋SD〉6个月）为53％,中位疾病进展时间（TTP）5个月,1年生存率为56．6％,2年生存率为34．8％,中位生存期为15个月。三组化疗方案间疗效无统计学差异。无化疗相关死亡病例,主要不良反应为骨髓抑制及胃肠道反应。结论以吉西他滨为主,联合顺铂、异环磷酰胺或希罗达方案对蒽环类和紫杉类均耐药的转移性乳腺癌有较好的疗效,不良反应可耐受,为有效的解救方案。     

抗肿瘤靶向药物引起的高血糖血症及机制

PI3K/mTOR/AKT信号转导通路是细胞信号传导的重要通路,与细胞的增殖和代谢有关,该通路异常活化可导致肿瘤细胞增殖.针对该通路研发的新型抗肿瘤靶向药物,主要不良反应为高血糖血症,高血糖血症可引起抗肿瘤药物治疗耐药.本文针对小分子靶向药物引发的高血糖血症的发生率、发生机制、表现及其处理方法作一综述.     

小分子抗血管生成药物在乳腺癌中的研究进展

乳腺癌是全世界发病率最高的肿瘤,为女性肿瘤第二大致死病因,内科治疗方法包括化疗、靶向药物治疗及内分泌治疗.化疗联合靶向治疗是恶性肿瘤辅助和晚期治疗的主要手段.血管生成在肿瘤局部进展和转移方面占据重要的地位,成为了一个潜在的治疗靶点.本文主要探讨索拉非尼、舒尼替尼及阿帕替尼这三种小分子酪氨酸激酶类抗血管生成药物在乳腺癌中的研究进展.