多西他赛联合表阿霉素治疗晚期乳腺癌的临床观察

目的观察多西他赛联合表阿霉素治疗晚期乳腺癌的临床疗效及毒副作用,并对其安全性进行评估。方法用多西他赛联合表阿霉素治疗晚期乳腺癌患者41例,其中初治患者18例,复治患者23例。结果41例患者中,3例达到完全缓解,21例部分缓解,9例病情稳定,8例出现进展,其中有效率达58．5％,临床获益率达80．5％。结论多西他赛联合表阿霉素对晚期乳腺癌具有较好的疗效和耐受性,可作为晚期乳腺癌的解救方案。     

Evaluation of epirubicin-induced cardiotoxicity by two-dimensional strain echocardiography in breast cancer patients

The value of two-dimensional strain echocardiography for assessing left ventricular regional systolic function in breast cancer patients who were treated with epirubicin was evaluated. A total of 116 breast cancer patients were divided into 3 groups： Thirty-eight patients in group A were given epirubicin （Epi） of 120-340 mg/m^2, 42 patients in group B received epimbicin of≥ 360 mg/m^2, and 36 patients after surging without chemotherapy served as the control group C. High frame rate two-dimensional images were recorded from apical long-axis view, four-chamber view, two-chamber view of left ventricle. Peak systolic strain of left ventricular subendocardial myocardium was measured using two-dimensional strain software. The conventional echocardiographic parameters were also obtained. Conventional echocardiography showed there was no significant changes in conventional echocardiographic parameters among the three groups （P〉0.05）. Two-dimensional strain echocardiography revealed that the peak systolic strain of left ventricular subendocardial myocardium in group A was reduced in some segments as compared with the controls （P〈0.05）. The peak systolic strain of left ventricular subendocardial myocardium in group B was reduced significantly as com- pared with group C （P〈0.05）, but that was reduced in group B just in some of the segments as compared with group A （P〈0.05）. It was concluded that two-dimensional strain echocardiography could early and sensitively display the effects of epirubicin-induced cardiotoxicity on the systolic function of left ventricular subendocardial myocardium, and early monitor the epirubicin-induced cardiotoxicity.     

载表柔比星磁性壳聚糖纳米粒的制备与表征检测

目的制备一种新型磁性纳米高分子聚合物-载表柔比星的磁性壳聚糖纳米粒,并对其表征、载药率进行检测。方法选用可生物降解的壳聚糖作为骨架材料。与具有超顺磁性的Fe3O4纳米粒、丙烯酸单体及抗癌药物表柔比星制备磁性纳米粒,并通过透射电镜、振动样品磁强计等考察磁性纳米粒的理化性质及体外磁场响应性。结果载表柔比星的磁性壳聚糖纳米粒直径约200nm,磁化曲线提示其超顺磁性,测得载药率15%、包封率20％。结论磁性表柔比星纳米粒粒径小,载药率和包封率高,体外具有良好的磁场响应性。     

Subclinical cardiotoxicity following adjuvant dose-escalated FEC, high-dose chemotherapy, or CMF in breast cancer

We compared adjuvant chemotherapy-related myocardial damage by antimyosin scintigraphy in patients who received either nine cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) where the doses of epirubicin and cyclophosphamide were escalated according to the leucocyte nadir (group I, n = 14), three cycles of FEC followed by high-dose chemotherapy with alkylating agents (CTCb) given with the support of peripheral blood stem cell transplantation (group II, n = 14), or six cycles of standard intravenous CMF (cyclophosphamide, methotrexate and fluorouracil; group III, n = 8). The cardiac uptake of In-111-antimyosin-Fab (R11D10) antibody was measured and the heart-to-lung ratio (HLR) calculated 8-36 months after the last dose of chemotherapy. Cardiac antimyosin antibody uptake was considerably higher among patients treated with nine cycles of dose-escalated FEC than among those who were treated with three cycles of FEC and high-dose CTCb (HLR, median 1.98; range 1.36-2.24 vs median 1.51; range 1.20-1.82; P < 0.001), or those treated with CMF (median 1.44; range 1.15-1.68; P < 0.001). The difference between groups II and III was not significant (P > 0.1). A linear association was found between the cumulative dose of epirubicin and the cardiac antimyosin uptake (P < 0.001). We conclude that subclinical cardiac damage caused by three cycles of conventional-dose FEC followed by one cycle of high-dose CTCb chemotherapy is small as compared with the damage caused by dose-escalated FEC.     

Randomised trial: survival benefit and safety of adjuvant dose-dense chemotherapy for node-positive breast cancer

We evaluated the survival benefit, safety, feasibility, and tolerability of dose-dense (DD) adjuvant chemotherapy with epirubicin and paclitaxel for women with node-positive primary breast cancer. Randomised patients (n=216) received DD or conventional-schedule (CS) chemotherapy. Dose-dense regimen patients (n=108) received epirubicin 90 mg m-2 plus paclitaxel 175 mg m-2 in four 14-day cycles, then cyclophosphamide 600 mg m-2, methotrexate 40 mg m-2, and fluorouracil 600 mg m-2 (CMF 600/40/600) in three 14-day cycles, plus filgrastim 5 microg kg day-1 as growth support in every cycle. Conventional-schedule regimen patients (n=108) received epirubicin 90 mg m-2 plus cyclophosphamide 600 mg m-2 in four 21-day cycles, then CMF 600/40/600 in three 21-day cycles, plus filgrastim if required. After a median follow-up of 38.4 months, 71 patients (33%) relapsed or died: DD, 33 patients (15 deaths); CS, 38 patients (22 deaths). Dose dense showed a trend for improved disease-free survival (DFS) and overall survival (OS). Four-year rates of DFS and OS were 64 and 85% for DD, and 58 and 75% for CS. All seven cycles were administered to 208 patients (96%). Rates of cycle delay, discontinuation, dose reduction, and adverse events were similar in both groups. Dose-dense sequential chemotherapy with epirubicin/paclitaxel then CMF, supported by filgrastim, is safe and improves survival for patients with node-positive breast cancer.     

表柔比星、卡介苗预防非肌层浸润性膀胱癌术后复发的荟萃分析

背景与目的：膀胱癌是泌尿系最常见的恶性肿瘤。对于非肌层浸润性膀胱癌，术后腔内灌注是预防其复发的重要措施。卡介苗被认为是最有效的免疫治疗制剂，而表柔比星是已报道肿瘤完全缓解率较高的灌注化疗药物。但两种制剂在膀胱癌的疗效比较尚无定论：本文收集相关资料，以期比较表柔比星、号介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发、疾病进展的疗效和副作用。方法：按文中所述纳入标准，检索国内外已公开发表的关于表柔比星、卡介苗膀胱灌注治疗非肌层浸润性膀胱癌的比较性研究文献，并应用Revman 4．2软件进行数据处理和分析。结果：共有6个研究符合标准被纳入，涉及总病例数1288例，其中表柔比星灌注治疗657例，复发253例；卡介苗治疗631例，复发184例。Meta分析结果提示卡介苗预防复发的疗效优于表柔比星，且统计学差异有显著性（Peto OR=1．60，95％CI=[1．26，2．03]，P=0．0001）；在预防疾病进展方面，卡介苗同样优于表柔比星（Peto OR=1．70，95％CI=[1．16，2．49]，P=0．006）；5个研究报道了药物主要局部副作用的比较，Meta分析显示表柔比星组在血尿（Peto OR=0．47，95％CI=[0．35，0．62]，P〈0．00001）、膀胱炎／膀胱刺激症（Peto OR=0．23，95％CI=[0．11，0．48]，P〈0．0001）发生率上显著低于卡介苗组。结论：卡介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发及疾病进展作用优于表柔比星，但副作用发生率明显升高，选择病例需谨慎。     

卡培他滨联合多西他赛对照多西他赛联合表柔比星治疗转移性乳腺癌的成本效果分析

目的对卡培他滨联合多西他赛对照多西他赛联合表柔比星治疗转移性乳腺癌的现状进行经济学评价。方法基于两方案治疗转移性乳腺癌疗效评价的Meta分析结果,以直接医疗成本进行成本计算,用Tree Age Pro 2009软件构建决策树,进行成本效果分析及敏感性分析。结果与多西他赛联合表柔比星相比,卡培他滨联合多西他赛的成本效果比大,影响因素分析及单因素敏感性分析表明,其成本效果分析的结果稳定。结论两方案的疗效相当,而成本效果分析表明,在完成相应治疗周期后,多西他赛联合表柔比星更具有经济学优势。     

Multimodal treatment with primary single-agent epirubicin in operable breast cancer: 5-year experience of the Michelangelo Cooperative Group.

BACKGROUND: To assess the efficacy of primary single-agent epirubicin (120 mg/m(2) every 3 weeks for three cycles) in reducing tumor burden in operable breast cancer >or=2.5 cm in largest diameter at diagnosis and its effect on the rate of conservative surgery. PATIENTS AND METHODS: A total of 319 eligible patients, who were all candidates for mastectomy, were enrolled on to a multicenter prospective non-randomized study. Tumor response was assessed clinically and pathologically. Relapse-free and overall survival were assessed on major prognostic variables. RESULTS: After primary epirubicin, complete disappearance of invasive neoplastic cells accounted for only 2.6% of patients, but 40% of patients had their primary tumor downstaged to epirubicin can avoid mutilating surgery in a high proportion of patients with tumors not amenable to primary conservative surgery. This multimodal treatment can be safely administered outside of clinical trials in patients presenting with large tumors and with a desire to preserve their body integrity.