NP方案与GX方案二线治疗晚期乳腺癌的临床对比观察

 目的　比较长春瑞滨联合顺铂（NP）方案和吉西他滨联合卡培他滨（GX）方案二线治疗蒽环类和（或）紫杉类耐药晚期乳腺癌患者的疗效和不良反应。方法　75例晚期乳腺癌患者被抽信封法随机分为2组，其中NP组40例，GX组35例。NP方案：长春瑞滨25 mg／m2，静脉滴注，第1、8天；顺铂25 mg／m2，静脉滴注，第1天至第3天；21 d为1个周期。GX方案：吉西他滨1000 mg／m2，静脉滴注，第1、8天；卡培他滨2500 mg／m2，分2次口服，第1天至第14天；21 d为1个周期，2个周期后评价疗效和不良反应。结果　NP组和GX组总有效率分别为42.5 ％（17／40）和40.0 %（14／35），中位疾病进展时间分别为7.0和6.5个月，中位生存期分别为15.8和15.0个月，1、2年生存率分别为60.0 %、32.5 %和57.1 %、31.4 %，Karnofsky评分提高率分别为50.0 %（20／40）和42.9 %（15／35）。以上差异均无统计学意义（均P＞0.05）。2组主要不良反应为骨髓抑制、消化道反应，其中GX组的手足综合征发生率明显高于NP组29 %（10／35）比0]，消化道反应NP组明显高于GX组95 %（38／40）比26 %（9／35）]，差异均有统计学意义（均P＜0.05）。结论　NP方案与GX方案对晚期乳腺癌患者有较好疗效，且不良反应均可耐受，可作为蒽环类、紫杉类药物治疗失败的晚期乳腺癌患者解救方案。

Clinical observation on NP and GX regimens in the treatment of advanced breast cancer

Objective　To observe the efficacy and adverse reaction of NP and GX regimens in the treatment of the anthracycline-and-taxane-resistant advanced breast cancer. Methods　Totally 75 patients with advanced breast cancer were divided into two groups, and received NP or GX regimen. NP group (n = 40): NVB 25 mg/m2, day 1, day 8; DDP 25 mg/m2, day 1-day 3, iv.drip. GX group (n = 35): GEM 1000 mg/m2 day 1, day 8, iv.drip; XEL 2500 mg/(m2.d), day 1-14, bid p.o. Every 21 days was a cycle. The efficacy and adverse reaction was evaluated after two cycles. Results　The overall response rates in the NP and GX group were 42.5 % (17/40) and 40.0 % (14/35). The median TTP of two group were 7 and 6.5 month.The MST was 15.8 months and 15.0 months in the NP and GX group. The 1-and 2-year survival rates were 60.0 %, 32.5 % and 57.1 %, 31.4 %. The increase ratio of Karnofsky was 50.0 % and 42.9 %. There was not a significant difference between the two groups in terms of their treatment response (P > 0.05). The main adverse reactions in the two group were myelosuppression, gastrointestinal reaction and phlebitis. Hand-foot syndrome in GX was significantly higher than that in NP group, Gastrointestinal reactions in NP was significantly higher than that in GX group. Conclusion　NP and GX regimens are effective for patients with metastatic breast cancer, their adverse reactions are tolerable,so they can be regarded as a ltermate regimens for anthracyclines and taxanes resistant patients with metastatic breast cancer.