卡培他滨与铂类在晚期乳腺癌一线二线治疗中的疗效对比

目的 分析卡培他滨与铂类在晚期乳腺癌一线、二线治疗中的疗效。方法 2010年1月至2013年6月收治317例晚期乳腺癌患者，采用含卡培他滨或铂类的联合化疗方案，每3周为1周期。采用实体肿瘤疗效评价标准1.1版（RECIST 1.1）评价疗效，不良反应采用NCI CTC 3.0毒性评价标准评价。对采用不同化疗方案的患者进行生存随访并比较其中位无进展生存期（PFS）。结果 一线、二线治疗分别有可评价病例118例和78例。含卡培他滨方案与含铂类方案一线化疗的有效率（53.6% vs. 63.3%）、疾病控制率（81.2% vs. 91.8%）及二线化疗的有效率（42.9% vs. 47.2%）、疾病控制率（90.5% vs. 91.7%）的差异均无统计学意义（P>0.05）；含卡培他滨方案与含铂类方案的一线化疗的中位PFS分别为15.6个月和12.4个月，差异有统计学意义（P<0.05），二线化疗的中位PFS分别为11.1个月和12.8个月，差异无统计学意义（P>0.05）。不良反应以血液学毒性、恶心呕吐、手足综合症、乏力、口腔溃疡和腹泻为主；与含铂类方案相比，含卡培他滨方案一线化疗的1、2级恶心呕吐发生率较低，手足综合症发生率较高，而二线化疗的1级恶心呕吐、乏力发生率均较低，手足综合症发生率较高，以上差异均有统计学意义（P<0.05）。结论 卡培他滨与铂类均对晚期乳腺癌一线、二线治疗有效，卡培他滨安全耐受性较好，一线治疗的中位PFS更长。

Comparison of the efficacy of capecitabine and platinum-based chemotherapy in first-line and second-line treatment of advanced breast cancer

Objective To explore the efficacy of capecitabine and platinum-based chemotherapy in first-line and second-line treatment of advanced breast cancer. Methods From January 2010 to June 2013， 317 patients with advanced breast cancer were enrolled in this study. They were treated capecitabine and platinum-based chemotherapy with a cycle of 3 weeks. Tumor evaluation was performed according to RECIST 1.0 criteria and toxicities were evaluated according to NCI CTC 3.0. Patients receiving different chemotherapy regimes were followed up and the medium progression free survival （PFS） were compared. Results One hundred and eighteen and 78 patients can be evaluated in first-line and second-line treatment， respectively. Difference in first-line response rate （53.6% vs. 63.3%） and disease control rate （81.2% vs. 91.8%） of capecitabine and platinum-based chemotherapy has no statistical significance （P>0.05）. Similarly， no statistical significance was observed in second-line response rate （42.9% vs. 47.2%） and disease control rate （90.5% vs. 91.7%） between capecitabine and platinum-based chemotherapy. In first-line treatment， median progression-free survival （PFS） of patients receiving capecitabine and platinum-based chemotherapy were 15.6 and 12.4 months with statistical significance （P<0.05）. However， in second-line treatment， median PFS of patients receiving capecitabine and platinum-based chemotherapy were 11.1 and 12.8 without statistical significance in difference （P>0.05）. Adverse reactions mainly included hematological toxicity， nausea and vomiting， hand foot syndrome， asthenia， oral ulcers and diarrhea. Compared with platinum-based chemotherapy， there were lower incidence of grade 1-2 nausea and vomiting but higher incidence of hand-foot syndrome in the first-line capecitabine-based chemotherapy with statistical significance （P<0.05）. Lower incidence of fatigue and grade 1 nausea and vomiting and higher incidence of hand-foot syndrome were observed in capecitabine versus platinum-based chemotherapy in second-line treatment with statistical significance （P<0.05）. Conclusion Both capecitabine and platinum are effective in the first-line and second-line treatments of advanced breast cancer. Well-tolerated patients treated with capecitabineare had a longer PFS in first-line treatment.