紫杉类药物治疗晚期乳腺癌疗效及其分子指标的相关性研究

目的探讨晚期乳腺癌患者应用含紫杉醇联合化疗方案的疗效评价及与分子指标的相关性。方法经病理确诊的170例患者入组,经紫杉醇单药或含紫杉醇联合方案化疗,至少治疗2个周期后,评价疗效和不良反应及与分子指标的相关性研究。结果ER阳性有效率为33.3%,ER阴性为48.5%,两者差异有显著性(P=0.018);当HER-2过表达定义为≥++时,有效率为55.7%,低表达者和阴性患者为33.3%,两者比较差异有显著性(P=0.004)。而PR、p53、MDR-1、BCL-2的阳性、阴性表达组间没有明显差别。对ER及HER-2的共表达进一步分层分析显示,在ER阴性同时HER-2过表达患者的有效率高达65.7%,其他各组均在35%左右,两者比较差异有显著性(P= 0.001);而其他三组差异无显著性。结论ER阴性患者有效率显著高于ER阳性患者,HER-2过表达的患者紫杉类药物敏感性较高。

Investigation on correlation between efficacy of paclitaxel in treatment of advanced breast cancer and molecular phenotypes

Objective To investigate the correlation between efficacy of paclitaxel in treatment of advanced breast cancer and molecular phenotypes.Methods 170 patients with advanced breast cancer were enrolled and treated with paclitaxel (Taxol) or docetaxel monotherapy or combined chemotherapy.Hormone receptors (ER and PR),HER-2,MDR-1 and apoptosis-related P53 and BCL-2 were measured with immu- nohistochemical method.Relation between efficacy of chemotherapy and expression of molecular markers was analyzed.Results The response rate to paclitaxel was 40.0% and if combined with other chemotherapeutic agents,such as cisplatine,the rate was not significantly changed.The response rate to docetaxel was 25.0% and was increased if docetaxel was combined with other agents.The expression of ER was 59.3%,PR was 50.9%,HER-2 was 25.7%,p53 was 33.9%,MDR-1 was 20.8% and BCL-2 was 21.5%.Correlation between response rate to chemotherapy and expression of molecular markers :High response rate was correla- ted with negative ER and positive Her-2 expression.Breast cancers with both ER and HER-2~+ phenotype had high response rate to the chemotherapy,up to 65.7%.PR,BCL-2,p53,MDR-1 were not predictive to response rate of breast cancer to the therapy with paclitaxel or docetaxel.Conclusions Paclitaxel-or do- cetaxel-based combination chemotherapy is an effective well-tolerated scheme for the treatment of breast cancer.ER negative is a positive predictive factor.Patients with positive HER-2 is highly sensitive to pacli- taxel.Immunohistochemical method can be used for molecular classification of breast cancer.