含长春瑞滨方案治疗晚期乳腺癌的临床观察

目的观察和比较长春瑞滨为基础的两组联合化疗方案二线治疗蒽环和紫杉类药物耐药的晚期乳腺癌的有效率、中位疾病进展时间（mTTP）和不良反应,同时探讨联合化疗对老年乳腺癌的作用及安全性。方法对蒽环类和紫杉类药物失败的晚期乳腺癌患者53例采用长春瑞滨联合顺铂（NP）或联合卡培他滨（NX）方案治疗,其中有8例为老年乳腺癌（≥70岁）,采用NX方案。结果 NP组23例,CR2例（8.7%）,PR10例（43.5%）,总有效率为52.2%,mTTP为8个月（95%CI为6.16～8.80个月）。NX组（〈70岁）22例,CR2例（9.1%）,PR12例（54.5%）,总有效率为63.6%,mTTP为8.5个月（95%CI为6.71～9.29个月）。两组有效率差异无显著性（P=0.436）。8例老年乳腺癌（≥70岁）中,CR1例,PR3例,SD2例,PD2例,mTTP为6.5个月（95%CI为3.16～12.09个月）。两种化疗方案不良反应主要有骨髓抑制及消化道反应,在〈70岁患者中NX方案恶心呕吐发生率较NP方案低,差异有显著性（P=0.04）。NX方案还可见皮肤色素沉着及手足综合征。结论含长春瑞滨方案对蒽环类和紫杉类药物失败的晚期乳腺癌均有较好的疗效,但NX方案消化道反应发生率较低。NX方案对于老年晚期乳腺癌治疗具有一定的疗效和安全性。

The efficacy of vinorelbine-containing regimens in treatment of advanced breast cancer

Objective To evaluate and compare the response rate,median time to progression（ mT-TP） and toxicity of vinorelbine-containing regimens in treatment of patients with advanced breast cancer resistant to anthracyclines and taxanes in two groups. To study the efficacy and safety of combined chemotherapy for elderly patients. Methods Fifty-three cases were recruited and treated with NP（ NVB ＋ DDP） or NX （ NVB ＋ capecitabine） regimen. Eight of them cases were elderly patients（ ≥70 years） who were treated with NX regimen. Results In the NP group,CR was achieved in 2 cases （ 8. 7% ） ,PR in 10 cases （ 43. 5%） ,SD in 7 cases（ 30. 4%） ,PD in 4 cases（ 17. 4%） . The overall response rate in the NP group was 52. 2% and mTTP was 8 months（ 95% CI： 6. 16-8. 80 months） . In the NX group（ 70 years） ,CR was achieved in 2 cases（ 9. 1% ） ,PR in 12 cases（ 54. 5% ） ,SD in 4 cases（ 18. 2% ） ,PD in 4 cases （ 18. 2%） . The overall response rate in the NX group was 63. 6% and mTTP was 8. 5 months（ 95% CI： 6. 71-9. 29 months） . In the 8 elderly patients,CR was achieved in 1 case,PR in 3 cases,SD in 2 cases, PD in 2 cases. The mTTP was 6. 5 months（ 95% CI： 3. 16-12. 09 months） . The common adverse reactions of the two groups included myelosuppression and gastrointestinal reactions. The rate of gastrointestinal reaction in NX group（ 70 years） was signifcantly lower than that in NP group（ P = 0. 04） . Skin pigmentation and hand-foot syndrome were observed in the NX group. Conclusions Vinorelbine-containing regimens can a-chieve effective results for patients with advanced breast cancer resistant to anthracyclines and taxanes. There was no statistical difference between the objective response rates of the two regimens. The rate of gastrointes-tinal reaction was lower in NX group than in NP group. NX regimen is effective and safe for elderly patients.