芳香化酶抑制剂不同顺序治疗转移性乳腺癌的临床研究  

A clinical study on the use of aromatase inhibitors in different order in the treatment of metastatic breast cancer

作　　者：张少华[1] 江泽飞[1] 宋三泰[1] 王涛[1] 吴世凯[1] 曹阳[1] 袁洋[1] 

机构地区：[1]军事医学科学院附属医院乳腺肿瘤科,北京100071

出　　处：《中国癌症杂志》2010年第5期385-389,共5页China Oncology

摘　　要：背景与目的:第三代芳香化酶抑制剂(aromatase inhibitors,AIs)已经成为治疗复发转移乳腺癌的重要手段。因此本研究旨在通过观察甾体类(依西美坦)和非甾体类(阿那曲唑、来曲唑)3种AIs不同顺序治疗复发转移性乳腺癌患者的疗效,探讨其是否存在交叉耐药。方法:回顾分析既往曾经先后用过甾体类和非甾体类AIs,且能够评价疗效和记录疾病进展时间(time to progression,TTP)和(或)治疗失败时间(time to failure,TTF)的80例复发转移性乳腺癌女性患者,全部患者都有雌激素受体(estrogen receptor,ER)和(或)孕激素受体(progesterone receptor,PR)阳性的结果,主要观察终点为临床获益率(clinical benefit rate,CBR)。结果:80例患者中,非甾体类阿那曲唑一线解救的CBR是62.5%(15/24)、来曲唑是71.1%(32/45)、甾体类依西美坦为81.8%(9/11)。一线甾体类治疗失败后换用非甾体类的CBR为36.4%(4/11),而一线非甾体类治疗失败后,换用甾体类CBR为24.6%(14/57),一线非甾体类失败后,换用另一种非甾体类的CBR为16.7%(2/12)。结论:一种AIs失败后换用另一种AIs仍有获益。总体而言,用药越晚,疗效越差,所以尽早选用疗效相对较高的药物是合适的选择。Background and purpose：The use of the third generation of aromatase inhibitors（AIs）has been an important method in the treatment of metastatic breast cancer.But since the birth of AIs,some related questions,such as which is the best,and whether these three medicines could produce cross-resistance,have not been clearly answered. Based on the observation of the curative effect of the use of steroidal and non-steroidal AIs in different order in the treatment of metastatic breast cancer,the dissertation tries to find out whether there is cross-resistance in such treatment. Methods：The authors analyze the treatment outcome of 80 patients with metastatic breast cancer,who have received steroidal AIs（exemestane）and non-steroidal AIs（anastrozole,letrozole）.All the patients were hormone receptorpositive,and the main observation endpoint is the clinical benefit rate（CBR）.The curative effects of these cases have been assessed,and the treatment reports have records of time to progression（TTP）and time to failure（TTF）.Results： Of the 80 patients,for those who were treated with non-steroidal anastrozole first line,the CBR was 62.5%（15/24）;for those with letrozole,the CBR was 71.1%（32/45）;and for those with steroidal exemestane,the CBR was 81.8%（9/11）. For those with the non-steroidal after the failure of the first-line steroidal,the CBR was 36.4%（4/11）,while for those with the steroidal after the failure of the non-steroidal,the CBR was 24.6%（14/57）,and for those with another type of the non-steroidal after the failure of the first-line non-steroidal,the CBR was 16.7%（2/12）.Conclusion：The use of another type of AIs is still effective in treatment if one type of AIs fails.Generally speaking,the later drugs are used,the worse the curative effect is.Therefore,it is an appropriate choice to use drug with relatively high curative effect as early as possible.

关 键 词：乳腺癌 内分泌治疗 芳香化酶抑制剂 交叉耐药 

分 类 号：R730.53[医药卫生—肿瘤] R737.9[医药卫生—临床医学]