含铂方案治疗HER-2阴性蒽环和紫杉类治疗失败晚期乳腺癌的临床研究  

Cisplatin combined chemotherapy in HER-2-negative metastatic breast cancer patients with anthracyclines and taxanes treatment failure

作　　者：张会强[1,2] 王涛[2] 边莉[2] 周金妹[2] 张少华[2] 吴世凯[2] 宋三泰[2] 张宏[2] 江泽飞[1,2] 

机构地区：[1]安徽医科大学解放军第307医院临床学院,北京100071 [2]解放军第307医院乳腺肿瘤科,北京100071

出　　处：《中华肿瘤防治杂志》2014年第22期1820-1824,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的分析含铂方案对人类表皮生长因子受体（human epidermal growth factor receptor-2,HER-2）阴性蒽环和紫杉类治疗失败的晚期乳癌患者的疗效,并对比不同含铂方案的疗效与不良反应。方法选择2005-04-01-2013-05-31就诊于解放军第307医院乳腺肿瘤科的186例晚期乳癌患者,均为蒽环和紫杉治疗失败,接受吉西他滨联合顺铂（gemcitabine-cisplatin,GP）治疗76例,长春瑞滨联合顺铂（vinorelbine-cisplatin,NP）治疗110例。GP方案：吉西他滨（1 000mg/m2）,静脉滴入,d1、d8;顺铂（75mg/m2）,静脉滴入,d1-d3。NP方案：长春瑞滨（25mg/m2）,静脉滴入,d1、d8;顺铂用法两组相同。治疗每3周为1个周期。结果含铂方案总有效率为29.6%（55/186）,中位无进展生存时间为5个月,95%CI：4.2-5.8个月,其中一线治疗和单器官受累者中疗效更佳。GP方案组和NP方案组的客观有效率分别为26.3%（20/76）和31.8%（35/110）,χ2=0.653,P=0.419;临床获益率分别为36.8%（28/76）和41.8%（46/110）,χ2=0.465,P=0.495;中位无进展生存时间分别为5个月（95%CI：3.8-6.2个月）和6个月（95%CI：5.0-6.9个月）,P=0.797,差异均无统计学意义。两组不良反应相似,其中3-4级主要为血液学毒性,非血液学毒性中1-2级呕吐发生率较高。结论在HER-2阴性蒽环和紫杉类治疗均失败的晚期乳腺癌患者中含铂方案疗效确切,不良反应可耐受。GP和NP两方案疗效相当,均可作为HER-2阴性乳腺癌患者的有效解救治疗方案。OBJECTIVE To evaluate the efficacy of cisplatin combined regimens in HER-2-negative metastatic breast cancer（MBC）patients with anthracyclines and taxanes treatment failure. To compare the efficacy and safety of the regimens.- gemcitabine plus cisplatin and vinorelbine plus cisplatin. METHODS One hundred and eighty-six HER-2-neg- ative MBC patients pretreated with anthracyclines and taxanes were enrolled. The patients received gemcitabine-cisplatin （GP,n= 76） or vinorelbine-cisplatin （NP, n= 110） regimen. Chemotherapy was given as follows： gemcitabine （1 000 mg/m2） or vinorelbine （25 mg/m2） on day 1,day 8; cisplatin （75 mg/m2） on day 1 through day 3 every 3 weeks. The efficacy was evaluated every two cycles. RESULTS For all of the patients, the objective response rate （ORR） was 29.6%（55/186）, the median progression-free survival （PFS） was 5 months （ 95 % CI： 4. 2-5.8 months）. The efficacy was better for the patients who received first line treatment and had single site metastasis. The ORR for GP were 26.3% （20/76） and 31.8%（35/110） （X^2=0.653,P=0.419） for NP. The clinical benefit rate （CBR） were 36.8%（28/76） and 41.8%（46/110） for the patients treated with GP and NP respectively（X^2 =0. 465,P=0. 495）. PFS for the GP and NP groups were 5 months（95%CI：3.8-6.2 months） and 6 months （95%CI：5.0-6.9 months） （Log-rank, P=0. 797）. No statistical significance of ORR,CBR and PFS were observed. The main adverse events of grade 3-4 were hematologicaltoxicities without statistical significance. The incidence rate of vomiting of grade 1-2 was high in the non-hematologic toxicities. CONCLUSIONS For HER-2-negative MBC patients pretreated with anthracyclines and taxanes, they can ben- efit from eisplatin-based regimens with acceptable toxicity. Both of the regimens can be considered as worthy options which have a similar efficacy.

关 键 词：人类表皮生长因子受体 乳腺肿瘤 顺铂 联合化疗 

分 类 号：R737.9[医药卫生—肿瘤]