重组人血管内皮抑素联合NX方案治疗蒽环及紫杉类药物失败的HER-2阴性晚期乳腺癌疗效观察  

Clinical observation of recombinant human endostatin combined with vinorelbine and capecitabine as thirdline treatment of HER-2 negative advanced breast cancer resistant to anthracyclines and taxanes

作　　者：罗皓[1] 徐磊[1] 赵青[1] 任凌燕[1] 赵怡[1] 桂伟伟 LUO Hao;XU Lei;ZHAO Qing;REN Ling-yan;ZHAO Yi;GUI Wei-wei(Department of Oncology,the 454th Hospital of PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]解放军第四五四医院肿瘤科,南京210002

出　　处：《东南国防医药》2018年第6期601-605,共5页Military Medical Journal of Southeast China

摘　　要：目的探讨重组人血管内皮抑素联合NX方案(卡培他滨+长春瑞滨)作为三线治疗蒽环类及紫杉类药物治疗失败的HER-2阴性晚期乳腺癌的疗效及不良反应。方法回顾性分析45例经病理证实为HER-2阴性且经蒽环类及紫杉类药物治疗失败的乳腺癌患者临床资料,其中23例采用NX化疗方案(化疗组),22例采用重组人血管内皮抑素注射液(恩度)联合NX化疗方案(联合组)。恩度30 mg加入10 mL等渗盐水24 h静脉泵入d1-7,21 d为一周期; NX方案(长春瑞滨25 mg/m2d1、8滴注;卡培他滨1000 mg/m2早晚各服用1次,d1-14)化疗,21 d为一周期,治疗前后进行血管内皮生长因子(VEGF)定量测定,按照RECTIST1.1评估疗效; NCI-CTC3.0评价毒性反应;根据不良反应情况调整用药剂量,每2周期评估疗效。结果联合组第2周期评估客观缓解率(RR)为45.5%,疾病控制率(DCR)为72.7%;对比化疗组RR为30.4%,DCR为65.2%,差异均无统计学意义(P>0.05)。联合组第4周期评估RR为59.1%,DCR为81.8%;对比化疗组RR为26.1%,DCR为47.8%,差异均有统计学意义(P<0.05)。治疗后2组间VEGF值差异有统计学意义(P<0.05),根据疗效分为有效组19例和无效组26例,有效组VEGF表达较无效组明显降低(P<0.05)。2组间的第2周期和第4周期不良反应差异均无统计学意义(P>0.05)。结论重组人血管内皮抑素联合NX方案作为三线方案在蒽环类及紫杉类药物失败的HER-2阴性晚期乳腺癌患者中疗效确切,较NX方案化疗具有优势。Objective To analyze the efficacy and toxicities of endostar combined with vinorelbine and capecitabine as the third-line treatment of HER-2 negative patients with advanced breast cancer resistant to anthracyclines and taxanes. Methods Forty-five patients were divided into two groups.Twenty-three patients of chemotherapy group were treated with vinorelbine and capecitabine.The other 22 patients of combined group were treated with endostar combined with vinorelbine and capecitabine.Edostar(30 mg in 10 mL saline)was 24 hour continued vein pumping within the first 7 days.Vinorelbine(25 mg/m 2)was injected intravenously on the first and eighth days.Capecitabine(1000 mg/m 2)was taken orally twice every day within the first 14 days.One treatment cycle was 21 days.VEGF expression was measured before and after the treatment.The curative effect and toxic reaction were evaluated by RECIST1.1 and NCI.CTC3.0,respectively.The dosage was adjusted according to the adverse reaction,and the effectiveness was evaluated every two cycles. Results After two cycles of treatment,the RR and DCR of the chemotherapy group were 30.4%and 65.2%.The RR and DCR of the 22 patients of combined group were 45.5%and 72.7%,which was shown nonsignificant differences(P>0.05).After four cycles of treatment,the RR and DCR of the chemotherapy group were 26.1%and 47.8%.The RR and DCR of the 22 patients of combined group were 59.1%and 81.8%,showing significant difference(P<0.05).The VEGF expression was shown significant differences in both groups(P<0.05).According to the curative effect,these patients were divided into two groups,effective group(19 cases)and ineffective(26 cases). VEGF expression in effective group was significantly lower than that in effective group.The toxic reaction in the second and fourth cycle showed nonsignificant differences(P>0.05). Conclusion Endostar combined with vinorelbine and capecitabine as the third-line treatment showed obvious curative effect in HER-2 negative patients with advanced breast cancer resistant to anthracycli

关 键 词：重组人血管内皮抑素 恩度 长春瑞滨 卡培他滨 晚期乳腺癌 抗肿瘤血管形成 

分 类 号：R737.9[医药卫生—肿瘤]