吉西他滨为主的方案治疗经紫杉类和蒽环类治疗失败的转移性乳腺癌的疗效比较

目的 观察经紫杉类和蒽环类治疗失败的转移性乳腺癌患者分别采用吉西他滨联合卡培他滨或氟尿嘧啶（5-FU）、吉西他滨联合顺铂或卡铂和吉西他滨联合羟基喜树碱（HCPT）进行解救治疗的疗效与安全性，探讨转移性乳腺癌经紫杉类和蒽环类治疗进展后适合的化疗方案。方法 2006年12月至2012年12月间经紫杉类和蒽环类治疗后进展的65例转移性乳腺癌患者分为：GX方案组（n=34）：吉西他滨800～1000mg／m2，d1、d8；卡培他滨850～1000mg／m2 bid，d1～d14或5-FU 500mg／m2 d1～d5。GP方案组（n=21）：吉西他滨800～1000mg／m2，d1、d8；顺铂70mg／m2或卡铂AUC=4～6。GH方案组（n=10）：吉西他滨800～1000mg／m2，d1、d8；HCPT 6～8mg／d，持续用5～6天。21天为1周期，每两个周期评价疗效，获疾病控制的患者继续化疗至6个周期。结果 64例可评价疗效，65例可评价不良反应。GX方案组、GP方案组及GH方案组的有效率分别为36.4％、33.3％和30.0％，组间差异无统计学意义；中位无进展生存时间分别为8个月（1～22个月）、8个月（1～48个月）和6个月（2～12个月），组间差异无统计学意义（P=0.415）；中位总生存时间分别为14.5个月（6～37个月）、14个月（4～48个月）和16个月（5～63个月），组间差异无统计学意义（P=0.653）。3组的3～4级不良反应的发生率均较低。结论 以吉西他滨为主的方案对既往经紫杉类和蒽环类治疗后进展的转移性乳腺癌患者有一定疗效，不良反应可耐受，为有效的解救方案。

Comparison of efficacy and safety of gemcitabine combined chemotherapy regimen after the failure of tax- ane and anthracycline therapy for metastatic breast cancer

Objective To observe the efficacy and safety of gemcitabine combined with capecitabine or fluorouracil（5-FU） , cisplatin or carboplatin and hydroxycamptothecine（HCPT） rescue treatment after failure of taxane and anthracycline therapy in patients with metastatic breast cancer, providing reference for the eligible chemotherapy for metastatic breast cancer that has progressed after ax- ane and anthracycline therapy. Methods Sixty-five patients progressive to taxane and anthracycline therapy were enrolled. Subgroup and chemotherapy regimen were： GX group： gemcitabine 800-1000mg/m2, dl, d8, capecitabine 850-1000mg/m2bid, dH4 or 5-FU 500mg/m2 dr_5 ; G~＇ group： gemcitabine 800-1000 mgc/m2, d1 , d8 , cisplatin 70mgc/m2 or carhoplatin AUC =4-6; GH group： gemcit- abine 800-1000 mg/m2 , dj , d8 , HCPT 6-8 mg/d, sharing 5-6 days. Three weeks was a cycle. The efficacy was evaluated every 2 cy- cles. The patients with disease control were given six cycles of chemotherapy. Results Sixty-four patients were available for objective response evaluation, and adverse events were evaluated among 65 patients. The response rates were 36.4%, 33.3% and 30. 0% in GX-group, GP-group and GH-group, respectively（ P 〉 0. 05 ）. The median progression free survival were 8 （1-22）months, 8 （1-48） months and 6 （ 2-12 ） months without significant difference （ P = 0. 415 ） ; the median overall survival were 14. 5 （ 6-37 ） months, 14 （ 4- 48 ）months and 16 （5-63）months without significant difference （P = 0. 653 ）. The incidence rates of grade 3-4 adverse reactions were low among 3 groups. Conclusion The treatment of gemcitabine-based combined chemotherapy regimen showed good efficacy in meta- static breast cancer patients with failure of taxane and anthracycline therapy.