长春瑞滨联合顺铂对蒽环类联合紫杉类辅助化疗失败的乳腺癌患者的疗效分析

Effects and toxidty of neoadjuvant chemotherapy with vinorelbine and dsplatin in treatment of operable breast cancer previously non-responsive to anthracyclines and taxans-containing regimen： analysis of 19 cases

目的探讨长春瑞滨联合顺铂（NP方案）对蒽环类联合紫杉类新辅助化疗失败的乳腺癌的近期疗效和毒副作用。方法2007年9月至2008年5月，针对19例蒽环类联合紫杉类方案新辅助化疗未达临床PR、CR的乳腺癌患者，更换NP方案新辅助化疗2个周期，通过动态增强MRI检查对临床疗效进行评估后实施手术治疗，并观察病灶的病理缓解情况及毒副反应。结果临床疗效评价：CR1例，PR9例，SD9例，PD0例，总有效率（CR＋PR）52．6％（10／19）。病理疗效评价G1 2例，G2 7例，G3 6例，G4 4例，G5 0例，反应率（G2＋G3＋G4＋G5）89．5％（17／19），常见毒副反应为骨髓抑制和胃肠道反应。结论NP方案作为蒽环类联合紫杉类新辅助化疗失败的二线新辅助化疗方案，有效率高。患者耐受性好，不良反应可逆，无治疗相关死亡。可以成为蒽环类联合紫杉类新辅助化疗无效患者的二线优选方案。

Objective To evaluate the short-term effects and toxicity of vinorelbine combined with cisplatin （NP） as a neoadjuvant chemotherapy regimen in treatment of operable breast cancer non-responsive to the combination of anthraxcyclines and taxans. Methods Nineteen breast cancer patients, all female, who failed to achieve complete remission （CR） or partial remission （PR） to the combination of anthracyclines and taxans as neoadjuvant regimen were treated with 2 cycles of NP regimen （ vinorelbine 25 mg/m2, on days 1 and 8 and cisplatin 70 mg/m2, on days 1 and 3, both by intravenous infusion, as a cycle）. The clinical objective response was evaluated with dynamic contrast-enhanced MRI of the breast before operation and the pathological response was evaluated by pathological examination. The toxicity of the NP regimen was evaluated according to National Cancer Institute- Common Toxicity Criteria v. 3.0. Results The CR ＋ PR rate of the NP regime was 52.6% （10/19） , and pathological response （ G2 ＋ G3 ＋ G4 ＋ G5 ） was found in 17 cases （ 89. 5% , 17/19 ）. The most common toxicities were neutropenia and nausea/ vomiting. These toxicities were reversible and did not cause death. Conclusion A well-tolerated and effective regimen for breast cancer patient who fail to respond to the combination of anthracyclines and taxans neoadjuvant chemotherapy, the NP regimen can be considered as an effective choice of second-line regimen. It can be considered as an effective choice of second-line regimen.