长春瑞滨联合顺铂治疗蒽环类和(或)紫杉类耐药转移性乳腺癌的临床分析

Clinical analysis of vinorelbine plus cisplatin in treatment of metastatic breast cancer with anthracyclines and/or taxanes resistance

目的探讨长春瑞滨联合顺铂治疗蒽环类和（或）紫杉类耐药晚期乳腺癌的疗效与安全性。方法 43例蒽环类和（或）紫杉类耐药的转移性乳腺癌患者接受长春瑞滨联合顺铂方案化疗：长春瑞滨（法国P ierre Fabre公司产品）25 mg/m2,第1天和第8天,静脉滴注;顺铂75~80 mg/m2,静脉滴注,分割为2~5 d。3周为一周期,每2周期治疗结束后两周评价疗效。结果 43例患者共化疗156个周期,中位化疗周期数为4周期。完全缓解2例（4.7%）,部分缓解26例（60.5%）,客观有效率为65.1%。41例患者的中位无进展生存期（PFS）9个月,中位生存时间（OS）15个月,其中治疗有效的患者中位无进展生存期为12个月。1年生存率为59.0%。单因素分析显示,肿瘤大小和近期疗效是PFS的影响因素,孕激素受体（PR）状况、三阴性、转移灶数目是OS的影响因素。COX模型多因素回归分析显示,PFS和OS的独立预后因素分别是近期疗效和转移灶数目。主要不良反应是骨髓抑制和胃肠道反应。结论长春瑞滨联合顺铂方案是治疗蒽环类和（或）紫杉类耐药转移性乳腺癌安全有效的解救方案。

Objective To investigate the efficacy and safety of vinorelbine plus cisplatin（NP regimen） in treatment of metastatic breast cancer with antracyclines and/or taxanes resistance.Methods Forty-three patients with metastatic breast cancer resistant to anthracyclines and/or taxanes received NP regimen：vinorelbine（NVB 25mg/m2,intravenous infusion,day 1,8） plus cisplatin（DDP 75-85 mg/m2,intravenous infusion in 2-5 days）.Three weeks were one cycle.The evaluation was performed two weeks after every two cycles.Results A Total of 156 cycles were administered in the 43 cases with a median of 4 cycles.The overall response rate was 65.1%.Two cases（4.7%） had complete response while 26 cases（60.5%） had partial response.Among the 41 patients,the median progression-free survival time（PFS） and the median overall survival time（OS） were 9 months and 15 months,respectively.The median progression-free survival time of the patients who had response to therapy was 12 months.The overall 1-year survival rate was 59%.Tumor size and short-term efficacy were influential factors of PFS.Progesterone receptor（PR）,triple-negative phenotype and number of metastastic foci were influential factors of OS.Multivariate Cox model analysis showed that efficacy and number of metastastic foci were independent predictive factors of PFS and OS,respectively.The main toxic reactions were myelosuppression and gastrointestinal reactions.Conclusion Vinorelbine plus cisplatin combination chemotherapy is effective and well tolerated treatment of metastastic breast cancer with anthracyclines and/or taxanes resistance.