吉西他滨和长春瑞滨联合治疗之后序贯吉西他滨或长春瑞滨治疗晚期耐药性乳腺癌的临床疗效

Clinical observation of gemcitabine combined vinorelbine×8 regimen versus vinorelbine combined vinorelbine×4 follow G or N ×4 regimen as chemotherapy for anthracycline and taxane resistant metastatic breast cancer

目的吉西他滨和长春瑞滨(GN)方案治疗晚期紫杉类及蒽环类药物耐药型乳腺癌中的作用已得到验证,但对于晚期乳腺癌化疗的疗程,是联合或单药,尚无标准方案,比较GN方案8疗程与GN方案4疗程后序贯G或N 4疗程,对蒽环类及紫杉类均耐药转移性乳腺癌(MBC)的疗效及不良反应。方法选取2008年1月至2009年12月确诊的晚期乳腺癌患者60人,所有患者均已接受过蒽环类和紫杉类方案化疗,采用GN方案8疗程或GN方案4疗程序贯G或N方案化疗,比较患者的总有效率(ORR)及1年生存率。结果 GN 8疗程组ORR为35.5%(11/30),其中CR 6.5%(2/31),PR 29%(9/31);GN方案4疗程序贯G或N治疗组ORR为34.5%(10/29),其中CR6.9%(2/29),PR 27.6%(8/29)。两组ORR差异无统计学意义(P=0.935)。GN方案8疗程组1年生存率为67.7%;GN方案4疗程序贯G或N治疗组1年生存率为65.5%,两组1年生存率(P=0.586)差异无统计学意义。两组均无化疗相关死亡病例,主要不良反应为骨髓抑制及胃肠道反应。结论 GN方案8疗程与GN方案4疗程序贯G或N治疗方案对蒽环类及紫杉类均耐药MBC均有较好的缓解率,不良反应均可耐受,同为有效解救方案。但从药物经济学上讲,GN×4-G or N更符合晚期患者治疗原则。

Objective To compare the efficacy and toxicities of gemcitabine combined vinorelbine（GN） 8 regimen and gemcitabine combined vinorelbine（GN） 4 follow G or N 4 regimen as chemotherapy for anthracycline-and taxane-resistant metastatic breast cancer（MBC）.Methods 58 patients were treated by GN or GN 4-G or N regimen.Overall response rate（ORR）and 1-year survival of two groups were assessed after treatment.Results CR was 6.5%（2/31）and PR was 29.0%（9/31）in GN group.2 patients（6.9%）had a complete response（CR）and 8 patients（27.6%）had a partial response（PR）in GN×4-G or N group.No statistically significant difference was observed in terms of ORR（35.5% vs.34.51%,P= 0.935）,or 1-year survival rate（67.7% vs.65.5%,P=0.586） of the two groups.No patients died in correlated with the two regimens.Myelosuppression and gastrointestinaltract reaction were the most common toxicities.Conclusions GP and GN 4-G or N regimens are both well effective for patients with anthracycline-and taxane-resistant MBC.Drug-related toxicities are tolerable.Two regimens can be considered as salvage regimens for those patients.