吉西他滨联合异环磷酰胺治疗难治性乳腺癌疗效观察

Efficacy observation of gemcitabine and isosfamide in treatment of refractory breast cancer

目的探讨吉西他滨联合异环磷酰胺治疗难治性乳腺癌的临床疗效。方法吉西他滨1 000 mg/m2,静脉滴注30 min,每周1次,连续3周,随后休息1周,每4周重复1次,依据患者的不良反应相应减少剂量;异环磷酰胺1.5g/m2,第1～5天静脉滴注;顺铂25～30 mg/m2,第1、3天静脉滴注;巯乙磺酸钠,每次剂量相当于20%的异环磷酰胺剂量,于异环磷酰胺用药后的0、4、8 h静脉滴注。30 d为1个化疗周期,至少完成2个化疗周期后进行疗效评价。观察组采用吉西他滨联合异环磷酰胺治疗方案,对照组采用吉西他滨联合顺铂治疗方案。结果观察组74例患者中,完全缓解3例,部分缓解17例,稳定28例,进展26例,有效率27.03%(20/74),临床控制率64.86%(48/74),与对照组比较差异无统计学意义(P>0.05)。观察组不良反应主要为嗜中性粒细胞减少症77.03%(57/74),血小板减少症58.11%(43/74),血红蛋白异常31.08%(23/74),恶心、呕吐27.03%(20/74),腹泻33.78%(25/74),肝功能损害28.38%(21/74),手足综合征20.27%(15/74);不良反应以Ⅰ～Ⅱ度为主,经对症治疗后好转。两组未出现因不良反应中止化疗患者,无治疗相关性死亡,均能耐受化疗。结论吉西他滨联合异环磷酰胺治疗难治性乳腺癌疗效满意。

Objective To evaluate the efficacy of gemcitabine and isosfamide in the treatment of refractory breast cancer.Methods Gemcitabine 1 000 mg/m2 was intravenously infused for 30 min,once a week for three weeks,then taking rest for a week,repeated every four weeks,the dose was correspondingly reduced according to adverse reactions.Isosfamide 1.5 g/m2 was taken by intravenous drip on 1,5 d.Cisplatinum 25-30 mg/m2 was given by intrvenous drip on 1,3 d.Mesna,each dose was equivalent to 20% of the amount of isosfamide,was given by intravenous drip at 0,4,8 h during isosfamide intravenous drip.30 d was a chemotherapeutic cycle.Each patient completed at least two chemotherapeutic cycles and the treatment effects were evaluatied.The observation group took the treatment scheme of gemcitabine and isosfamide and the control group received the treatment scheme of gemcitabine and cisplatinum.Results Among 74 cases in the observation group,3 cases were CR,17 cases were PR,28 cases were SD,26 cases were PD,the effective rate was 27.03%（20/74） and the clinical control rate was 64.86%（48/74）,which showed no statistical difference compared with the control group（P〈0.05）.The adverse reactions in the observation group were neutropenia（77.03%,57/74）,thrombocytopenia（58.11%,43/74）,abnormal hemoglobin（31.08%,23/74）,nausea and vomiting（27.03%,20/74）,diarrhea（33.78%,25/74）,liver function damage（28.38%,21/74）,hand-foot syndrome（20.27%,15/74）.The adverse reactions were dominated by Ⅰ~Ⅱdegree,which were improved after symptomatic treatment.No case in two groups discontinued chemotherapy due to adverse reactions and no treatment-related death occurred.The chemotherapy was tolerable.Conclusion Gemcitabine plus isosfamide is satisfactory in the treatment of refractory breast cancer.