吉西他滨联合长春瑞滨用于乳腺癌二线新辅助化学治疗的观察

Vinorelbine and gemcitabine combination for seconde-line neoadjuvant treatment for locally advanced breast cancer

目的:评价GN方案(吉西他滨联合长春瑞滨)作为二线新辅助化学治疗方案,用于TAC治疗方案(多西他赛、多柔比星和环磷酰胺)耐药的局部晚期乳腺癌(LABC)的疗效和安全性。方法:26例经2～4周期TAC方案化学治疗反应不佳的LABC患者,采用GN方案治疗;吉西他滨1 000 mg/m2静脉滴注,第1、8日;长春瑞滨25 mg/m2静脉滴注,第1、8日。每21日为1周期,2周期后评定疗效,同时记录不良事件。病情稳定或进展的患者停止化学治疗,缓解的患者继续行化学治疗至最多6周期,所有患者化学治疗结束2周后行手术切除。结果:26例患者共完成83周期化学治疗,平均3.2周期。其中完全缓解2例(8%),部分缓解10例(38%),病情稳定9例(35%),进展4例(15%),其中1例(4%)患者获得病理完全缓解。总反应率46%(12/26)。4例(15%)患者成功实施保乳手术,无1例患者需植皮。主要毒副反应为Ⅰ～Ⅱ度骨髓抑制、胃肠道反应、黏膜炎和周围神经毒性。结论:GN方案可作为二线新辅助化学治疗方案,用于蒽环类和紫杉类耐药的LABC患者,临床反应率较好,耐受性尚可。

Objective： To study the efficacy and toxicity of the second- line neoadjuvant vinorelbine and gemcitabine （GN） in the treatment of locally advanced breast cancer （LABC） resistant to anthracyclines and taxanescontaining regimen. Methods： Twenty-six LABC patients who failed to response to 24 cycles of acombination of docetaxel, doxorubicin, and cyclophosphamide （TAC） treatment were enrolled. Vinorelbine and gemcitabine were given intravenously of 25mg/m^2 and 1000mg/m^2, respectively, at Day 1 and 8, cycled every 21 days. Response was assessed every two cycles. Operation was carried out on the stable and progressed patients 2 weeks after chemotherapy, while total 6-week chemotherapy was given to those responded. Results： Among these 26 patients, the clinical response rate was 46%, with CR and PR were revealed in 2 and 10 cases, respectively. Breast conservative surgery （BCS） was succeeded in 4 cases （15%）. The most common adverse events were neutropenia, thrombocytopenia, nausea, vomiting, mucositis and neuropathy. Conclusion： GN combination can be used as secondline neoadjuvant chemotherapy in LABC patients who resistant to TAC regimen, with sufficient efficacy and safety.