培美曲塞联合顺铂与长春瑞滨联合顺铂治疗晚期乳腺癌对比观察

Comparative observation of pemetrexed combined with cisplatin and vinorelbine combined with cisplatin in the treatment of advanced breast cancer

目的:比较培美曲塞联合顺铂与长春瑞滨联合顺铂(NP)治疗蒽环类和紫杉类耐药晚期乳腺癌临床疗效和毒副反应。方法:58例对蒽环类和紫杉类耐药晚期乳腺癌患者随机分为两组,分别给予培美曲塞联合顺铂30例与NP方案28例至少治疗两周期后进行评价。结果:培美曲塞联合顺铂组总有效率(RR)CR+PR=53.3%,疾病控制率(DCR)CR+PR+SD=83.3%,NP方案组总有效率(RR)CR+PR=50.0%,疾病控制率(DCR)CR+PR+SD=78.6%。两组疗效比较无显著性差异(P>0.05)。主要毒副反应为骨髓抑制和胃肠道反应。Ⅲ-Ⅳ度白细胞减少发生率:培美曲塞联合顺铂组8例(26.7%),NP方案组11例(39.3%),Ⅲ-Ⅳ度胃肠道反应率:培美曲塞联合顺铂组3例(10.0%),NP方案组6例(21.4%),培美曲塞联合顺铂Ⅲ-Ⅳ度毒副反应明显低于NP方案组,两组相比有显著性差异(P<0.05)。结论:培美曲塞联合顺铂与NP方案均是治疗蒽环类和紫杉类耐药晚期乳腺癌有效的方案。前者血液学及消化道反应毒性较轻,患者耐受性好,值得临床进一步推广。

Objective：To explore the efficacy and toxicity of pemetrexed combined with cisplatin and NP regimens in the treatment of advanced breast cancer resistant to anthracycline and taxane.Methods：Totally fifty-eight patients with advanced breast cancer resistant to anthracycline and taxane were randomly divided into two groups.All of them were treated by the two regimens responsively for at least two cycles.Results：The response rate was 53.3% in pemetrexed combined with cisplatin group and 50.0% in NP group.The disease control rate was 83.3% in pemetrexed combined with cisplatin group and 78.6 % in NP group（P〈0.05）.The major side effects were bone marrow suppression and gastrointestinal reaction.8 patients（26.7 %） in pemetrexed combined with cisplatin group and 11 patients（39.3%） in NP group had Ⅲ-Ⅳ level bone marrow suppression（P〈0.05）.3 patients（10.0%） in pemetrexed combined with cisplatin group and 6 patients（21.4%） in NP group had Ⅲ-Ⅳ level gastrointestinal reaction（P〈0.05）.Conclusion：Both are effective for advanced breast cancer resistant to anthracycline and taxane.Pemetrexed combined with cisplatin regimen has less bone marrow and gastrointestinal toxicity.The former is more tolerable.