长春瑞滨联合异环磷酰胺方案治疗蒽环类和紫杉类耐药晚期乳腺癌

Clinical research of the combination of vinorelbine and ifosfamide in the treatment of advanced breast cancer resistant to anthracycline and taxane

目的观察长春瑞滨（NVB）联合异环磷酰胺（IFO）方案（NI方案）治疗晚期乳腺癌的近期疗效和安全性，并与NVB联合顺铂（DDP）（NP方案）作对照。方法回顾性分析82例蒽环和紫杉类药物治疗后复发转移或治疗失败的乳腺癌患者资料，其中40例接受NI方案：NVB25mg／m^2静脉滴注，第1、8天；IFO1．2g／m^2静脉滴注，第1天至第3天；42例接受NP方案：NVB25mg／m^2静脉滴注，第1、8天；DDP25mg／m^2静脉滴注，第1天至第3天；均每21d为1个周期。化疗过程中记录不良事件，每2个周期评价疗效。结果所有患者均可评价客观疗效，M组与NP组总有效率分别为52．50％（21／40）和57．14％（24／42），差异无统计学意义（P〉0．05）。相关因素分析显示，M组对雌激素受体、孕激素受体、人类表皮生长因子受体2均阴性（三阴性）乳腺癌患者有效率与NP组疗效接近[43．75％（7／16）比44．44％（8／18），P〉0．05]。两组不良反应均主要为骨髓抑制及胃肠道反应，NI组Ⅲ一Ⅳ度中性粒细胞减少发生率与NP组差异无统计学意义[57．50％（23／40）比57．14％（24／42），P〉0．051；NI组Ⅲ．Ⅳ度胃肠道不良反应发生率低于NP组[7．50％（3／40）比26．19％（11／42），P〈0．05]。结论NI方案对晚期乳腺癌有较好疗效，其总有效率与NP方案相似，对于三阴性乳腺癌患者亦有较高的有效率，不良反应患者能够耐受，且胃肠道反应发生率较NP组低，是治疗蒽环和紫杉类耐药复发转移性乳腺癌的有效方案之一。

Objective To observe and compare efficacy and safety of vinorelbine （NVB） plus ifosfamide （IFO） （NI regimen） and NVB plus cisplatin（DDP） （NP regimen） in treatment of metastatic breast cance Methods 82 cases of recmTent and metastatic breast cancer after the failure of treatment with anthracychnes and taxanes, 40 cases were treated with NI regimen （NVB 25 mg/m2, day 1, day 8, IFO 1.2 g/m2, day 1, day 2, day 3）, and the other 42 cases received NP regimen （NVB 25 mg/m2, day 1, day 8, DDP 25 mg/m2, day 1, day 2, day 3）. Both groups were constituted of 21 days one cycle. After 2 cycles of chemotherapy, the response rate and side effects were evaluated. Results All 82 cases were evaluated for objective response. The total response rate of NI group and NP group were 52.50 % （21/40） and 57.14 % （24/42）. There was no significiant difference （P 〉 0.05）. By analysis of the correlative factors, the total response rate in treatment of triple-negative breast cancer of NI group was 43.75 % （7/16）, and that of NP group was 44.44 % （8/18）. The two rates were also approximative （P 〉 0.05）. Main side effects were both bonemarrow suppression and gastrointestinal reaction. Bonemarrow suppression rate at grade ]]I-IV of NI group [57.5 % （23/40）] had no significant difference compared with that of NP group[57.14 % （24/42）] （P 〉 0.05）. But grade II-IV gastrointestinal rate of NI group [7.50 % （3/40）] was significantly lower than that of NP group [26.19%（11/42）]（P 〈 0.05）. Conclusion NI regimen in treatment of advanced breast cancer is effective, and it shows a similar response rate compared with NP regimen. Also it is effective for triple ncgeative breast cancers. The toxicity can be tolerated, and the gastrointestinal reaction rate of NI regimen is lower. NI regimen is a good choose in treatment of advanced breast cancer.