培美曲塞为主化疗方案治疗蒽环及紫杉烷类耐药乳腺癌的临床观察

Efficacy and safety of pemetrexed-based chemotherapy for patients with anthracycline-and taxane-resistant breast cancer

目的探讨培美曲塞(pemetrexed,PEM)为主联合化疗方案治疗蒽环及紫杉烷类耐药的晚期乳腺癌疗效及安全性,并分析影响疗效的相关因素。方法回顾性分析接受培美曲塞为主化疗方案治疗的蒽环及紫杉烷类等多线化疗失败的晚期乳腺癌患者39例的临床及病理资料。结果 39例患者中位化疗3(2-14)周期,总有效率(ORR)为15.4%,疾病控制率(DCR)为46.2%;中位随访时间9.0(2.0-30.0)月,中位肿瘤进展时间(TTP)4.4(1.0-18.0)月,中位总生存时间(OS)8.5(2.0-30.0)月。亚组分析显示,绝经前乳腺癌患者近远期疗效均优于绝经后患者(P<0.05);不同激素受体及HER2状态、不同肿瘤转移部位数目与PEM疗效无相关性(P>0.05)。主要不良反应为骨髓抑制和胃肠道反应,未出现因不良反应不能耐受而中止治疗的患者。结论培美曲塞为主的联合化疗方案治疗蒽环及紫杉烷类耐药的晚期乳腺癌有较好的疗效,患者耐受性可,疗效的影响因素值得进一步研究。

Objective To evaluate the therapeutic efficacy and safety of pemetrexed（ PEM）-based chemotherapy in patients with anthracycline- and taxane-resistant advanced breast cancer. Methods Thirty-nine patients with advanced breast cancer who failed to respond to multiline chemotherapy including anthracycline and taxane underwent pemetrexedbased chemotherapy. The clinicopathologic data of the patients were retrospectively reviewed. Results The median number of cycles delivered was 3（ 2 ～ 14）. Overall response rate（ ORR） was 15. 4% and disease control rate（ DCR） was46. 2%. The median follow-up time was 9. 0（ 2. 0 ～ 30. 0） months,the median time to progression（ TTP） was 4. 4（ 1. 0 ～18. 0） months,and the median overall survival（ OS） time was 8. 5（ 2. 0 ～ 30. 0） months. Subgroup analysis showed that premenopausal breast cancer patients were superior to postmenopausal patients in terms of short- and long-term efficacy（ P〈0. 05）. The efficacy of PEM-based chemotherapy was not correlated with hormone receptor status,HER2 expression and tumor metastasis（ P〉 0. 05）. Adverse events were mainly myelosuppression and gastrointestinal tract reaction. There were no clear trends of the effect of supplementation on toxicity. Conclusion Pemetrexed-based chemotherapy is effective and safe for patients with anthracycline- and taxane-resistant advanced breast cancer.