药物性卵巢去势在绝经前转移性乳腺癌患者中的应用

Application of medical ovarian suppression in the treatment of metastatic breast cancer in premenopausal women

目的探讨卵巢去势药物戈舍瑞林联合三苯氧胺(TAM)治疗雌激素受体(ER)阳性的绝经前转移性乳腺癌患者的临床疗效及安全性。方法将36例符合条件的乳腺癌患者随机分为观察组和对照组,每组18例。两组患者治疗前均接受解救化疗。对照组患者应用三苯氧胺10 mg,2次/d口服至病情进展;观察组在对照组的基础上加用戈舍瑞林3.6 mg皮下注射,1次/28 d,连续用药至病情进展。所有患者按期评价疗效及不良反应。结果观察组的总有效率(CR+PR)为44.4%(8/18),疾病控制率(CR+PR+SD)为61.1%(11/18),中位生存期(OS)为38个月;对照组的总有效率(CR+PR)为11.1%(2/18),疾病控制率(CR+PR+SD)为27.8%(5/18),中位OS为24个月,两组比较差异均有统计学意义(P<0.05)。戈舍瑞林联合三苯氧胺的不良反应以潮热、烦躁等卵巢去势引起的围绝经期症状为主,两组均未出现血液学毒性、消化系统毒性及外周神经病变等,均无严重不良事件发生。结论戈舍瑞林联合三苯氧胺治疗绝经前ER阳性的转移性乳腺癌患者疗效肯定,副作用小,值得临床推广。

Objective To explore the clinical efficacy and safety of medical ovarian suppression（ goserelin）combined with tamoxifen on ER overexpressing premenopausal metastatic breast cancer. Methods 36 cases of qualified breast cancers were randomly divided into observation group and control group,each group contained 18 cases. The two groups accepted chemotherapy before treatment. Control group took tamoxifen 10 mg orally twice daily. Observation group was applied with tamoxifen,and also administered with goserelin 3. 6 mg hypodermic injection every 28 days. All of treatments were administered till disease progressing. The clinical effect and toxicities were evaluated regularly. Results In observation group,the total effective rate（ CR ＋ PR） was 44. 4%（ 8 /18）,disease control rate（ CR ＋PR ＋ SD） was 61. 1%（ 11 /18）,the median overall survival（ OS） was 38 months. In control group the,total effective rate（ CR ＋ PR） was 11. 1%（ 2 /18）,disease control rate（ CR ＋ PR ＋ SD） was 27. 8%（ 5 /18）,the median overall survival（ OS） was 24 months,there were significant differences between the two groups（ P 0. 05）. The adverse reactions of goserelin combined with tamoxifen were chiefly perimenopausal symptoms because of ovarian suppression such as hectic fever and dysthesia. Adverse reactions concerning hematologic sytem,digestive apparatus,nervous system or other serious adverse event hadn＇t been detected in the two groups. Conclusion The combination of goserelin and tamoxifen has good curative effect with acceptable toxicities in the treatment of patients with ER positive metastatic breast cancer,it is worthy of clinical application.