三阴性乳腺癌表柔比星和环磷酰胺联合紫杉醇周疗新辅助化疗临床观察

Clinical observation of neoadjuvant chemotherapy with paclitaxel administered weekly combined with epirubicin and cyclophosphamide regimen in triple-negative breast cancer

目的 观察表柔比星和环磷酰胺联合紫杉醇周疗在三阴性乳腺癌（triple-negative breast cancer,TNBC）新辅助化疗中的疗效和安全性.方法 2010-01-01-2012-10-31河南省肿瘤医院经空芯针活检结合免疫组化检查诊断为TNBC患者67例,术前接受紫杉醇80 mg/m2（静脉滴入,d1、d8和d15）、表柔比星75 mg/m2（静脉滴入,d1）和环磷酰胺600mg/m2（静脉推注,d1）化疗,21d为1个周期,共4个周期.根据RECIST实体瘤疗效评价标准及术后病理组织学检查评价疗效,按照WHO抗癌药物不良反应分度标准评价不良反应.结果 总有效率为91.0％,临床完全缓解（cCR）43.3％（29/67）,部分缓解（PR）47.7％（32/67）,疾病稳定（SD）9.0％（6/67）,无疾病进展（PD）病例;病理完全缓解（pCR）率为41.8％（28/67）.Ⅲ～Ⅳ度中性粒细胞减少发生率为28.4％（19/67）,2例（3.0％）出现中性粒细胞减少性发热.Ⅲ～Ⅳ度贫血、血小板减少、恶心呕吐、腹泻及口腔黏膜炎的发生率分别为14.9％（10/67）、3.0％（2/67）、7.5％（5/67）、4.5％（3/67）和4.5％（3/67）.治疗期间未发生严重心脏毒性病例.3年无病生存率和总生存率分别为73.6％和88.9％.结论 表柔比星和环磷酰胺联合紫杉醇周疗用于TNBC的新辅助化疗,近期疗效较好,不良反应可耐受.

OBJECTIVE To evaluate the efficacy and safety of neoadjuvant chemotherapy with paclitaxel administered weekly combined with epirubicin and cyclophosphamide regimen in triple-negative breast cancer（TNBC）.MEDTH-ODS From January 1,2010 to October 31,2012,67 patients with TNBC confirmed by core needle biopsy combined with immunohistochemistry were treated with neoadjuvant chemotherapy,the regimen containing paclitaxel 80 mg/m2 （ivgtt d1,d8,d1s） and epirubicin 75 mg/m2 （ivgtt d1） and cyclophosphamide 600 mg/mz （iv d1）,administered every 3 weeks for 4 cycles before surgery.Standard RECIST guidelines were used to evaluate clinical and pathological response.Toxicity was evaluated at every period of chemotherapy treatment and recorded according to the WHO anticancer drug adverse reaction criterion.RESULTS The objective response rate （ORR） was 91.0％,clinical complete remission （cCR） was 43.3％ （29/67）,partial remission（PR） was 47.7％ （32/67）,stable disease（SD） was 9.0％ （6/67）,and no progressive disease （PD）.pCR was found in 28 cases （41.8 ％）.Neutropenia with grade 3 and 4 occurred in 28.4 ％ （19/67）,Febrile neutropenia occurred in 2 patients（3.0％）.Anemia and thrombocytopenia with grade 3 and 4 were 14.9％（10/67） and 3.0％ （2/67）.Nausea and vomiting with grade 3 and 4 was 7.5％（5/67）.Diarrhea with grade 3 and 4 was 4.5％（3/67）.Oral mucositis with grade 3 and 4 was 4.5％ （3/67）.There was no serious cardiac toxicity.The 3-year DFS and OS were 73.6％ and 88.9％,respectively.CONCLUSION Regimen of paclitaxel administered weekly combined with epirubicin and cyclophosphamide is effective and well-tolerated in the neoadjuvant chemotherapy for TNBC.