雷替曲塞联合长春瑞滨在晚期三阴性乳腺癌中的临床研究

Clinical research on the raltitrexed -vinorelbine combination to treat patients with advanced triple -negative breast cancer

目的评价雷替曲塞（raltitrexed）联合长春瑞滨（vinorelbine）治疗蒽环及紫杉类耐药的晚期三阴性乳腺癌（TNBC）的疗效和毒副反应。方法选取21例对蒽环及紫杉类耐药的晚期TNBC患者，采用雷替曲塞3mg／m^2，静脉滴注，d1；长春瑞滨25mg／m^2，静脉滴注，d1、8。3周为一个疗程，2个疗程后评价患者的疗效、KPS评分等，每周期化疗后评价毒副反应。结果完全缓解（CR）2例，部分缓解（PR）6例，稳定（SD）6例，进展（PD）7例，总有效率（RR）为38．1％，疾病控制率（DCR）为66．7％。中位疾病进展时间（TTP）为5个月。化疗前后KPS评分差异有统计学意义（P〈0．05）。无化疗相关死亡病例，毒副反应主要为中性粒细胞减少（16例）、血小板减少（6例）、胃肠道反应（8例）、脱发（17例）等。结论雷替曲塞联合长春瑞滨对蒽环及紫杉类耐药的晚期TNBC有较好的疗效，毒副反应可耐受，是可以选择的治疗方案之一。

Objective To evaluate the clinical efficacy and toxicity of the rahitrexed - vinorelbine combination on patients with advanced triple - negative breast cancer resistant to anthracyelines and taxanes. Methods A total of 21 patients were included into the current study, who suffered with advanced triple - negative breast cancer and became resistant to anthracyclines and taxanes. All patients were administrated with raltitrexed （3 mg/m^2, ivgtt, d1 ） and vinorelbine （25 mg/m^2 , ivgtt, d1 and 8） for six weeks. Then, their efficacy and Karnofsky performance status （KPS） scores were assessed, while toxic and adverse reactions were recorded every three weeks. Results Complete remission （CR） was seen in two patients, partial remission （PR） in six patients, stable disease （SD） in six patients, and progression disease （PD） in seven patients. The overall response rate （RR = CR ＋ PR） was 38.1%, while the clinical benefit rate （DCR = CR ＋ PR ＋ SD） was 66.7%. The median time to progression （TTP） was 5.0 months. Their KPS scores before and after chemotherapy were statistically significant （P 〈 0.05 ）. There was no death related to chemotherapy. Untoward reactions ineluded leucopenia （ 16 patients）, thrombocytopenia （6）, gastrointestinal reactions （8） and alopecia （ 17 ）. Conclusion The raltitrexed - vinorelbine combination is effective and well tolerated for patients with advanced triple - negative breast cancer who are resistant to anthracyclines and taxanes, which can be applied as one of practical regimens.