培美曲塞联合铂类治疗晚期乳腺癌的疗效

Efficacy of pemetrexed combined platinum in the treatment of advanced breast cancer

目的探讨培美曲赛联合铂类治疗晚期乳腺癌患者的疗效及安全性。方法选取2009年1月至2014年1月间收治的126例乳腺癌患者,根据患者采用化疗后的骨髓抑制程度分为观察组（62例）和对照组（64例）。观察组患者采用培美曲赛＋顺铂治疗,对照组患者采用培美曲赛＋奥沙利铂治疗,中位化疗为6个周期。根据实体瘤疗效评估标准进行疗效评价,观察培美曲赛联合铂类治疗晚期乳腺癌患者的疗效及不良反应。结果观察组和对照组患者的总有效率为29.0%和31.3%;观察组中50.0%患者处于疾病稳定状态,对照组中45.2%患者处于疾病稳定状态。126例患者经培美曲赛联合铂类化疗药物治疗,总有效率为30.3%,47.6%患者处于疾病稳定状态。126例患者中,随访12个月,82例（65.1%）患者存活,随访21个月时,50例（39.7%）患者存活。其中,观察组和对照组患者随访12个月的生存率为62.9%（39/62）和64.1%（41/64）,随访21个月的生存率分别为38.7%（24/62）和40.6%（26/64）,组间差异无统计学意义（P〉0.05）。两组主要不良反应为乏力、骨髓抑制、皮疹和消化道不良反应,且多为Ⅰ~Ⅱ级,Ⅲ级以上不良反应率最高仅为15.9%。未出现肾功能损害及心功能损害,且两组患者不良反应发生率比较,差异无统计学意义（P〉0.05）。结论在晚期乳腺癌的治疗中,培美曲赛＋顺铂与培美曲赛＋奥沙利铂的疗效和不良反应相当,疗效较好,不良反应较轻。培美曲赛联合铂类治疗晚期乳腺癌患者值得临床推广。

Objective To explore the efficacy of pemetrexed combined platinum in the treatment of advanced breast cancer. Methods Between January 2009 and January 2014 in The First People＇s Hospital of Yancheng,126 breast cancer patients were enrolled in the study. And according to the past bone marrow suppression after chemotherapy,they were respectively divided into the observation group（ n = 62） and the control group（ n = 64）. The patients in the observation group accepted pemetrexed ＋ cisplatin and those in the control group accepted pemetrexed ＋ oxaliplatin treatment. The curative effect and adverse reactions between the two groups were compared. Results The total effective rate of the observation group was29. 0%,50. 0% patients achieved stable disease. The total effective rate of the control group was 31. 3%,45. 2% patients achieved stable disease. For 126 patients,the total effective rate was 30. 3%,47. 6% patients achieved stable disease. After 12 months,82 cases were alive（ 65. 1%）; After 21 months,50 cases were alive（ 39. 7%）. In the observation group,after 12 months,the survival rate was 62. 9%（ 39 /62）.In the control group,after 12 months,the survival rate was 64. 1%（ 41 /64）,21 months were 38. 7%（ 24 /62） and 40. 6%（ 26 /64）. The difference of the survival rate between the two groups showed no significant difference（ P 〉0. 05）. The major adverse reactions were lack of power,bone marrow suppression,rash and gastrointestinal adverse reactions. Conclusion Pemetrexed with platinum therapy has good curative efficacy in patients with advanced breast cancer and the adverse reaction is lighter.