聚乙二醇多柔比星脂质体与表柔比星在乳腺癌新辅助化疗中的疗效比较

Efficacy of Pegylated Liposomal Doxorubicin and Epirubicin in Neoadjuvant Chemotherapy for Breast Cancer

目的对比聚乙二醇多柔比星脂质体(PLD)与表柔比星(EPI)在乳腺癌新辅助化疗(NAC)中的疗效。方法将郑州大学第一附属医院2016年1月至2020年5月收治的接受NAC的121例乳腺癌患者根据治疗方法分为PLD组(41例)和EPI组(80例)。对PLD组采用PLD联合环磷酰胺续贯紫杉烷类药物方案,对EPI组采用EPI联合环磷酰胺续贯紫杉烷类药物方案,两组HER-2基因扩增者加用曲妥珠单抗。PLD和EPI化疗疗程结束后,评价两组完全缓解(CR)率、部分缓解(PR)率、总体有效(OR)率、疾病稳定(SD)率、疾病进展(PD)率及毒副反应情况。结果PLD组和EPI组年龄、临床分期、病理类型、组织学分级、分子分型比较,差异无统计学意义(P>0.05)。PLD组和EPI组OR率比较,差异无统计学意义(P>0.05)。PLD组和EPI组各分子分型疗效比较,差异无统计学意义(P>0.05)。PLD组白细胞减少、呕吐、脱发发生率均低于EPI组,口腔炎、手足综合征发生率均高于EPI组(P<0.05)。结论PLD与EPI在乳腺癌NAC中临床疗效相当,而PLD更适用于具有骨髓危险因素(患血液疾病、高龄或既往接受过蒽环类药物治疗等)、呕吐反射灵敏或者对保留头发有要求的女性患者,但其皮肤毒性需要引起重视。

Objective To compare the efficacy of pegylated liposomal doxorubicin(PLD)and epirubicin(EPI)in neoadjuvant chemotherapy(NAC)for breast cancer.Methods A total of 121 breast cancer patients receiving NAC admitted to the First Affiliated Hospital of Zhengzhou University from January 2016 to May 2020 were divided into PLD group(41 cases)and EPI group(80 cases)according to the treatment method.PLD group was treated with PLD combined cyclophosphamide followed by taxanes,and EPI group was treated with EPI combined cyclophosphamide followed by taxanes.Patients with HER-2 gene amplification in the two groups were added with trastuzumab.At the end of PLD and EPI chemotherapy,the complete response(CR)rate,partial response(PR)rate,overall effective(OR)rate,stable disease(SD)rate,progressive disease(PD)rate and toxicity of the two groups were evaluated.Results There were no statistical differences in age,clinical stage,pathological type,histological grade and molecular type between PLD group and EPI group(P>0.05).There was no statistical difference in OR rate between PLD group and EPI group(P>0.05).There were no statistical differences in efficacy of each molecular type between PLD group and EPI group(P>0.05).The incidences of leukopenia,vomiting and hair loss in PLD group were all lower than those in EPI group,and the incidences of stomatitis and hand-foot syndrome were both higher than those in EPI group(P<0.05).Conclusion PLD has the similar clinical efficacy to EPI in NAC for breast cancer.and PLD is preferred for female patients with bone marrow risk factors(blood disease,advanced age or previous treatment with anthracyclines,etc.),sensitive vomiting reflex or a need to keep hair.But its skin toxicity needs to be taken into account.