卡培他滨节拍化疗在晚期三阴性乳腺癌维持治疗中的疗效观察

Clinical efficacy of capecitabine metronomic chemotherapy in the maintenance treatment of advanced triple negative breast cancer

目的:探讨卡培他滨节拍化疗在晚期三阴性乳腺癌患者维持治疗中的近远期疗效、生活质量以及不良反应。方法:将经联合化疗有效的58例晚期三阴性乳腺癌患者随机分为卡培他滨节拍化疗组和卡培他滨常规剂量组两组,每组患者各29例。节拍化疗组患者给予卡培他滨节拍化疗,常规剂量组患者给予常规剂量卡培他滨化疗。治疗2个月后评价近期疗效,每个月评价不良反应,并统计两组患者的中位疾病进展时间、中位生存时间、1年生存率、2年生存率和生活质量的变化。结果:58例患者均可评价疗效。节拍化疗组患者中CR 0例,PR 5例,SD 22例,PD 2例,客观缓解率(ORR)和疾病控制率(DCR)分别为17.2%和93.1%;常规剂量组患者中CR 0例,PR 6例,SD 20例,PD 3例,客观缓解率(ORR)和疾病控制率(DCR)分别为20.7%和89.7%。两组患者的ORR和DCR相比差异无统计学意义(P>0.05)。节拍化疗组患者的中位肿瘤无进展生存时间(PFS)为7.1个月,与常规剂量组患者(6.9个月)比较,差异无统计学意义(P>0.05);节拍化疗组患者的1年、2年生存率分别为72.4%、58.6%,与常规剂量组患者(69.0%、55.2%)比较,差异无统计学意义(P>0.05)。生活质量改善方面,节拍化疗组患者显著优于常规剂量组患者(P<0.05);节拍化疗组患者的主要不良反应为骨髓抑制、消化道反应和手足综合征等,均以Ⅰ-Ⅱ度为主,均可耐受,常规剂量组患者的消化道反应、骨髓抑制、手足综合征等不良反应的发生率和严重程度均显著高于节拍化疗组(P<0.05)。结论:卡培他滨节拍化疗作为晚期三阴性乳腺癌患者的维持治疗,其近远期疗效与常规剂量维持化疗相当,同时可提高患者生活质量,不良反应轻且发生率低,值得临床推广应用。

Objective:To explore the efficacy,quality of life and toxicity of capecitabine metronomic chemotherapy in the maintenance treatment of patients with advanced triple negative breast cancer.Methods:58 patients with advanced triple negative breast cancer who had been effective by the combined chemotherapy were randomly divided into capecitabine metronomic chemotherapy group(n=29)and capecitabine conventional dose group(n=29).The clinical responses were assessed after two months.Toxicity was assessed every month,and the median disease progression time,median survival time,1-year survival rate,2-year survival rate and quality of life changes of the two groups of patients were counted.Results:All of the 58 patients were assessable for response and toxicity.In capecitabine metronomic chemotherapy group,there were 0 case of CR,5 cases of PR,22 cases of SD and 2 cases of PD with the objective response rate(ORR)of 17.2%and disease control rate(DCR)of 93.1%.In capecitabine conventional dose group,there were 0 case of CR,6 cases of PR,20 cases of SD and 3 cases of PD with the objective response rate(ORR)of 20.7%and disease control rate(DCR)of 89.7%.No significant difference was observed on ORR and DCR between both groups(P>0.05).The median progress free survival(PFS)in capecitabine metronomic chemotherapy group was 7.1 months,compared with 6.9 months in the capecitabine conventional dose group,there was no significant difference(P>0.05).The 1-and 2-year survival rates were 72.4%and 58.6%in capecitabine metronomic chemotherapy group,and the 1-and 2-year survival rates were 69.0%and 55.2%in capecitabine conventional dose group.No significant difference was observed on 1-and 2-year survival rates between both groups(P>0.05).The improvement of life quality in capecitabine metronomic chemotherapy group was significantly better than that of the capecitabine conventional dose group(P<0.05).The incidence rates of hand-foot syndrome,myelosuppression and gastrointestinal reactions were significantly higher in the conventional chemotherapy group than those in the metronomic chemotherapy group(P<0.05).Conclusion:The clinical efficacy of capecitabine metronomic chemotherapy in the life-sustaining treatment of patients with triple negative metastatic breast cancer is comparable to that of conventional dose maintenance therapy,and it can alleviate the adverse reaction of patients,and improve the quality of life.It was worthy of clinical promotion.