来曲唑与依西美坦在绝经后老年乳腺癌新辅助内分泌治疗中的临床效果评价

Clinical evaluation of letrozole and exemestane in neoadjuvant endocrine therapy for elderly postmenopausal women with breast cancer

目的探讨来曲唑、依西美坦在绝经后老年乳腺癌新辅助内分泌治疗中的临床效果。方法64例绝经后老年乳腺癌患者,依据治疗方案的差异分成观察组与对照组,各32例。对照组采用依西美坦治疗,观察组采用来曲唑治疗。对比两组疗效、无进展生存时间(PFS)、不良反应发生情况及治疗前后的雌激素水平。结果观察组治疗总缓解率(ORR)为46.88%,与对照组的50.00%对比,差异无统计学意义(P>0.05)。观察组PFS为(5.26±1.20)个月,与对照组的(5.31±1.22)个月对比,差异无统计学意义(P>0.05)。治疗前、治疗4周、治疗8周,两组雌二醇、孕酮组间对比,差异均无统计学意义(P>0.05)。观察组血脂水平上升发生率34.38%高于对照组的9.38%,胃肠道反应发生率9.38%、肝/肾功能损伤发生率6.25%低于对照组的37.50%、31.25%,差异均有统计学意义(P<0.05);两组关节疼痛、乏力发生率对比,差异无统计学意义(P>0.05)。结论来曲唑、依西美坦在绝经后老年乳腺癌新辅助内分泌治疗中疗效、PFS、抗雌激素治疗的效果基本相当,但依西美坦不会对血脂水平造成较大影响,而来曲唑对患者肝肾功能的影响更小。如患者为高脂血症则建议选择依西美坦,如存在肝肾功能损伤,则建议选择来曲唑。

Objective To discuss the clinical effect of letrozole and exemestane in neoadjuvant endocrine therapy for elderly postmenopausal women with breast cancer.Methods A total of 64 elderly postmenopausal women with breast cancer were divided into an observation group and a control group based on the difference in treatment regimens,with 32 cases in each group.The control group was treated with exemestane,and the observation group was treated with letrozole.The efficacy,progression-free survival(PFS),occurrence of adverse reactions,and estrogen level before and after treatment were compared between the two groups.Results The overall remission rate(ORR)in the observation group was 46.88%,and the difference was not statistically significant compared with 50.00%in the control group(P>0.05).The PFS in the observation group was(5.26±1.20)months,and the difference was not statistically significant compared with(5.31±1.22)months in the control group(P>0.05).Before treatment,after 4 weeks of treatment and after 8 weeks of treatment,there was no statistically significant difference between the two groups in terms of estradiol and progesterone(P>0.05).The incidence of rising blood lipid level was 34.38%in the observation group,which was higher than 9.38%in the control group;the incidence of gastrointestinal reactions and hepatic or renal impairment were 9.38%and 6.25%in the observation group,which were lower than 37.50%and 31.25%in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of joint pain and weakness between the two groups(P>0.05).Conclusion For elderly postmenopausal women with breast cancer,the efficacy,PFS,and anti-estrogen effect of letrozole and exemestane in neoadjuvant endocrine therapy are basically comparable,but exemestane does not have a greater impact on lipid levels,and letrozole has less impact on patients'liver and kidney functions.Exemestane is recommended if the patient is hyperlipidemic,and letrozole is recommended if there is hepatic or renal impairment.