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目的观察多烯紫杉醇(DXL)联合顺铂(DDP)和吉西他滨(GEM)联合顺铂(DDP)序贯治疗转移复发性乳腺癌的临床疗效及毒副作用。方法53例经病理确诊为转移复发性乳腺癌,随机分为TP(多烯紫杉醇+顺铂)/GP(吉西他滨+顺铂)序贯组和TP组(多烯紫杉醇+顺铂)。TP:25例,多烯紫杉醇35 mg/m~2,静滴d1,d 8;顺铂25 mg/m~2静滴,d1～3,28 d为一个周期,共治疗4～6周期。TP/GP序贯组28例,先用TP方案化疗3～4周期,方案同上,后改用GP方案:GEM 1 000 mg/ m~2,静滴d 1,8;DDP 25 mg/m~2,静滴,d 1～3;28 d为一个周期,治疗3～4周期。或先用GP方案3～4周期,后改用TP方案3～4周期。至少应用4个周期。结果TP/GP组与TP组有效率(RR)分别为67.9%和56.0%(x~2=0.790,P=0.374);疾病控制率(DCR)分别为92.9%和88.0%(x~2=0.365,P =0.658)。其中TP/GP组一线治疗6例,CR 2例,PR 4例,有效率为100.0%;二线治疗22例,CR 2例,PR 11例,有效率59.1%。TP组一线治疗5例,CR 2例,PR 3例,有效率为100.0%,二线治疗20例,CR 0例,PR 9例,有效率45.0%。TP/GP、TP组中位无进展生存时间分别为9.5和8.0个月;中位生存时间分别为19.0和19.0个月(P=0.3894)。1年生存率分别为82.2%和60.0%,2年生存率分别为28.6%和30.0%,两组差异无显著性(P>0.05)。主要不良反应为骨髓抑制。结论多烯紫杉醇/吉西他滨联合顺铂序贯治疗转移复发性乳腺癌临床疗效好,不良反应轻,值得进一步扩大样本研究。
Objective To observe the clinical efficacy and side effects of sequential treatment of metastatic recurrent breast cancer with docetaxel (DXL) combined with cisplatin (DDP) and gemcitabine (GEM) and cisplatin (DDP). Methods Fifty-three patients with pathologically confirmed metastatic breast cancer were randomly divided into TP (docetaxel + cisplatin) / GP (gemcitabine + cisplatin) sequential group and TP group (docetaxel + cisplatin). TP: 25 cases, docetaxel 35 mg / m ~ 2, intravenous d1, d8; cisplatin 25 mg / m ~ 2 intravenous infusion, d1 ~ 3,28 d for a cycle, a total of 4 to 6 cycles. TP / GP sequential group of 28 patients, first with TP chemotherapy 3 to 4 cycles, the program is the same as above, then switch to GP regimen: GEM 1 000 mg / m 2, intravenous infusion d 1,8; DDP 25 mg / m ~ 2, intravenous infusion, d 1 ~ 3; 28 d for a period of treatment of 3 to 4 cycles. Or first with the GP program 3 to 4 cycles, then switch to the TP program 3 to 4 cycles. Apply at least 4 cycles. Results The effective rates (RR) of TP / GP group and TP group were 67.9% and 56.0% respectively (x ~ 2 = 0.790, P = 0.374). The disease control rates (DCR) were 92.9% and 88.0% 0.365, P = 0.658). The first-line treatment of TP / GP group 6 cases, CR 2 cases, PR 4 cases, the effective rate was 100.0%; second-line treatment in 22 cases, CR 2 cases, PR 11 cases, the effective rate of 59.1%. In the TP group, 5 cases were treated first-line, 2 cases were CR and 3 cases were PR. The effective rate was 100.0%. There were 20 cases of second-line treatment, 0 cases of CR and 9 cases of PR with an effective rate of 45.0%. The median progression-free survival time in TP / GP and TP groups was 9.5 and 8.0 months, respectively; and the median survival time was 19.0 and 19.0 months (P = 0.3894). The 1-year survival rates were 82.2% and 60.0%, respectively, and the 2-year survival rates were 28.6% and 30.0% respectively. There was no significant difference between the two groups (P> 0.05). The main adverse reaction is myelosuppression. Conclusion Docetaxel / gemcitabine combined with cisplatin sequential treatment of metastatic breast cancer with good clinical efficacy, adverse reactions, it is worth further to expand the sample study.