外周造血干细胞支持下大剂量化疗治疗年轻转移性乳腺癌疗效观察

摘要

Background and purpose: Incidences of breast cancer occurring in younger people have been increasing gradually.The prognosis for these patients is very poor.It is difficult to achieve specific desired results, especially in younger metastatic breast cancer patients.Specific treatment measures are needed.High dose chemotherapy (HDC) supported by peripheral hematopoietic stem cells used on breast cancer is still controversial,although it may benefit some subgroups.This study explored the benefits of HDC for metastatic breast cancer in younger patients.Methods: Thirty metastatic breast cancer patients, ≤40 years old, were enrolled in this study.Of all cases, 16 received HDC and 14 received standard dose chemotherapy (SDC).For HDC group, peripheral CD34+ and hematopoietic stem cells were mobilized using chemotherapy docetaxel 120 mg/m2 and G-CSF; followed by 2 cycles of HDC were subsequently administered (15 cases with docetaxel 120 mg/m2+thiotepa 175 mg/m2+carboplatin AUC=6, 1 case with docetaxel 120 mg/m2+thiotepa 175 mg/m2).For SDC group, docetaxel 75 mg/m2+thiotepa 50-60 mg/m2 were administered every 3 weeks for 4 to 6 cycles according to the progression of the disease.The primary objective of this study was to compare progression free survival (PFS) and overall survival (OS).Results: We observed 5 (31.3％) vs 1 (7.1％) with partial responses with HDC and SDC, respectively.Median PFS was 9 months (2.3-15.7 months) vs 3.8 months (2.7-4.9 months, P=0.044) for HDC and SDC, respectively.Overall survival was 11.8-21.2 months (median 18 months) vs 6.8-16.0 months (median 11.4 months, P=-0.058) for HDC and SDC, respectively.The toxicities of HDC were tolerable.Conclusion: HDC supported by peripheral hematopoietic stem cells was an effective treatment for metastatic breast cancer in younger patients.This conclusion is worthy of future usage and further investigation.%背景与目的:年轻乳腺癌的发病率成逐渐升高的趋势,预后较差,尤其对于复发转移性年轻乳腺癌的治疗更是很难达到理想的疗效,缺乏针对性的治疗措施.干细胞支持下大剂量化疗(high dose chemotherapy,HDC)在乳腺癌中的应用目前仍存在争议,有可能一些亚组人群在其中获益.本研究旨在探讨外周造血干细胞支持下大剂量化疗对于年轻复发转移性乳腺癌的治疗效果.方法:30例年龄≤40岁的转移性乳腺癌患者,其中16例接受外周造血干细胞支持下的HPC,14例接受常规剂量化疗(standard dose chemotherapy,SDC).HDC组:首先应用化疗多西他赛120mg/m2和G-CSF 5 μg/kg动员.采集外周血CD34+干细胞,然后行2个周期大剂量化疗,方案为15例接受了3药联合化疗:多西他赛120 mg/m2+塞替派175 mg/m2+卡铂AUC=6,1例接受两药联合化疗:多西他赛120 mg/m2+塞替派175 mg/m2.SDC组:多西他赛75 mg/m2+塞替派50～60 mg/m2,每21 d为1个周期,应用4～6个周期或至疾病进展.比较两组患者的无进展生存期时间(progression free survival,PFS)和总生存期(overall survival,OS).结果:HDC组部分缓解5例,有效率为31.3%;SDC组部分缓解1例,有效率为7.1%.HDC组PFS为9个月(2.3～15.7个月);SDC组PFS为3.8个月(2.7～4.9个月),两组间差异有统计学意义(P=0.044);HDC组OS为11.8～21.2个月(中位生存期18个月),SDC组OS为6.8～16.0个月(中位生存期是11.4个月),差异接近有统计学意义(P=0.058).大剂量化疗安全性良好.结论:干细胞支持下大剂量化疗对年轻转移性乳腺癌是一个有效的治疗手段,值得今后进一步推广研究.