蒽环类联合紫杉类方案在乳腺癌新辅助化疗中的有效性及安全性评价

摘要

目的：探讨蒽环类联合紫杉类方案在乳腺癌新辅助化疗中的有效性及安全性。方法收集2005年6月至2014年10月接受蒽环类联合紫杉类方案新辅助化疗的早期或局晚期乳腺癌192例患者的临床资料，探讨化疗方案的疗效以及安全性，并分析影响病理完全缓解的相关因素。结果192例患者均可评价疗效，有效率为84�9％（163／192），病理完全缓解率为20�3％（39／192），其中 HR（＋）／HER⁃2（－）组为8�5％（10／118）、HR（－）／HER⁃2（＋）组为42�8％（6／14）、HR（＋）／HER⁃2（＋）组为25�0％（5／20）、HR （－）／HER⁃2（－）组为45�0％（18／40）。 HR （－）组病理完全缓解率显著高于 HR （＋）组（ P＜0�001）；在HR（－）组中，HR（－）／HER⁃2（＋）与HR（－）／HER⁃2（－）组之间病理完全缓解率的差异无统计学意义（ P＞0�05）。Logistic回归分析显示，ER 状态是影响病理完全缓解率的独立因素。主要的剂量限制性毒性为3、4级中性粒细胞减少（94�8％）；非血液学毒性包括2、3级呕吐（6�2％），骨骼肌肉疼痛、麻木（14�1％），中性粒细胞缺乏性发热（16�7％），黏膜炎（2�1％）以及心脏毒性（5�7％）等。结论蒽环类联合紫杉类方案在乳腺癌新辅助化疗疗效确切，不良反应可耐受，可作为乳腺癌新辅助化疗的优选方案。%Objective To assess the efficacy and safety of anthracyclines in combination with taxanes for neo⁃adjuvant chem⁃otherapy in patients with breast cancer. Methods The data of 192 breast cancer patients treated by taxanes and anthracyclines neoad⁃juvant regimens was reviewed. The efficacy and safety of taxanes and anthracyclines neoadjuvant regimens, as well as factors influencing pathological complete remission were analyzed. Results The efficacy of 192 patients could be evaluated. The effective rate was 84�9%(163/192),and the overall pathologic complete remission rate was 20�3%(39/192). The complete remission rates were 8�5%(10/118) in patients of HR(+)/HER⁃2(-) subtype, 42�8%( 6/8) in patients of HR(-)/HER⁃2(+) subtype, 25�0%( 5/20) in patents of HR(+)/HER⁃2(+) subtype, and 45�0%( 18/40) in patients of HR⁃/HER⁃2⁃subtype. The logistic regression revealed that ER status affected the complete remission rate after neoadjuvant chemotherapy of the breast cancer. The main dose limiting toxicities was grade 3/4 neutropenia ( 94�7%) . Other non⁃hematologic toxicities included grade 2/3 vomitting ( 6�2%) , bone pain ( 14�1%) , febrile neutro⁃penia ( 16�7%) , mucocitis ( 2�1%) and cardiotoxicity ( 5�7%) and etc. Conclusion Taxanes and anthracyclines chemotherapy regi⁃mens for the treament of patients with confirmed breast cancer show satisfied efficacy and safety, which can be regarded as an optimal neoadjuvant regimen for breast cancer.