依西美坦治疗Luminal A型乳腺癌高龄患者的临床疗效
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摘要
目的分析依西美坦治疗Luminal A型乳腺癌高龄患者的临床疗效。方法选择2013年5月至2016年5月新疆医科大学第一附属医院收治疗的73例Luminal A型乳腺癌高龄患者为研究对象,根据治疗方法不同分为两组:对照组35例,采取卡培他滨单药化疗治疗,每次1 g/m~2,每日2次,连用2周,休息1周,3周为1个周期,持续治疗6个周期;观察组38例,方案为口服依西美坦,每次25 mg,每日1次,持续治疗8～24个月。比较两组患者的近期疗效、不良反应发生情况及随访结果。结果观察组总有效率为65. 79%(25/38),对照组为74. 29%(26/35),两组临床疗效比较差异无统计学意义(P> 0. 05)。观察组未出现严重不良反应,没有因不耐受而停止治疗的病例,不良反应均较为轻微,6例患者出现面部潮红、恶心、骨关节痛,均为Ⅰ级;对照组恶心呕吐发生率为42. 86%(15/35),白细胞及血小板减少率为34. 29%(12/35),贫血发生率为11. 43%(4/35)。观察组中位无进展生存期长于对照组(6. 4个月比3. 2个月)(P <0. 05)。结论依西美坦治疗Luminal A型乳腺癌高龄患者的效果与化疗相当,但前者的安全性更高,不良反应轻微,预后良好,可作为高龄、不能耐受化疗或手术治疗患者较好的治疗方法。
Objective To observe the effect of exemestane on elderly patients with Luminal type A breast cancer.Methods Clinical data of 73 elderly patients with Luminal type A breast cancer admitted to the First Affiliated Hospital of Xinjiang Medical University from May 2013 to May 2016 were analyzed,which were divided into an observation group( 38 cases) and a control group( 35 cases) according to the therapy method. Patients in the control group received treatment of capecitabine,1 g/m~2 at one time,twice a dat for 2 weeks,rest for 1 weeks,3 weeks for 1 cycle,continuous treatment for6 cycles; patients in the observation group received treatment of endocrine therapy,25 mg/time,once a day,continuous trentment for 8 to 24 months. The short-term curative effect,adverse effects and follow-up results of the two groups were compared. Results The total effective rate of the observation group and control group was 65. 79%( 25/38) and 74. 29%( 26/35) respectively,there was no significant difference between the two groups( P > 0. 05). In the observation group,there were no serious adverse effects,no cases stopped treatment because of intolerance,and the adverse effects were mild,6 cases had facial flashes,nausea,bone and joint pain,all of them were gradeⅠ. The incidence of nausea and vomiting,leukopenia and thrombocytopenia in the control group were 42. 86%( 15/35),34. 29%( 12/35) and 11. 43%( 4/35) respectively. The median progression-free survival of the observation group was longer than that of the control group( 6. 4 months vs 3. 2 months,P < 0. 05). Conclusion The clinical efficacy of exemestane on elderly patients with Luminal type A breast cancer is same with the chemotherapy,while the former has higher safety,fewer adverse reactions and better prognosis,therefore can be used as a good treatment for the elderly patients who cannot tolerate chemotherapy or surgery.
Objective To observe the effect of exemestane on elderly patients with Luminal type A breast cancer.Methods Clinical data of 73 elderly patients with Luminal type A breast cancer admitted to the First Affiliated Hospital of Xinjiang Medical University from May 2013 to May 2016 were analyzed,which were divided into an observation group( 38 cases) and a control group( 35 cases) according to the therapy method. Patients in the control group received treatment of capecitabine,1 g/m~2 at one time,twice a dat for 2 weeks,rest for 1 weeks,3 weeks for 1 cycle,continuous treatment for6 cycles; patients in the observation group received treatment of endocrine therapy,25 mg/time,once a day,continuous trentment for 8 to 24 months. The short-term curative effect,adverse effects and follow-up results of the two groups were compared. Results The total effective rate of the observation group and control group was 65. 79%( 25/38) and 74. 29%( 26/35) respectively,there was no significant difference between the two groups( P > 0. 05). In the observation group,there were no serious adverse effects,no cases stopped treatment because of intolerance,and the adverse effects were mild,6 cases had facial flashes,nausea,bone and joint pain,all of them were gradeⅠ. The incidence of nausea and vomiting,leukopenia and thrombocytopenia in the control group were 42. 86%( 15/35),34. 29%( 12/35) and 11. 43%( 4/35) respectively. The median progression-free survival of the observation group was longer than that of the control group( 6. 4 months vs 3. 2 months,P < 0. 05). Conclusion The clinical efficacy of exemestane on elderly patients with Luminal type A breast cancer is same with the chemotherapy,while the former has higher safety,fewer adverse reactions and better prognosis,therefore can be used as a good treatment for the elderly patients who cannot tolerate chemotherapy or surgery.
引文
[1]宋国红,邸立军,宛凤玲,等.依西美坦在非甾体类芳香化酶抑制剂经治失败的晚期乳腺癌患者中的临床应用[J].中国癌症杂志,2010,20(7):535-538.
[2]陈伟财,何劲松,吴恢升,等.高龄Luminal A型乳腺癌的临床内分泌治疗[J].中国老年学杂志,2015,35(8):2065-2067.
[3]Han W,Kang SY.Relationship between age at diagnosis and outcome of premenopausal breast cancer:Age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer[J].Breast Cancer Res Treat,2010,119(1):193-200.
[4]曾银朵,汪颖,吴雯静,等.绝经前激素受体阳性乳腺癌辅助内分泌治疗的研究进展[J].现代肿瘤医学,2016,24(15):2466-2470.
[5]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017版)[J].中国癌症杂志,2017,27(9):695-760.
[6]Zhou WB,Ding Q,Chen L,et al.Toremifene is an effective and safe alternative to tamoxifen in adjuvant endocrine therapy for breast cancer:Results of four randomized trials[J].Breast Cancer Res Treat,2011,128(3):625-631.
[7]刘颖,马骥,赵庆丽,等.依西美坦治疗绝经后乳腺癌的临床疗效及安全性观察[J].现代生物医学进展,2013,13(12):2332-2334,2324.
[8]高宏,周跃华,殷东风,等.乳岩宁方联合依西美坦诱导绝经后裸鼠乳腺癌移植瘤细胞凋亡的实验研究[J].现代肿瘤医学,2013,21(9):1923-1926.
[9]Su FP,Gu RD,Jia WMD,et al.A comparison of survival outcomes and side effects of toremifene or tamoxifen therapy in premenopausal estrogen and progesterone receptor positive breast cancer patients:A retrospective cohort study[J].BMC Cancer,2012,12(1):161-166.
[10]广东省人民医院肿瘤中心.Luminal A型绝经前乳腺癌患者保乳术后全身多发性转移[J].循证医学,2011,11(1):60-64.
[11]Li GJ,Sun P,Zhou Y,et al.Preventive effects of Dendrobium candidum Wall ex Lindl.on the formation of lung metastases in BALB/c mice injected with 26-M3.1 colon carcinoma cells[J].Oncology Letters,2014,8(4):1879-1885.
[12]郭运杰,井小会.依维莫司联合依西美坦治疗激素受体阳性、HER2阴性复发转移性乳腺癌的安全性及有效性分析[J].现代肿瘤医学,2018,26(8):1222-1224.
[13]Moscetti L,Vici P,Gamucci T,et al.Safety analysis,association with response and previous treatments of everolimus and exemestane in 181 metastatic breast cancer patients:A multicenter Italian experience[J].Breast,2016,29:96-101.
[14]杨巧鹭,张志明.依西美坦与他莫昔芬联合卵巢抑制剂在绝经前乳腺癌治疗中的价值比较[J].中国卫生标准管理,2015,14(30):112-113.
[15]Daniel K,John H,Mark C,et al.Investigating the discernible and distinct effects of platinum basedchemotherapy regimens for metastatic triple negative breast cancer on time toprogression[J].Oncology Letters,2014,7(3):866-870.
[16]郭德阳,陈雷,王劲松,等.芳香化酶抑制剂用于绝经后激素依赖性乳腺癌患者新辅助内分泌治疗效果的Meta分析[J].第三军医大学学报,2016,38(7):781-786.
[17]Goldhirsch A,Wood WC,Coates AS,et al.Strategies for subtypes-dealing with the diversity of breast cancer:Highlights of the St.Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011[J].Ann Oncol,2011,22(8):1736-1747.
[18]Howell SJ.Advances in the treatment of luminal breast cancer[J].Curr Opin Obstet Gynecol,2013,25(1):49-54.
[19]Okazaki M,Horimoto Y,Tanabe M,et al.Predictive markers for efficacy of everolimus plus exemestane in patients with luminal HER2-negative metastatic breast cancer[J].Med Oncol,2018,35(4):48.
[20]Millar EK,Graham PH,Mc Neil CM,et al.Predicti on of outcome of early ER+breast cancer is improved using a biomarker panel,which includes Ki-67 and p53[J].Br J Cancer,2011,105(2):272.
[21]Goss PE,Hershman DL,Cheung AM,et al.Effects of adjuvant exemestane versus anastrozole on bone mineral density for women with early breast cancer(MA.27B):A companion analysis of a randomised controlled trial[J].Lancet Oncol,2014,15(4):474-482.
[2]陈伟财,何劲松,吴恢升,等.高龄Luminal A型乳腺癌的临床内分泌治疗[J].中国老年学杂志,2015,35(8):2065-2067.
[3]Han W,Kang SY.Relationship between age at diagnosis and outcome of premenopausal breast cancer:Age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer[J].Breast Cancer Res Treat,2010,119(1):193-200.
[4]曾银朵,汪颖,吴雯静,等.绝经前激素受体阳性乳腺癌辅助内分泌治疗的研究进展[J].现代肿瘤医学,2016,24(15):2466-2470.
[5]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017版)[J].中国癌症杂志,2017,27(9):695-760.
[6]Zhou WB,Ding Q,Chen L,et al.Toremifene is an effective and safe alternative to tamoxifen in adjuvant endocrine therapy for breast cancer:Results of four randomized trials[J].Breast Cancer Res Treat,2011,128(3):625-631.
[7]刘颖,马骥,赵庆丽,等.依西美坦治疗绝经后乳腺癌的临床疗效及安全性观察[J].现代生物医学进展,2013,13(12):2332-2334,2324.
[8]高宏,周跃华,殷东风,等.乳岩宁方联合依西美坦诱导绝经后裸鼠乳腺癌移植瘤细胞凋亡的实验研究[J].现代肿瘤医学,2013,21(9):1923-1926.
[9]Su FP,Gu RD,Jia WMD,et al.A comparison of survival outcomes and side effects of toremifene or tamoxifen therapy in premenopausal estrogen and progesterone receptor positive breast cancer patients:A retrospective cohort study[J].BMC Cancer,2012,12(1):161-166.
[10]广东省人民医院肿瘤中心.Luminal A型绝经前乳腺癌患者保乳术后全身多发性转移[J].循证医学,2011,11(1):60-64.
[11]Li GJ,Sun P,Zhou Y,et al.Preventive effects of Dendrobium candidum Wall ex Lindl.on the formation of lung metastases in BALB/c mice injected with 26-M3.1 colon carcinoma cells[J].Oncology Letters,2014,8(4):1879-1885.
[12]郭运杰,井小会.依维莫司联合依西美坦治疗激素受体阳性、HER2阴性复发转移性乳腺癌的安全性及有效性分析[J].现代肿瘤医学,2018,26(8):1222-1224.
[13]Moscetti L,Vici P,Gamucci T,et al.Safety analysis,association with response and previous treatments of everolimus and exemestane in 181 metastatic breast cancer patients:A multicenter Italian experience[J].Breast,2016,29:96-101.
[14]杨巧鹭,张志明.依西美坦与他莫昔芬联合卵巢抑制剂在绝经前乳腺癌治疗中的价值比较[J].中国卫生标准管理,2015,14(30):112-113.
[15]Daniel K,John H,Mark C,et al.Investigating the discernible and distinct effects of platinum basedchemotherapy regimens for metastatic triple negative breast cancer on time toprogression[J].Oncology Letters,2014,7(3):866-870.
[16]郭德阳,陈雷,王劲松,等.芳香化酶抑制剂用于绝经后激素依赖性乳腺癌患者新辅助内分泌治疗效果的Meta分析[J].第三军医大学学报,2016,38(7):781-786.
[17]Goldhirsch A,Wood WC,Coates AS,et al.Strategies for subtypes-dealing with the diversity of breast cancer:Highlights of the St.Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011[J].Ann Oncol,2011,22(8):1736-1747.
[18]Howell SJ.Advances in the treatment of luminal breast cancer[J].Curr Opin Obstet Gynecol,2013,25(1):49-54.
[19]Okazaki M,Horimoto Y,Tanabe M,et al.Predictive markers for efficacy of everolimus plus exemestane in patients with luminal HER2-negative metastatic breast cancer[J].Med Oncol,2018,35(4):48.
[20]Millar EK,Graham PH,Mc Neil CM,et al.Predicti on of outcome of early ER+breast cancer is improved using a biomarker panel,which includes Ki-67 and p53[J].Br J Cancer,2011,105(2):272.
[21]Goss PE,Hershman DL,Cheung AM,et al.Effects of adjuvant exemestane versus anastrozole on bone mineral density for women with early breast cancer(MA.27B):A companion analysis of a randomised controlled trial[J].Lancet Oncol,2014,15(4):474-482.