詹　颖　童远和　陈志勇　卢翠萍福建医科大学附属龙岩第一医院肿瘤治疗中心，福建龙岩　364000

吉西他滨联合顺铂与多西他赛联合顺铂在晚期三阴乳腺癌化疗中的对比研究

詹颖童远和陈志勇卢翠萍
福建医科大学附属龙岩第一医院肿瘤治疗中心，福建龙岩364000

目的 探讨吉西他滨联合顺铂方案（gemcitabine&cis-platinum，GP方案）与多西他赛联合顺铂方案（docetaxel&cis-platinum，DP方案）在治疗晚期三阴乳腺癌（triple negative breast cancer，TNBC）的近期疗效和不良反应。方法 采用前瞻性随机对照的临床研究设计，将38例经病理及免疫组化确诊的三阴乳腺癌患者分为GP方案组和DP方案组，观察其近期有效率（response rate，RR）、疾病控制率（disease control rate，DCR）、疾病进展时间（time to progression，TTP）和不良反应。结果GP方案组中，完全缓解（complete remission，CR）1例，部分缓解（partial remission，PR）7例，疾病稳定（stable disease，SD）7例，疾病进展（progressive disease，PD）4例，RR为42.1% （8/19），DCR为78.9%（15/19）；TTP（5.4±0.5）个月。DP方案组中CR 0例，PR 7例，SD 8例，PD 4例，RR为36.8% （7/19），DCR为78.9%（15/19）；TTP（5.2±0.3）个月。两组的主要不良反应为消化道反应、骨髓抑制。GP方案组血小板减少发生率高于DP方案组（P＜0.05）。结论GP方案和DP方案治疗晚期TNBC疗效确切，不良反应均可耐受。

三阴乳腺癌；抗肿瘤联合化疗方案；顺铂；吉西他滨；多西他赛

［Abstract］Objective To prospectively evaluate the efficacy and toxicity of cisplatin plus gemcitabine（GP regimen）versus cisplatin plus docetaxel（DP regimen）in treatment of advanced triple-negative breast cancer（TNBC）.Methods A prospective randomized controlled clinical study was designed，38 patients confirmed TNBC patients by pathology and immunohistochemistry were divided into GP regimen group and DP regimen group.The response rate（RR），disease control rate（DCR），median time to tumor progression（TTP）and side effects were observed.Results Among the 19 case of GP regimen group，1 patient had CR，7 patients had PR，7 patients had SD and 4 patients had PD.The RR and DCR were 42.1%（8/19）and 78.9%（15/19），the TTP was（5.4±0.5）months.Among the 19 case of DP regimen group，no patient had CR，7 patients had PR，8 patients had SD and 4 patients had PD.The RR and DCR were 36.8%（7/19）and 78.9%（15/19）.The TTP was（5.2±0.3）months.The main side effects of the two groups included hematologic toxicities，digestive tract reaction and myelosuppression.The incidence of thrombocytopenia in the GP regimen group was significantly higher than that in the DP regimen group（P＜0.05）.Conclusion Our findings demonstrate that the DP and GP regimens have similar efficacy as treatment for advanced TNBC.The major toxicities of the two regimens are well tolerable.

［Key words］TNBC；Antineoplastic combined chemotherapy protocol；Cisplatin；Gemcitabine；Docetaxel

三阴乳腺癌（triple-negative breast cancer，TNBC）ER、PR和Her-2均为阴性的乳腺癌［1］，虽对化疗有良好的近期疗效，但易发生局部复发及远处转移，5年生存率往往不超过15%［2］。三阴乳腺癌患者的雌孕激素受体和Her-2均不表达，对内分泌及抗Her-2靶向治疗抗拒无效，化疗是其主要的治疗手段，目前尚无标准的化疗方案，比较推荐的有紫杉醇、蒽环类［3］。但对于进展的晚期转移性三阴乳腺癌患者，在既往辅助治疗中多应用紫杉醇及蒽环类药物，近年来许多临床研究表明铂类、吉西他滨及多西他赛对于复发的晚期三阴乳腺癌都显示较好的客观缓解率［4］。……