Key words breast cancer chemotherapy Navelbine
January 1999 to June 2003, I Navelbine fluorouracil plus cisplatin joint program, the treatment of metastatic breast cancer in 52 cases, the results reported below.
1 Materials and Methods
1.1 General Information All 52 cases were female; aged 32 to 59 years old, with a median age of 46 years old. Pathological types: 34 cases of invasive ductal carcinoma, the other 18 cases. ER-positive in 28 cases (53.9%); PR was positive in 28 cases (53.9%). Invading an organ or part, 12 patients (23.1%), two organs or parts of nine cases (17.3%) and ≥ 3 organs or parts of those 31 cases (59.6%). Used to line the radical mastectomy or modified radical mastectomy in 48 cases, 46 cases radiotherapy, endocrine treatment of 46 cases, 47 cases of postoperative chemotherapy, 28 of which were used CMF regimen, 19 patients used the CAF program. When the transfer is used anthracycline program chemotherapy in 28 cases, and taxane chemotherapy nine cases.
25mg/m2 intravenous infusion of 1.2 treatments Navelbine (NVB), d1, d5; fluorouracil (5-Fu) 1 000mg / d last 24h infusion, d1 ~~ d3; leucovorin (CF) 100mg / d , intravenous, d1 ~~, d3, 5 Fu; cis-platinum (DDP) 20 ~ 30mg/m2 infusion, d1 ~~, d3, 21 days for a period.
1.3 Evaluation Criteria (1) recent efficient: after the end of treatment, according to WHO Response Evaluation Criteria in Solid Tumors into complete remission (CR), partial remission (PR); stable (SD) and progress (PD); (2) survival period: from the day of chemotherapy until death or last follow-up time; (3) in remission: Self-determination as CR or PR until the time of tumor recurrence or progression; (4) toxicity reaction divided into standards published by the WHO 0 ~ Ⅳ degrees.
1.4 statistical methods of data statistical analysis SPSS10.0 package.
2.1 tumor-related symptoms improve before treatment, 22 patients with pain, 18 cases of dysfunction, 15 patients with asthma, 17 patients required morphine; 19 patients (86.4%) patients after chemotherapy to alleviate pain disappeared, asthma and dysfunction in patients are improved. The original need to take the morphine-like drugs after treatment Disable all.
2.2 the efficiency of the whole group, a total of 177 cycles of chemotherapy. The median number of cycles was 3 (range 1-6). 6 cases 1 cycle of chemotherapy, bone marrow metastasis platelets, white blood cells was severely reduced due to ARDS, patients terminate treatment, four cases for other reasons refused to continue chemotherapy treatment for at least 2 cycles; 46 cases. Whole group to evaluate the efficacy of 46 cases, according to the intention-to-treat analysis (ITT) 52 example calculation, the total effective rate of 71.2%, with a CR rate of 26.9%, PR rate was 44.2%.
2.3 survival and remission follow-up to December 2003, the overall median survival of 14 months (95% confidence interval, 12 to 16 months), which effective chemotherapy for 16 months, and the invalid 10 months; median response duration of 7 months (95% confidence interval, 5 to 9 months).
2.4 toxicities whole group of 52 patients with evaluable for toxicity. 1 case of 13 days of chemotherapy appear Ⅳ myelosuppression combined ARDS death. The patient was 48 years old, for the left breast after surgery, radiotherapy and chemotherapy, liver, lung, bone, pleural metastasis, radiation pneumonitis. Before treatment, dry cough, chest pain, wheezing, no fever, lung breath sounds diminished, but have nothing to do, the moist rales blood like white blood cells normally. With methylprednisolone and chemotherapy, patients with these symptoms disappear, but 10 days Ⅳ myelosuppression, with no signs of infection, ARDS 13 days after she died. Whole group of white blood cells decreased rate of 100%, which grade Ⅰ ~ Ⅱ 47.4% 52.6% degree of of Ⅲ ~~ IV; platelet decline was 23.1%, the incidence of anemia was 78.8%, mostly Ⅰ ~ Ⅱ; gastrointestinal reactions occur rate of 86.2%, which grade Ⅰ ~ Ⅱ 71.2%, 23.1% of Ⅲ ~~ IV degree; peripheral nerve toxicity, the incidence of constipation was 21.2% and 34.6%, respectively.
The group 2/3 patients with liver or lung metastases, and 71.2% were previously used anthracycline or taxane chemotherapy, and poor prognosis. Navelbine is a more effective drug for treating breast cancer recognized, the literature suggests that considerable efficacy of single-use can be achieved with CMF. Nole and Orlando [1,2] report Navelbine combined with fluorouracil and cisplatin in the treatment of advanced breast cancer, the total effective rate of 73%, including 19% complete remission, time to tumor progression was 6.8 months. We apply the program to the treatment of metastatic breast cancer, found that 86.4% of the patients with pain relief, disappeared, of asthma and activities dysfunction complete remission, and significantly improve the quality of life of patients. Objective response, the program’s total effective rate of 71.2%, 26.9% of the patients achieved complete remission, Orlando and Nole reported similar results. Hematologic toxicity decreased white blood cells, which Ⅲ ~ Ⅳ degree of 52.6%, significantly higher than Orlando and Nole result of the larger dose used with bone metastasis were more likely related to us. The nonhematologic toxicity gastrointestinal reactions, peripheral neurotoxicity and constipation, the incidence of the above-mentioned reports in the literature is similar. We have not observed significant hand-foot syndrome, may be associated with patients receiving less chemotherapy cycles. In summary, we believe that the main Navelbine combined with fluorouracil and cisplatin in the treatment of metastatic breast cancer is safe and effective, and can be used as a rescue plan for patients with advanced breast cancer.