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多西他赛:其在晚期乳腺癌治疗中应用的最新进展

Docetaxel: an update of its use in advanced breast cancer.

作者信息

Figgitt D P, Wiseman L R

机构信息

Adis International Limited, Mairangi Bay, Auckland, New Zealand.

出版信息

Drugs. 2000 Mar;59(3):621-51. doi: 10.2165/00003495-200059030-00015.


DOI:10.2165/00003495-200059030-00015
PMID:10776837
Abstract

UNLABELLED: Docetaxel, a semisynthetic member of the taxoid class of antineoplastic agents, is effective in the treatment of patients with advanced (locally advanced or metastatic) breast cancer. Reported objective response rates for docetaxel 100 mg/m2 ranged from 54 to 69% and 53 to 82% as first-line monotherapy or combination therapy, respectively. Objective response rates of 23 to 65% and 30 to 81% have been reported for docetaxel as second-line monotherapy or combination therapy, respectively. In Japanese studies, second-line docetaxel 60 mg/m2 produced objective response rates of 42 to 55%. At the recommended dose of 100 mg/m2 given as a 1-hour intravenous (i.v.) infusion every 3 weeks, docetaxel had significantly greater efficacy than doxorubicin, mitomycin plus vinblastine and methotrexate plus fluorouracil, and similar efficacy to fluorouracil plus vinorelbine in pretreated patients with advanced breast cancer. In chemotherapy-naive patients, first-line combined therapy with docetaxel and doxorubicin had significantly greater efficacy than doxorubicin plus cyclophosphamide. Promising results have been achieved in phase I/II trials of a weekly regimen of docetaxel (generally 30 to 45 mg/m2). Preliminary data indicate a potential role for docetaxel in the neoadjuvant therapy of early breast cancer. The major dose-limiting adverse event associated with docetaxel is neutropenia. Although other adverse events are common, the tolerability profile of docetaxel is generally acceptable in the majority of patients, particularly in comparison with other antineoplastic regimens. CONCLUSIONS: Although no single standard regimen has been identified as optimal for the treatment of advanced breast cancer, phase III trials have shown that docetaxel has improved efficacy over doxorubicin alone (considered one of the current gold standards), methotrexate/fluorouracil and mitomycin/vinblastine in second-line therapy. In combination with doxorubicin, docetaxel has demonstrated better efficacy than doxorubicin/cyclophosphamide in first-line therapy. These results provide a basis for therapy choice in advanced breast cancer. Clinical trials comparing docetaxel monotherapy versus paclitaxel monotherapy and versus docetaxel combination therapy are warranted. The role of docetaxel in the adjuvant and neoadjuvant treatment of early breast cancer is being evaluated.

摘要

未标记:多西他赛是紫杉烷类抗肿瘤药物的半合成成员,对晚期(局部晚期或转移性)乳腺癌患者的治疗有效。据报道,多西他赛100mg/m²作为一线单药治疗或联合治疗的客观缓解率分别为54%至69%和53%至82%。多西他赛作为二线单药治疗或联合治疗的客观缓解率分别为23%至65%和30%至81%。在日本的研究中,二线多西他赛60mg/m²的客观缓解率为42%至55%。在每3周进行1小时静脉输注的推荐剂量100mg/m²下,多西他赛在晚期乳腺癌预处理患者中比阿霉素、丝裂霉素加长春碱和甲氨蝶呤加氟尿嘧啶具有显著更高的疗效,与氟尿嘧啶加长春瑞滨疗效相似。在未经化疗的患者中,多西他赛与阿霉素的一线联合治疗比阿霉素加环磷酰胺具有显著更高的疗效。在多西他赛每周方案(一般为30至45mg/m²)的I/II期试验中取得了有前景的结果。初步数据表明多西他赛在早期乳腺癌新辅助治疗中具有潜在作用。与多西他赛相关的主要剂量限制性不良事件是中性粒细胞减少。虽然其他不良事件也很常见,但多西他赛的耐受性在大多数患者中总体上是可以接受的,特别是与其他抗肿瘤方案相比。 结论:虽然尚未确定单一的标准方案是晚期乳腺癌治疗的最佳方案,但III期试验表明,在二线治疗中,多西他赛比单独使用阿霉素(被认为是当前的金标准之一)、甲氨蝶呤/氟尿嘧啶和丝裂霉素/长春碱具有更高的疗效。在一线治疗中,多西他赛与阿霉素联合使用比阿霉素/环磷酰胺具有更好的疗效。这些结果为晚期乳腺癌的治疗选择提供了依据。有必要进行比较多西他赛单药治疗与紫杉醇单药治疗以及与多西他赛联合治疗的临床试验。多西他赛在早期乳腺癌辅助和新辅助治疗中的作用正在评估中。

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