Nagykálnai Tamás
Fôvárosi Onkormányzat Uzsoki utcai Kórháza, Budapest, Hungary.
Magy Onkol. 2002;46(4):307-13. Epub 2003 Feb 1.
The author summarizes the progress of adjuvant chemotherapy of breast cancer from the classical Bonadonna-type CMF over the anthracyclines to the taxanes. The CMF regimen represented the prototype of combination chemotherapy which significantly improved early and long term results. After 20 years the patients given adjuvant combination chemotherapy with CMF had significantly better rates of relapse-free survival (p<0.001) and overall survival (p=0.03) compared with no chemotherapy. 6 cycles of CMF was the gold standard of adjuvant chemotherapy in breast cancer for decades. The Milan research group decided in the early 1980s to challange this popular CMF combination by introducing doxorubicin within the adjuvant program. Compared with standard CMF, anthracyclin-containing regimens reduced the annual risk of recurrence by 12% and the annual risk of death by 11%, equating to a 3.2% absolute reduction in recurrence and a 2.7% absolute reduction in mortality at 5 years. This small but real difference seen with regimens containing three or more agents (e.g. CEF and CAF, FAC, FEC, etc.), whereas 4 cycles of 2-drug regimens (e.g. AC or EC) appears to be equivalent to 6 cycles of CMF. Among the novel chemotherapeutic drugs introduced in the 1990s the taxanes have emerged as the most powerful compounds in breast cancer. Several large, adjuvant clinical trials are currently ongoing or have recently completed accrual. The available results from innumerable clinical studies are still inconclusive and do not support the routine use of taxanes in the adjuvant setting - with the exception of the BCIRG 001 docetaxel trial, in which significant improvement was documented in disease free survival with 6 x TAC compared with 6 x FAC (82% vs 74%). Studies on the effect of the new trastuzumab (an antibody against the extracellular domain of the HER2) in adjuvant setting was initiated in early 2000. The Herceptin adjuvant trial programme is extensive, involving more than 12,000 patients worldwide. This trials will potentially offer many women with HER2-positive disease the chance of improved survival.
作者总结了乳腺癌辅助化疗从经典的Bonadonna型CMF方案，到蒽环类药物，再到紫杉烷类药物的进展。CMF方案是联合化疗的原型，显著改善了早期和长期治疗效果。20年后，接受CMF辅助联合化疗的患者与未接受化疗的患者相比，无复发生存率（p<0.001）和总生存率（p=0.03）显著更高。几十年来，6周期的CMF方案一直是乳腺癌辅助化疗的金标准。米兰研究小组在20世纪80年代初决定在辅助治疗方案中引入多柔比星，以挑战这种流行的CMF联合方案。与标准CMF相比，含蒽环类药物的方案将年复发风险降低了12%，年死亡风险降低了11%，相当于5年时复发绝对降低3.2%，死亡率绝对降低2.7%。含三种或更多药物的方案（如CEF和CAF、FAC、FEC等）出现了这种微小但真实的差异，而两药方案（如AC或EC）的4周期似乎等同于CMF的6周期。在20世纪90年代引入的新型化疗药物中，紫杉烷类药物已成为乳腺癌中最有效的化合物。目前正在进行几项大型辅助临床试验，或最近已完成入组。无数临床研究的现有结果仍无定论，不支持在辅助治疗中常规使用紫杉烷类药物——BCIRG 001多西他赛试验除外，该试验中记录到，与6×FAC相比，6×TAC在无病生存方面有显著改善（82%对74%）。关于新型曲妥珠单抗（一种针对HER2细胞外结构域的抗体）在辅助治疗中的作用的研究于2000年初启动。赫赛汀辅助试验项目规模庞大，全球涉及超过12000名患者。这些试验可能会为许多HER2阳性疾病的女性提供提高生存率的机会。
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