Schrama J G, de Boer M M, Baars J W, Schornagel J H, Rodenhuis S
Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Anticancer Res. 2003 May-Jun;23(3C):2795-800.
We evaluated the toxicity and efficacy of the first palliative chemotherapy regimen after failure of high-dose chemotherapy in 148 patients with primary or metastatic breast cancer treated with high-dose chemotherapy (one full dose CTC, (cyclophosphamide 6000 mg/m2, thiotepa 480 mg/m2, carboplatin 1600 mg/m2) or multiple courses CTC or 'tiny' CTC (tCTC) (two-thirds of the agents of the full-dose regimen), all divided over 4 days). After a median follow-up time of 46.8 (range 1-120) months, 79 patients had a relapse or progressive disease and 41 patients were treated with palliative chemotherapy. The most commonly used regimens were classical CMF (n = 13), docetaxel (n = 16) and less frequently anthracycline (n = 4), paclitaxel (n = 5), capecitabine (n = 2) and vinorelbine (n = 2). In both the CMF and docetaxel group, 3 patients required a dose reduction because of hematological toxicity. Objective responses were seen with CMF (23%) and docetaxel (69%) with a median duration of 161 (range 28-481) and 196 (range 62-437) days, respectively. We found no relationship of toxicity and response with treatment-free interval after high-dose chemotherapy. This report shows that conventional-dose palliative chemotherapy regimens may be safe and effective after failure of high-dose chemotherapy.
我们评估了148例接受大剂量化疗（一全量环磷酰胺、噻替派、卡铂方案（环磷酰胺6000mg/m²、噻替派480mg/m²、卡铂1600mg/m²）或多疗程环磷酰胺、噻替派、卡铂方案或“小剂量”环磷酰胺、噻替派、卡铂方案（全量方案中三分之二的药物），均在4天内分剂量给予）后一线姑息化疗方案对原发性或转移性乳腺癌患者的毒性和疗效。中位随访时间为46.8（范围1 - 120）个月后，79例患者出现复发或疾病进展，41例患者接受了姑息化疗。最常用的方案是经典的CMF方案（n = 13）、多西他赛方案（n = 16），较少使用蒽环类药物方案（n = 4）、紫杉醇方案（n = 5）、卡培他滨方案（n = 2）和长春瑞滨方案（n = 2）。在CMF和多西他赛组中，各有3例患者因血液学毒性需要减少剂量。CMF方案（23%）和多西他赛方案（69%）均观察到客观缓解，中位缓解持续时间分别为161（范围28 - 481）天和196（范围62 - 437）天。我们发现大剂量化疗后的无治疗间隔与毒性和缓解无相关性。本报告表明，大剂量化疗失败后，常规剂量的姑息化疗方案可能是安全有效的。
