Silvestris N, D'Aprile M, Andreola G, Locopo N, Marini L, Crucitta E, De Lena M, Lorusso V
Operative Unit of Medical Oncology, Oncology Center Giorgio Porfiri, Latina, Italy.
Int J Oncol. 2004 Feb;24(2):389-98. doi: 10.3892/ijo.24.2.389.
Many active cytotoxic drugs and several regimens exist for breast cancer therapy. However, these conventional treatments have not changed the outcome of patients with locally advanced and metastatic disease. As a consequence, the dynamic balance between chemotherapy-induced side effects and benefits attributable to relief of cancer-related symptoms must be carefully considered in this setting. Gemcitabine is a pyrimidine nucleoside antimetabolite that has shown activity in a variety of solid tumors, a good toxicity profile, and non-overlapping toxicity with other chemotherapeutic drugs. As a single agent, gemcitabine yields response rates ranging from 14 to 37% as first-line treatment for advanced breast cancer and 12-30% as salvage therapy for patients previously treated with anthracycline and/or taxane treatment. Combined with vinorelbine, platinum, anthracyclines, and taxanes as doublets or triplets, response rates of 50 to 80% have been reported in phase II clinical studies. Gemcitabine in combination with anthracyclines and taxanes has been evaluated in the neoadjuvant setting in patients with early-stage breast cancer with interesting clinical and pathological response rates. Preliminary results of gemcitabine in combination with the biologic agent, trastuzumab, are encouraging. Phase III trials of gemcitabine combinations compared to standard regimens are ongoing with the aim to assess the independent contribution of gemcitabine.
目前有多种活性细胞毒性药物和几种治疗方案可用于乳腺癌治疗。然而，这些传统治疗方法并未改变局部晚期和转移性疾病患者的治疗结果。因此，在这种情况下，必须仔细考虑化疗引起的副作用与癌症相关症状缓解所带来的益处之间的动态平衡。吉西他滨是一种嘧啶核苷抗代谢物，已在多种实体瘤中显示出活性，具有良好的毒性特征，且与其他化疗药物的毒性不重叠。作为单一药物，吉西他滨作为晚期乳腺癌一线治疗的有效率为14%至37%，作为先前接受过蒽环类药物和/或紫杉烷治疗患者的挽救治疗的有效率为12%至30%。在II期临床研究中，吉西他滨与长春瑞滨、铂类、蒽环类药物和紫杉烷联合使用作为双药或三药联合方案，有效率报告为50%至80%。吉西他滨与蒽环类药物和紫杉烷联合使用已在早期乳腺癌患者的新辅助治疗中进行了评估，取得了令人感兴趣的临床和病理有效率。吉西他滨与生物制剂曲妥珠单抗联合使用的初步结果令人鼓舞。与标准方案相比，吉西他滨联合方案的III期试验正在进行中，目的是评估吉西他滨的独立作用。
