Tong Fuzhong, Yang Deqi, Zhou Bo, Cao Yingming, Liu Peng, Liu Hongjun, Wang Shu, Qiao Xinmin, Zhang Jiaqing
Dept. of 4th Surgery and Breast Disease Research Center, People's Hospital, Peking University Medical School, Beijing 100044, China.
Gan To Kagaku Ryoho. 2004 Feb;31(2):205-8.
Neoadjuvant chemotherapy of epirubicin plus paclitaxel was administered to 75 patients (including a 2-cycle group of 39 patients and a 4-cycle group of 36 patients) with locally advanced breast cancer (35 cases of stage IIb, 28 of stage IIIa, 12 of stage IIIb) to compare efficacy and toxicity of 2 cycle and 4 cycle regimens. All patients were female. They were treated with epirubicin 60 mg/m2, on day 1, by i.v., followed by paclitaxel 150 mg/m2, by 3 hour continuous infusion on day 2 repeated every 3 weeks. Premedication with dexamethasone, ondansetron, diphenhydramine and cimetidine were administered to prevent gastroenteritic and allergic reactions before chemotherapy. Thirty-nine patients were given 2 cycles and thirty-six were given 4 cycles of this regimen. One of 39 patients had complete response, 28 had partial response and 10 had no change in the 2-cycle group. In addition, 21 of 36 patients had complete response (including 9 who had pathologic complete response), 13 had partial response and 2 had no change. The response rates were 74% (29/39) in the 2-cycle group and 94% (34/36) in the 4-cycle group. There were no progressive disease in these 2 groups. However a higher proportion of PR was observed in stage II patients than in stage III patients. Twelve of 36 patients underwent breast conserving surgery, as tumor size had become smaller and down-staging was realized after neoadjuvant chemotherapy. In addition, axillary lymph nodes were palpable in all 75 patients before neoadjuvant chemotherapy with the ET regimen. But 46% (18/39) in the 2-cycle group and 75% (27/36) in the 4-cycle group became impalpable. Conversely, major toxicities (including leukopenia and gastroenteric reactions) were similar in both groups, but myalgia, arthralgia, neurotoxicity and alopecia were more severe in the 4-cycle group than in the 2-cycle group. In the present study, neoadjuvant chemotherapy with a 4-cycle ET regimen was more effective than with a 2-cycle regimen in down staging locally advanced breast cancer. Although major toxicities were more severe in the 4-cycle group than in the 2-cycle group, the regimen was tolerable and safe.
对75例局部晚期乳腺癌患者（包括39例接受2周期治疗的患者和36例接受4周期治疗的患者，其中IIb期35例、IIIa期28例、IIIb期12例）给予表柔比星联合紫杉醇新辅助化疗，以比较2周期和4周期方案的疗效和毒性。所有患者均为女性。治疗方法为第1天静脉注射表柔比星60mg/m²，随后第2天持续3小时静脉滴注紫杉醇150mg/m²，每3周重复一次。化疗前给予地塞米松、昂丹司琼、苯海拉明和西咪替丁进行预处理，以预防胃肠道和过敏反应。39例患者接受2周期该方案治疗，36例患者接受4周期该方案治疗。2周期组中，39例患者中有1例完全缓解，28例部分缓解，10例病情无变化。此外，36例患者中有21例完全缓解（包括9例病理完全缓解），13例部分缓解，2例病情无变化。2周期组的缓解率为74%（29/39），4周期组为94%（34/36）。这2组均无疾病进展。然而，II期患者的部分缓解比例高于III期患者。36例患者中有12例行保乳手术，因为新辅助化疗后肿瘤体积变小且实现了降期。此外，所有75例患者在接受ET方案新辅助化疗前均可触及腋窝淋巴结。但2周期组中有46%（18/39）、4周期组中有75%（27/36）的患者腋窝淋巴结触诊不清。相反，两组的主要毒性（包括白细胞减少和胃肠道反应）相似，但4周期组的肌痛、关节痛、神经毒性和脱发比2周期组更严重。在本研究中，4周期ET方案新辅助化疗在局部晚期乳腺癌降期方面比2周期方案更有效。虽然4周期组的主要毒性比2周期组更严重，但该方案耐受性良好且安全。
