Kurian Sobha, Qazilbash Muzzafar, Fay Joseph, Wolff S, Herzig Roger, Hobbs Gerry, Bunner Pam, Weisenborn Robin, Aya-Ay Melanie, Lynch Joseph, Ericson Solveig
West Virginia University, Morgantown, West Virginia 26505, USA.
Breast J. 2006 Nov-Dec;12(6):531-5. doi: 10.1111/j.1524-4741.2006.00341.x.
Metastatic breast cancer is an incurable disease even with high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (ASCT). Even though phase III studies have not shown a survival advantage for this group as a whole, it is possible that a small subset of patients may benefit from HDC/ASCT with careful patient selection. A total of 198 patients from three different institutions were treated with HDC/ASCT. After complete staging, patients with central nervous system or bone marrow involvement were excluded. The HDC regimen consisted of: Carboplatin 600 mg/m(2) IV infusion over 48 hours, Thiotepa 300 mg/m(2) IV infusion over 2 hours, and Cytoxan 60 mg/kg IV infusion given over 2 hours x3 days. The median age at the time of transplant was 46 (24-62) years and median follow-up was 20 months. Hormone receptor status was known in 148 patients, of whom 84 had estrogen receptor (ER) and/or progestrone receptor (PgR)-positive tumors. Eighty patients had no evidence of disease at the time of HDC/ASCT (CR1). At the completion of HDC and ASCT, complete responses (CR) were seen in an additional 57 patients (CR2). Using Kaplan-Meier analysis, the median relapse-free survival (RFS) for the entire group was 15 months and overall survival (OS) was 27 months. The patients in CR1 had a median RFS and OS of 20.7 and 50.6 months, respectively. This was very similar to the RFS and OS in patients achieving CR2 after HDC/ASCT (p < 0.001; median: 19 and 40 months, respectively). In contrast, the patients with persistent residual disease had an RFS and OS of 7 and 12 months (p < 0.001). These data show that patients achieving a CR after HDC/ASCT have a better relapse-free and OS, when compared to patients with persistent residual disease after HDC/ASCT. This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve CR with HDC and ASCT which may result in better long-term outcome.
转移性乳腺癌即使采用大剂量化疗（HDC）和自体造血干细胞移植（ASCT）也是一种无法治愈的疾病。尽管III期研究尚未显示该组患者总体有生存优势，但通过仔细挑选患者，一小部分患者可能会从HDC/ASCT中获益。来自三个不同机构的198例患者接受了HDC/ASCT治疗。在完成全面分期后，排除有中枢神经系统或骨髓受累的患者。HDC方案包括：卡铂600mg/m²静脉输注48小时，噻替派300mg/m²静脉输注2小时，环磷酰胺60mg/kg静脉输注2小时，共3天。移植时的中位年龄为46（24 - 62）岁，中位随访时间为20个月。148例患者的激素受体状态已知，其中84例患者的肿瘤为雌激素受体（ER）和/或孕激素受体（PgR）阳性。80例患者在接受HDC/ASCT时无疾病证据（CR1）。在HDC和ASCT完成时，另外57例患者出现完全缓解（CR2）。使用Kaplan-Meier分析，整个组的中位无复发生存期（RFS）为15个月，总生存期（OS）为27个月。CR1组患者的中位RFS和OS分别为20.7个月和50.6个月。这与HDC/ASCT后达到CR2的患者的RFS和OS非常相似（p < 0.001；中位值分别为19个月和40个月）。相比之下，有持续性残留疾病的患者的RFS和OS分别为7个月和12个月（p < 0.001）。这些数据表明，与HDC/ASCT后有持续性残留疾病的患者相比，HDC/ASCT后达到CR的患者有更好的无复发生存期和总生存期。这项研究表明，标准化疗后有残留转移性乳腺癌的一部分患者可以通过HDC和ASCT达到CR，这可能会带来更好的长期结果。
