Sarah Cannon Research Institute, Nashville, TN 37203, USA.
Clin Breast Cancer. 2010 Feb;10(1):64-73. doi: 10.3816/CBC.2010.n.009.
Patients with metastatic breast cancer (MBC) have poor prognoses and 5-year survival rates of approximately 20%. The site(s) and degree of metastatic dissemination are among the principal prognostic factors for patients with MBC. Patients with visceral metastases to the liver and/or lung have a very poor prognosis. Although good performance status, restricted disease dissemination, and limited extent of metastatic infiltration are associated with higher responses to chemotherapy, responses are generally short lived, with rapid disease progression after treatment failure. Thus, novel strategies for the management of patients with MBC with visceral disease are urgently needed. We have analyzed outcomes of trials that evaluated various chemotherapeutic agents as monotherapy or in combination with capecitabine in patients with MBC with primary visceral disease involvement. Treatment with microtubule inhibitors such as paclitaxel, docetaxel, and albumin-bound paclitaxel, generally administered in earlier lines of treatment, resulted in comparable responses. Lower response rates (RRs) were reported with other agents such as capecitabine, vinorelbine, and gemcitabine. Adverse events consistent with known toxicities of each agent were observed in the selected trials and related to dose and administration schedule. The epothilone B analogue ixabepilone has demonstrated clinical efficacy and manageable safety in populations of heavily pretreated patients with MBC with high visceral disease burdens to liver and/or lung (61%-86% of patients). Objective RRs ranging from 12% to 57% have been reported for ixabepilone, as monotherapy and in combination with capecitabine, depending on degree of pretreatment. Responses to ixabepilone in patients with visceral metastases were comparable to those observed in overall study patient populations.
转移性乳腺癌（MBC）患者预后较差，5 年生存率约为 20%。MBC 患者的主要预后因素包括转移部位和转移扩散程度。有肝和/或肺内脏转移的患者预后极差。虽然良好的表现状态、有限的疾病扩散和转移性浸润的有限程度与对化疗的更高反应相关，但反应通常是短暂的，在治疗失败后疾病迅速进展。因此，迫切需要为有内脏疾病的 MBC 患者制定新的管理策略。我们分析了评估各种化疗药物作为单一药物或与卡培他滨联合用于有原发性内脏疾病受累的 MBC 患者的试验结果。微管抑制剂（如紫杉醇、多西他赛和白蛋白结合型紫杉醇）的治疗，通常在早期治疗线中使用，导致可比的反应。其他药物（如卡培他滨、长春瑞滨和吉西他滨）的报告反应率较低。所选试验中观察到与每个药物已知毒性一致的不良事件，并与剂量和给药方案有关。埃坡霉素 B 类似物伊沙匹隆在高内脏疾病负荷（肝和/或肺 61%-86%的患者）的 MBC 大量预处理人群中显示出临床疗效和可管理的安全性。作为单一药物和与卡培他滨联合使用，伊沙匹隆的客观缓解率（RR）报告范围为 12%至 57%，具体取决于预处理程度。伊沙匹隆在有内脏转移的患者中的反应与在总体研究患者人群中观察到的反应相当。
