Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan, R.O.C.
Anticancer Res. 2010 Jul;30(7):3087-91.
Cancer-related acute disseminated intravascular coagulation (DIC) is uncommon, but it is a severe complication resulting in a very dismal prognosis. Choosing the appropriate chemotherapy agents to treat the underlying cancer and stop the acute DIC process effectively, while avoiding chemotherapy-induced myelosuppression which may contribute to bleeding-related mortality, is difficult. Acute DIC in breast cancer is a rare condition and is not well studied. Therefore, we designed this study to determine the clinical characteristics and effective treatment for breast cancer patients with acute DIC.
From March 1996 to November 2008, patients with histologically proven breast cancer who presented with acute DIC at National Taiwan University Hospital were retrospectively analyzed.
Sixteen patients were included in the study. Thirteen patients with breast cancer-related acute DIC were treated with various kinds of chemotherapy, one with tamoxifen, and two with supportive care only. Four patients responded to treatment; three of the responders received vinorelbine with high-dose 5-fluorouracil and leucovorin (HDFL), the other received vinorelbine with cisplatin. The median survival of the responders and non-responders was 13 months and 0.5 month (p<0.001). There were no grade 3 or 4 hematologic or non-hematologic toxicities in the patients receiving vinorelbine-HDFL.
Vinorelbine plus HDFL is considered a safe and effective palliative treatment of choice for breast cancer patients with acute DIC. Further prospective study is warranted.
癌症相关性急性弥散性血管内凝血（DIC）并不常见，但它是一种严重的并发症，导致预后极差。选择合适的化疗药物来治疗基础癌症并有效停止急性 DIC 过程，同时避免可能导致与出血相关的死亡率的化疗诱导的骨髓抑制，这是很困难的。乳腺癌相关性急性 DIC 是一种罕见的情况，尚未得到很好的研究。因此，我们设计了这项研究来确定乳腺癌伴急性 DIC 患者的临床特征和有效治疗方法。
从 1996 年 3 月至 2008 年 11 月，回顾性分析了在国立台湾大学医院就诊的经组织学证实患有乳腺癌且伴有急性 DIC 的患者。
本研究纳入了 16 例患者。13 例乳腺癌相关性急性 DIC 患者接受了各种化疗，1 例接受了他莫昔芬治疗，2 例仅接受了支持性治疗。4 例患者对治疗有反应；3 例反应者接受了长春瑞滨联合高剂量 5-氟尿嘧啶和亚叶酸（HDFL）治疗，另 1 例反应者接受了长春瑞滨联合顺铂治疗。反应者和无反应者的中位生存期分别为 13 个月和 0.5 个月（p<0.001）。接受长春瑞滨-HDFL 治疗的患者无 3 级或 4 级血液学或非血液学毒性。
长春瑞滨联合 HDFL 被认为是治疗乳腺癌伴急性 DIC 的安全有效的姑息治疗选择。需要进一步的前瞻性研究。
