Zang Meng-fang, Zhang Yong-mei, Zhi Ying-hui, Zhai Zhen, Zhang Min, Gu Feng, Zhi Xiang-cheng
Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.
Zhonghua Yi Xue Za Zhi. 2011 May 31;91(20):1388-92.
To compare the chemosensitivity of pirarubicin (THP) and epirubicin (EPI) in primary breast cancer (PBC) cells so as to examine their differential chemosensitivity to THP and EPI by CD-DST (collagen gel droplet embedded culture-drug sensitivity test) system; To detect the differences in the short-term clinical efficacy and side effects between TAC (docetaxel + pirarubicin + cyclophosphamide) and TEC (docetaxel + epirubicin + cyclophosphamide) as the neoadjuvant chemotherapy regimens and the long-term clinical efficacy of CAF (cyclophosphamide + pirarubicin + fluorouracil) and CEF (cyclophosphamide + epirubicin + fluorouracil) as the chemotherapy regimens in breast cancer; To evaluate the feasibility of THP as an adjuvant chemotherapeutic regimen in the treatment of breast cancer.
From January 2008 to January 2009, a total of 129 fresh breast cancer samples were collected. The differential chemosensitivity of cultured PBC cells to THP and EPI was measured by CD-DST test. And 139 cases of PBC patients inIIb-IIIc phase were randomly divided into two groups: TAC and TEC groups. After 4-6 cycles of neoadjuvant chemotherapy, the primary lesion, axillary lymph nodes and side effects were assessed; The clinical data and survival status of 1241 cases of PBC patients treated at our hospital from 2003 to 2006 were collected and divided into CAF and CEF groups according to their chemotherapeutic regimens. Long-term prognosis was compared between two groups.
There was no significant difference of chemosensitivity between THP and EPI in PBC cells (P = 0.743); The overall response rate (RR) of neoadjuvant chemotherapy was 87.8%; the clinical objective responses, pathologic complete remission (pCR), clinical complete remission (cCR), clinical partial remission (cPR) and stable disease (SD) of groups TAC and TEC were 88.7%, 11.3%, 28.2%, 60.6%, 11.3% vs 86.8%, 10.3%, 26.5%, 60.3%, 13.2% respectively. There was no significant difference between two groups (P > 0.05). No significant differences existed between two groups in such side effects as leukopenia, thrombocytopenia, constipation, cardiotoxity and hepatorenal dysfunction (P > 0.05). The gastrointestinal reactions of nausea and vomiting was less frequent in the TAC group than that in the TEC group (46.5% vs 66.2%, P = 0.019); There was no significant difference in 5-year disease-free survival rate (79% vs 78%) and overall survival rate between two groups (85% vs 82%, P > 0.05).
There were no significant differences in chemosensitivity, clinical efficacy of neoadjuvant chemotherapy, side effects or long-term efficacy between THP and EPI. Both pirarubicin and epirubicin may be used as conventional chemotherapy in breast cancer.
比较吡柔比星（THP）与表柔比星（EPI）对原发性乳腺癌（PBC）细胞的化学敏感性，通过胶原凝胶滴包埋培养-药物敏感性试验（CD-DST）系统检测二者的化学敏感性差异；检测多西他赛+吡柔比星+环磷酰胺（TAC）与多西他赛+表柔比星+环磷酰胺（TEC）作为新辅助化疗方案的短期临床疗效及副作用差异，以及环磷酰胺+吡柔比星+氟尿嘧啶（CAF）与环磷酰胺+表柔比星+氟尿嘧啶（CEF）作为乳腺癌化疗方案的长期临床疗效差异；评估THP作为乳腺癌辅助化疗方案的可行性。
2008年1月至2009年1月，共收集129例新鲜乳腺癌样本。采用CD-DST试验检测培养的PBC细胞对THP和EPI的化学敏感性差异。139例IIb-IIIc期PBC患者随机分为两组：TAC组和TEC组。新辅助化疗4-6周期后，评估原发灶、腋窝淋巴结及副作用；收集2003年至2006年在我院接受治疗的1241例PBC患者的临床资料及生存状况，根据化疗方案分为CAF组和CEF组。比较两组的长期预后。
PBC细胞对THP和EPI的化学敏感性无显著差异（P = 0.743）；新辅助化疗的总有效率（RR）为87.8%；TAC组和TEC组的临床客观缓解率、病理完全缓解（pCR）、临床完全缓解（cCR）、临床部分缓解（cPR）及疾病稳定（SD）分别为88.7%、11.3%、28.2%、60.6%、11.3%和86.8%、10.3%、26.5%、60.3%、13.2%。两组间无显著差异（P > 0.05）。两组在白细胞减少、血小板减少、便秘、心脏毒性及肝肾功能障碍等副作用方面无显著差异（P > 0.05）；TAC组恶心、呕吐等胃肠道反应发生率低于TEC组（46.5% vs 66.2%，P = 0.019）；两组5年无病生存率（79% vs 78%）及总生存率无显著差异（85% vs 82%，P > 0.05）。
THP与EPI在化学敏感性、新辅助化疗临床疗效、副作用及长期疗效方面无显著差异。吡柔比星和表柔比星均可作为乳腺癌的常规化疗药物。
