Johnson P A, Muss H, Bonomi P, Von Roenn J, Wolter J, Paschold E, Black W, Cooper M
University of Illinois, Carle Clinic, Urbana 61801.
Semin Oncol. 1988 Apr;15(2 Suppl 1):34-7.
The records of 133 patients treated with megestrol acetate as primary hormonal therapy for advanced breast cancer were reviewed retrospectively, using International Union Against Cancer (UICC) criteria for response. The median age was 65 years, 121 patients were over age 50, and the age range was 39 to 94 years. Response rates (complete response [CR] + partial response [PR]/total) by qualitative receptor level, with levels of 10 fmol/mg of protein considered positive, were as follows (ER = estrogen receptor, PgR = progesterone receptor): For ER + PgR+, 13 + 15/56 (50%); for those with one positive receptor, 0 + 12/47 (26%); for ER - PgR-, 0 + 0/12 (0%); and for receptor-unknown cases, 2 + 3/18 (14%). Response for ER less than 30 fmol/mg was 2 + 6/39 (21%); for ER 30 to 50, 1 + 5/16 (40%); and for ER greater than 50 fmol/mg, 11 + 15/56 (46%). For PgR less than 30, response was 0 + 6/37 (16%); for PgR 30 to 50 fmol/mg, 1 + 4/14 (36%); and for PgR greater than 50 fmol/mg, 12 + 13/54 (46%). For the 75 patients with a disease-free interval (DFI) of 2 years or less, the response rate was 5 + 1/75 (8%), and for the 58 patients with DFI greater than 2 years, 10 + 12/60 (37%). For patients with prior chemotherapy, 3 + 8/49 (22%) had an objective response. For those with no prior chemotherapy, 12 + 19/84 (37%) responded. Response by dominant site of disease was as follows: soft tissue 12 + 9/43 (49%), bone 2 + 13/49 (31%), viscera 2 + 5/41 (17%). Of these seven patients with visceral dominant disease who responded, all had PgR levels greater than 50 fmol/mg, all but one had an ER level over 100 fmol/mg, all but one were over age 65, and all but two received no prior chemotherapy. We conclude that megestrol acetate is effective initial hormonal therapy for patients with advanced breast cancer. It may have some role to play in the treatment of carefully selected cases with visceral disease.
回顾性分析了133例接受醋酸甲地孕酮作为晚期乳腺癌一线激素治疗患者的记录，采用国际抗癌联盟（UICC）的疗效标准。患者年龄中位数为65岁，121例患者年龄超过50岁，年龄范围为39至94岁。根据定性受体水平（蛋白质水平≥10 fmol/mg视为阳性）计算的缓解率（完全缓解[CR]+部分缓解[PR]/总数）如下（ER=雌激素受体，PgR=孕激素受体）：ER+PgR+者，13+15/56（50%）；单一阳性受体者，0+12/47（26%）；ER - PgR -者，0+0/12（0%）；受体情况未知者，2+3/18（14%）。ER低于30 fmol/mg者的缓解率为2+6/39（21%）；ER为30至50者，1+5/16（40%）；ER大于50 fmol/mg者，11+15/56（46%）。PgR低于3者的缓解率为0+6/37（16%）；PgR为30至50 fmol/mg者，1+4/14（36%）；PgR大于50 fmol/mg者，12+13/54（46%）。75例无病生存期（DFI）为2年或更短的患者，缓解率为5+1/75（8%）；58例DFI大于2年的患者，缓解率为10+12/60（37%）。接受过化疗的患者中，3+8/49（22%）有客观缓解。未接受过化疗的患者中，12+19/84（37%）有缓解。根据主要病灶部位的缓解情况如下：软组织为12+9/43（49%），骨为2+13/49（31%），内脏为2+5/41（1%）。这7例有内脏主要病灶且有缓解的患者中，所有患者的PgR水平均大于50 fmol/mg，除1例患者外所有患者的ER水平均超过了100 fmol/mg，除1例患者外所有患者年龄均超过65岁，除2例患者外所有患者均未接受过化疗。我们得出结论，醋酸甲地孕酮是晚期乳腺癌患者有效的初始激素治疗药物。在精心挑选的内脏疾病患者的治疗中可能有一定作用。
