Hortobagyi G N
Semin Hematol. 1987 Apr;24(2 Suppl 1):56-61.
Salvage chemotherapy for metastatic breast cancer includes regimens for hormonal responsive patients and patients refractory to cyclophosphamide, methotrexate, and fluorouracil (CMF) or fluorouracil, doxorubicin, and cyclophosphamide (FAC). For hormone responsive patients, progestins, aminoglutethimide with hydrocortisone, and androgens provide second-line therapy and produce objective remissions in 50% of patients. Some patients respond to further hormonal manipulation. When metastatic disease becomes refractory, combination chemotherapy is the treatment of choice. For those patients refractory to CMF, salvage therapy should consist of single agents, such as mitomycin, doxorubicin, or vinblastine, or combinations of drugs not contained in the CMF regimen. As with single-agent therapy in previously untreated patients, remission durations are usually short. Two-drug combinations result in response rates from 30% to 50% and longer duration of remission. For patients refractory to FAC, doxorubicin is discontinued after reaching a cumulative dose, and therapy is continued with a CMF-type combination. Thus, both doxorubicin and methotrexate are used, and salvage chemotherapy is based on mitomycin and vinblastine. All agents used for salvage therapy of breast cancer may produce toxic effects. Appropriate surveillance and limiting the cumulative dose of drugs reduces the risk of irreversible toxic effects.
转移性乳腺癌的挽救性化疗包括针对激素反应性患者以及对环磷酰胺、甲氨蝶呤和氟尿嘧啶（CMF）或氟尿嘧啶、多柔比星和环磷酰胺（FAC）耐药患者的化疗方案。对于激素反应性患者，孕激素、氨基导眠能联合氢化可的松以及雄激素可提供二线治疗，约50%的患者会出现客观缓解。一些患者对进一步的激素治疗有反应。当转移性疾病变得难治时，联合化疗是首选治疗方法。对于那些对CMF耐药的患者，挽救性治疗应包括单药治疗，如丝裂霉素、多柔比星或长春碱，或CMF方案中未包含的药物组合。与先前未治疗患者的单药治疗一样，缓解期通常较短。两药联合的缓解率为30%至50%，缓解期更长。对于对FAC耐药的患者，多柔比星累积剂量达到一定程度后停用，继续使用CMF类联合方案治疗。因此，多柔比星和甲氨蝶呤都可使用，挽救性化疗以丝裂霉素和长春碱为基础。所有用于乳腺癌挽救性治疗的药物都可能产生毒性作用。适当的监测和限制药物累积剂量可降低不可逆毒性作用的风险。
