Gregory W M, Smith P, Richards M A, Twelves C J, Knight R K, Rubens R D
Imperial Cancer Research Fund, Guy's Hospital, London, UK.
Br J Cancer. 1993 Nov;68(5):988-95. doi: 10.1038/bjc.1993.467.
The outcome for 758 consecutive patients who had received one or more chemotherapy regimens for recurrent or metastatic breast cancer is presented. The response rate following first line treatment was 34%. Median duration of response was 7.8 months, median time to progression was 3.7 months and median survival was 7.9 months. The only factor predicting for response, of factors recorded at presentation and at initiation of chemotherapy, was the use of anthracycline based regimens, though this may reflect the patient selection policy. Initial disease free interval, presence of liver metastases and use of anthracyclines were significantly related to time to progression. Several factors related to survival following first chemotherapy, but anthracycline usage showed only a very weak correlation. One third of patients (249/758) received two or more chemotherapy regimens. The response rate (16%) and median time to progression (2.3 months) were significantly worse than for first line treatment. The outcome after third line chemotherapy was very similar to that observed following second line treatment. Achievement of an objective response with first line chemotherapy predicted for second response, but with insufficient power to be of use in selecting patients for subsequent chemotherapy. Time to progression following first line chemotherapy did not influence that after second line treatment.
本文呈现了758例连续接受一种或多种化疗方案治疗复发性或转移性乳腺癌患者的治疗结果。一线治疗后的缓解率为34%。中位缓解持续时间为7.8个月，中位疾病进展时间为3.7个月，中位生存期为7.9个月。在化疗开始时记录的因素中，唯一预测缓解的因素是使用蒽环类药物为基础的方案，不过这可能反映了患者的选择策略。初始无病间期、肝转移的存在以及蒽环类药物的使用与疾病进展时间显著相关。与首次化疗后的生存相关的因素有多个，但蒽环类药物的使用仅显示出非常微弱的相关性。三分之一的患者（249/758）接受了两种或更多的化疗方案。其缓解率（16%）和中位疾病进展时间（2.3个月）显著低于一线治疗。三线化疗后的结果与二线治疗后观察到的结果非常相似。一线化疗实现客观缓解可预测二线缓解，但预测效力不足，无法用于选择后续化疗的患者。一线化疗后的疾病进展时间并不影响二线治疗后的疾病进展时间。
