Kreienberg R
Universitäts-Frauenklinik und Poliklinik, Klinikum Universität Ulm.
Praxis (Bern 1994). 1998 Apr 22;87(17):573-7.
Treatment of anthracycline-resistant metastatic breast cancer with new antineoplastic agents remains a challenge for the next future. The 5-year survival for this disease is only 15%, and hormonal and chemotherapeutic options remain essentially palliative. New treatment drugs or drug combinations are urgently needed to improve the prospects for patients with metastatic breast cancer, particularly for those with disease characteristics indicating a particularly poor prognosis. Taxanes are promising new drugs and have shown encouraging activity in patients with disease resistant to anthracyclines and in patients with visceral metastases, both with a poor prognosis. Paclitaxel (taxol) is applied with a dose of 175 mg/m2 in a 3 hour infusion and docetaxel (taxotere) with a dose of 100 mg/m2 q 3 weeks. Remission rates are expected between 6-30% for taxol and between 29-48% for docetaxel. Highly active in patients with anthracycline-resistant disease appears to be the vinca-alkaloid vinorelbine too. In patients treated with adriamycin objective remissions between 15-33% can be obtained. The long time known 5-fluorouracil comes to the third place of the effective drugs. Continuous infusion or addition of folic acid increases the intracellular efficacy and results in 5-53% objective remissions. In second-line chemotherapy platin-analogues together with etoposide, vincristine and 5-FU achieve partial or complete remissions between 19-37% for cisplatin containing and 5-12 for carboplatin containing combinations. This may eventually play a role especially if three drug combinations containing paclitaxel, epirubicin and vinorelbine will be used, which are reported to result in 20-33% complete response rates and 66% objective response. The indication for other new drugs like tomudex, topoisomerase-I-inhibitor and gemcitabine for anthracycline-resistant breast cancer remains to be established in multicenter studies.
使用新型抗肿瘤药物治疗蒽环类耐药转移性乳腺癌在未来一段时间内仍是一项挑战。这种疾病的5年生存率仅为15%，激素和化疗方案基本上仍只能起到姑息治疗的作用。迫切需要新的治疗药物或药物组合来改善转移性乳腺癌患者的前景，尤其是那些具有预后特别差的疾病特征的患者。紫杉烷类是很有前景的新药，已在对蒽环类耐药的患者以及内脏转移患者中显示出令人鼓舞的活性，这两类患者的预后均较差。紫杉醇（泰素）以175mg/m²的剂量静脉输注3小时，多西他赛（泰索帝）以100mg/m²的剂量每3周给药一次。紫杉醇的缓解率预计在6% - 30%之间，多西他赛的缓解率在29% - 48%之间。长春花生物碱长春瑞滨在蒽环类耐药疾病患者中似乎也具有高活性。在用阿霉素治疗的患者中，客观缓解率可达15% - 33%。早已为人所知的5 - 氟尿嘧啶是有效药物中的第三位。持续输注或添加叶酸可提高细胞内疗效，客观缓解率为5% - 53%。在二线化疗中，铂类类似物与依托泊苷、长春新碱和5 - 氟尿嘧啶联合使用，含顺铂的组合的部分或完全缓解率为19% - 37%，含卡铂的组合为5% - 12%。这最终可能会发挥作用，特别是如果使用含紫杉醇、表柔比星和长春瑞滨的三联药物组合，据报道其完全缓解率为20% - 33%，客观缓解率为66%。其他新药如托姆德克斯、拓扑异构酶 - I抑制剂和吉西他滨用于蒽环类耐药乳腺癌的适应证仍有待在多中心研究中确定。
