Crown J
Medical Oncology Unit, St Vincent's Hospital, Dublin, Ireland.
Semin Oncol. 1998 Oct;25(5 Suppl 12):12-7.
There has been a gradual evolution in the philosophy of treatment for metastatic breast cancer. It has long been known that endocrine therapy, radiotherapy, and chemotherapy could offer substantial palliative benefits to patients with symptomatic metastases. While these quality of life issues remain crucially important, it is increasingly recognized that the survival of patients with this condition also appears to be improving as a result of therapeutic advances. Chemotherapy appears to prolong the median duration of survival of patients, probably by approximately 1 year. It is the common experience of oncologists that patients with life-threatening visceral metastases may be rescued with chemotherapy. Until recently, doxorubicin was considered to be the most active single agent available for the treatment of metastatic breast cancer, with response rates of 40% to 50% commonly reported. Other active agents include cisplatin, cyclophosphamide, 5-fluorouracil, ifosfamide, methotrexate, mitomycin-C, mitoxantrone, vinblastine, and vincristine. Anthracycline-containing regimens were found to be more effective than combinations without anthracyclines, but overall, it is not clear whether combinations are superior to high-dose single-agent anthracyclines. Since the development of the cyclophosphamide/doxorubicin/5-fluorouracil regimen, no major improvements on combination regimens have been achieved until the discovery of the taxoids. These new agents have substantial activity against metastatic breast cancer. The results of phase II studies suggest that of these agents, used at the recommended doses, docetaxel (Taxotere, Rhône-Poulenc Rorer, Antony, France) may be the most active, achieving an objective response rate of 59% in minimally pretreated patients and 47% when used in second-line treatment. In these studies, docetaxel was given at the standard dose of 100 mg/m2 over 1 hour. Recent results from phase III studies in which individual studies with docetaxel and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) have been compared with standard therapies indicate that docetaxel is the most active single agent in metastatic breast cancer.
转移性乳腺癌的治疗理念一直在逐步演变。长期以来，人们都知道内分泌治疗、放射治疗和化学疗法能够为有症状转移的患者带来显著的姑息疗效。虽然这些生活质量问题仍然至关重要，但人们越来越认识到，由于治疗进展，这种疾病患者的生存率也似乎在提高。化学疗法似乎能延长患者的中位生存期，可能延长约1年。肿瘤学家的普遍经验是，患有危及生命的内脏转移的患者可以通过化疗得到救治。直到最近，阿霉素仍被认为是治疗转移性乳腺癌最有效的单一药物，通常报道的缓解率为40%至50%。其他活性药物包括顺铂、环磷酰胺、5-氟尿嘧啶、异环磷酰胺、甲氨蝶呤、丝裂霉素-C、米托蒽醌、长春碱和长春新碱。含蒽环类药物的方案比不含蒽环类药物的联合方案更有效，但总体而言，联合方案是否优于高剂量单一蒽环类药物尚不清楚。自从环磷酰胺/阿霉素/5-氟尿嘧啶方案出现以来，直到紫杉烷类药物被发现，联合方案都没有取得重大进展。这些新药对转移性乳腺癌有显著活性。II期研究结果表明，在推荐剂量下使用这些药物时，多西他赛（泰索帝，法国罗纳普朗克乐安公司，安东尼）可能是最具活性的，在预处理最少的患者中客观缓解率达到59%，二线治疗时为47%。在这些研究中，多西他赛以100mg/m²的标准剂量静脉滴注1小时。近期III期研究的结果将多西他赛和紫杉醇（泰素；百时美施贵宝公司，新泽西州普林斯顿）的个体研究与标准疗法进行了比较，结果表明多西他赛是转移性乳腺癌中最具活性的单一药物。
