| Yannan Zhao,Biyun Wang. Systemic chemotherapy for metastatic breast cancer. Oncol Transl Med, 2015, 1: 226-232. |
| 转移性乳腺癌的全身化疗现状和进展 |
| Systemic chemotherapy for metastatic breast cancer |
| Received:December 29, 2014 Revised:September 29, 2015 |
| DOI：10.1007/s10330-014-0048-6 |
| 中文关键词: 化疗；转移性乳腺癌；单药化疗；联合化疗；三阴性乳腺癌；维持治疗 |
| 英文关键词: chemotherapy; metastatic breast cancer (MBC); single-agent chemotherapy; combination chemotherapy; triple-negative breast cancer; maintenance treatment |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Yannan Zhao | Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai,200032,China | 14211230018@fudan.edu.cn | | Biyun Wang* | Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai,200032,China | wangbiyun0107@hotmail.com |
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| 中文摘要: |
| 乳腺癌是全球妇女最常见的恶性肿瘤，近年来也跃居中国女性发病率之首。转移性乳腺癌的治疗决策受到各种因素的影响。对于HR阴性转移性乳腺癌、HR阳性伴有症状的内脏转移或疾病发展迅速的患者首选细胞毒类药物的全身化疗。单药序贯化疗与联合化疗有着相似的总体生存率以及生活质量。蒽环类通常被认为是转移性乳腺癌一线治疗的首选药物，而紫杉烷类药物是蒽环类药物或方案耐药后的首选。当患者在接受过蒽环类和紫杉烷的治疗后疾病进展或毒性不能耐受时，可以选择的药物有卡培他滨、长春瑞滨和吉西他滨。艾日布林和伊沙匹隆也是有效的单药。而在疾病进展迅速，有威胁生命的内脏转移，或需要控制症状时，联合化疗会更加适用，能提高总体有效率以及疾病进展时间。在辅助/新辅助治疗中已经应用过蒽环类药物的患者中，可首选紫杉类药物的方案，如多西他赛联合卡培他滨和吉西他滨联合紫杉醇。铂类为基础的方案是治疗转移性三阴性乳腺癌的合理选择。与化疗药物联合使用的靶向药物，如Iniparib，贝伐珠单抗，西妥昔单抗，其疗效还有待证明。维持治疗在临床上广泛推广。一项韩国的多中心、III期临床试验中，一线化疗吉西他滨联合紫杉醇的患者维持GT 治疗可显著提高PFS 和OS。我国开展的一系列研究结果显示，以卡培他滨为基础的联合化疗继以卡培他滨单药维持治疗（X Based X）成为晚期乳腺癌全程管理模式下的合理选择。 |
| 英文摘要: |
| Breast cancer is the leading cause of cancer among women worldwide and the most common cancer in China. Many factors influence the treatment strategy for metastatic breast cancer (MBC). Chemotherapy should be administered to patients with hormone receptor-negative tumors, symptomatic visceral metastasis, and a short disease-free interval. Sequential single-agent chemotherapy has similar efficacy as combination agents in terms of overall survival and quality of life. Anthracyclines are the cornerstone of first-line treatment for MBC, and taxanes represent the second treatment option after resistance. When progression or intolerable toxicity occurs after optimal treatment, the alternative treatments include capecitabine, vinorelbine, and gemcitabine. Ixabepilone and eribulin are relatively new effective single agents. A combination of cytotoxic agents for patients with rapid clinical progression can further improve the overall response rate and time to progression compared to single-agent treatment. For patients with MBC who were pretreated with anthracyclines in the eoadjuvant/adjuvant setting, a taxane-containing regimen such as docetaxel plus capecitabine or gemcitabine plus paclitaxel should be administered. Platinum-based therapies such as cisplatin or carboplatin have a role in the treatment of triple-negative breast cancer. Meanwhile, the efficacy of the addition of targeted drugs such as iniparib, bevacizumab, and cetuximab to chemotherapy remains unproven. Maintenance chemotherapy is routinely recommended in clinical practice at present. Patients who were previously treated with paclitaxel and gemcitabine have better progression-free and overall survival with maintenance chemotherapy according to a Korean phase III clinical trial. Sequential maintenance treatment with capecitabine monotherapy after capecitabine-based combination chemotherapy (X-based X) appears favorable based on a series of domestic studies. |
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