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目的探讨培美曲赛联合铂类治疗晚期乳腺癌患者的疗效及安全性。方法选取2009年1月至2014年1月间收治的126例乳腺癌患者,根据患者采用化疗后的骨髓抑制程度分为观察组(62例)和对照组(64例)。观察组患者采用培美曲赛+顺铂治疗,对照组患者采用培美曲赛+奥沙利铂治疗,中位化疗为6个周期。根据实体瘤疗效评估标准进行疗效评价,观察培美曲赛联合铂类治疗晚期乳腺癌患者的疗效及不良反应。结果观察组和对照组患者的总有效率为29.0%和31.3%;观察组中50.0%患者处于疾病稳定状态,对照组中45.2%患者处于疾病稳定状态。126例患者经培美曲赛联合铂类化疗药物治疗,总有效率为30.3%,47.6%患者处于疾病稳定状态。126例患者中,随访12个月,82例(65.1%)患者存活,随访21个月时,50例(39.7%)患者存活。其中,观察组和对照组患者随访12个月的生存率为62.9%(39/62)和64.1%(41/64),随访21个月的生存率分别为38.7%(24/62)和40.6%(26/64),组间差异无统计学意义(P>0.05)。两组主要不良反应为乏力、骨髓抑制、皮疹和消化道不良反应,且多为Ⅰ~Ⅱ级,Ⅲ级以上不良反应率最高仅为15.9%。未出现肾功能损害及心功能损害,且两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论在晚期乳腺癌的治疗中,培美曲赛+顺铂与培美曲赛+奥沙利铂的疗效和不良反应相当,疗效较好,不良反应较轻。培美曲赛联合铂类治疗晚期乳腺癌患者值得临床推广。
Objective To investigate the efficacy and safety of pemetrexed combined with platinum in the treatment of patients with advanced breast cancer. Methods A total of 126 breast cancer patients who were treated between January 2009 and January 2014 were divided into the observation group (62 cases) and the control group (64 cases) according to the degree of myelosuppression after chemotherapy. Patients in the observation group were treated with pemetrexed + cisplatin, and patients in the control group were treated with pemetrexed + oxaliplatin. The median chemotherapy was 6 cycles. According to the evaluation criteria of curative effect of solid tumor, the curative effect and adverse reaction of pemetrexed combined with platinum on patients with advanced breast cancer were observed. Results The total effective rate was 29.0% in the observation group and 31.3% in the control group. In the observation group, 50.0% of the patients in the observation group were in stable condition, and 45.2% in the control group were in stable condition. Of 126 patients treated with pemetrexed combined with platinum-based chemotherapy, the total effective rate was 30.3%, 47.6% of patients were in stable condition. Of the 126 patients who were followed up for 12 months, 82 (65.1%) survived, and at 21 months of follow-up, 50 (39.7%) survived. Survival rates of observation group and control group at 12-month follow-up were 62.9% (39/62) and 64.1% (41/64), respectively. The survival rates at follow-up of 21 months were 38.7% (24/62) and 40.6 % (26/64), no significant difference between groups (P> 0.05). The main adverse reactions of two groups were fatigue, myelosuppression, rash and gastrointestinal adverse reactions, and mostly grade Ⅰ ~ Ⅱ, Ⅲ grade above the highest rate of adverse reactions was only 15.9%. There was no renal dysfunction and cardiac dysfunction, and there was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion In the treatment of advanced breast cancer, pemetrexed + cisplatin and pemetrexed + oxaliplatin have similar efficacy and adverse reactions, with better curative effect and less adverse reactions. Pemeimei match platinum treatment of advanced breast cancer patients worthy of clinical promotion.