孕激素类药物解救治疗芳香化酶抑制剂耐药的转移性乳腺癌的临床研究

马焱; 吴世凯; 孟祥颖; 孙冰; 杜萌; 王涛; 张少华; 江泽飞; 宋三泰

doi:10.3969/j.issn.1000-8179.2012.08.006

孕激素类药物解救治疗芳香化酶抑制剂耐药的转移性乳腺癌的临床研究

Effects of Progesterone on Metastatic Breast Cancer Resistant to Aromatase Inhibitors

摘要

摘要:
目的评价孕激素类药物解救治疗第三代芳香化酶抑制剂(AIs)耐药的复发转移性乳腺癌的临床疗效。
方法回顾性分析了本院自2000年1月至2010年12月, 87例接受孕激素类药物解救治疗AIs耐药的复发转移性乳腺癌的临床资料, 对临床疗效、影响疗效的因素以及不同孕激素类药物疗效差别等进行了分析。
结果 87例孕激素类药物解救治疗第三代AIs耐药的复发转移性乳腺癌患者, 临床获益率21.8%, 中位无进展生存期(PFS)3.0(2.5~3.5)个月。第三代AIs解救治疗是否获益与孕激素类药物PFS无关(P=0.796), 第三代AIs未获益者后接受孕激素类药物解救治疗仍然有22.8%患者临床获益。两种孕激素类药物甲羟孕酮、甲地孕酮有效率、临床获益率、PFS无差异(P=0.595, 0.737, 0.664)。Cox多因素分析显示孕激素类药物PFS与术后病理分型、同侧腋窝淋巴结转移状态、年龄、ER/PR状态、Her-2状态、是否接受辅助治疗等因素均无关相关性。
结论孕激素类药物是解救治疗芳香化酶抑制剂(AIs)耐药的转移性乳腺癌的重要治疗选择。

Abstract:
Objective This study evaluates the effect of progesterone on metastatic breast cancer resistant to aromatase inhibitors.
Methods The epidemio-clinical records (i.e., clinical effects, influencing factors, and difference between medroxyprogesterone and megestrol) of metastatic breast cancer patients resistant to aromatase inhibitors and those who underwent progesterone therapy were an- alyzed retrospectively.
Results The clinical benefit rate of progesterone was 21.8 %, and the median progression free survival (PFS). (P = 0.737). Even if the third generation aromatase irLhibitors were not benefited, 22, B % of the patients obtained a benefit through pro- gesterone therapy. Moreover, no difference was observed between the effects of medroxyprogesterone and megestrol in response rate, clinical benefit rate, and PFS (P = 0.595; P = 0.737; P = 0.664). Cox regression showed that the PFS of progesterone was not associat- ed with pathological type, lymph node metastatic status, age, estrogen/progesterone receptor status, Her-2 status, or adjuvant therapy.
Conclusions Progesterone is a good choice of treatment for metastatic breast cancer patients resistant to aromatase inhibitors.

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