The Therapeutic Effect Of Capecitabine On The Recurrence And Metastasis Of Tri-negative Breast Cancer

【Background and Objective】: Breast cancer has become the most common malignant tumor in the life and health of modern women.Worldwide,about 1.2 million women are sickened each year,and about half a million die from breast cancer.The incidence of breast cancer is the highest in women in developed countries.Compared with developed countries,the incidence of breast cancer in China is not high,but the incidence of breast cancer in recent years has been increasing.Carey according to the analysis of immunohistochemical detection results,breast cancer can be divided into 4 groups,molecular classification:LuminalA type:ER(+)or PR(+)and HER 2(-),LuminalB type:ER(+)or PR(+)and HER 2(+),HER 2 expression type:ER(-),PR(-)and HER 2(+)and three Yin(triple negative breast cancer)type: ER(-),PR(-)and HER 2(-).Is now generally accepted applications Perou etc.based on the cluster analysis method of gene expression profiles of breast cancer can be divided into five kinds of molecular classification,namely(1)the Luminal type:ER/PR +,(2)HER 2 expression type: ER,PR,and HER2 +,(3)Basal hominins-like type: ER,PR,and HER2-,(4)Normal-like.Luminal type is divided into Luminal-A(Ki-67≤14% and her-2),Luminal-B(Ki-67>14% or/and her-2+),and Basal-like and Normal breast-like breast cancers are mainly distinguished by the expression of myoepithelial markers.Surgery、chemotherapy、endocrine therapy、targeted therapy,and radiotherapy are the treatments for breast cancer.With the development of science and technology,the early diagnosis technology and the effective treatment means the great progress,the mortality of breast cancer shows the decline trend.In reality,there are still a large number of patients who relapse and metastasis every year,which can cause clinical problems for treatment and further treatment.One of the molecular types of breast cancer:triple-negative breast cancer(TNBC),as a special type of breast cancer,has attracted more and more attention.ER:estrogen receptor(estrogen receptor),PR:progesterone receptor(progesterone receptor)and her-2:human epidermal growth factor receptor2.About 15%-20% of breast cancer,characterized by early onset age(<40 years old),late stage,high incidence among African American women.TNBC a highly invasive,easy to relapse,special malignant tumor with poor prognosis,the type of breast cancer is still a lack of molecular target and endocrine treatment indications,generally prone to early metastasis,recurrence and more time within 1 to 3 years after the original,mortality is higher,within five years after the recurrence rate dropped significantly.TNBC is more likely to invade the lungs,brain and other organs than other types of breast cancer,and bone metastasis is relatively low.Have a retrospective study showed that about more than 200 patients with TNBC.TNBC starting transfer parts associated with prognosis:starting the part of the transfer for the prognosis of pulmonary metastasis is the best(median OS16.6 months),the second bone,liver,respectively,the prognosis of patients with brain metastases from worst.Due to the poor efficacy of endocrine therapy and anti-her-2 targeted therapy,chemotherapy is the primary means of treating metastatic.TNBC.There is no effective maintenance therapy after routine chemotherapy,which may be one of the reasons for the poor prognosis in patients with triple-negative breast cancer.In addition to intensive doses of chemotherapy,patients with triple-negative breast cancer with recurrent metastasis need a treatment regimen that is sustained for a long period of time.There was a study that used capecitabine to maintain treatment for recurrent metastatic tri-negative breast cancer.Moreover,capecitabine has been used as an oral chemotherapy drug in gastric cancer,colon cancer and other tumors,and the therapeutic effect is significant.The national comprehensive cancer network(NCCN)guidelines recommend capecitabine as a first-line drug for the treatment of metastatic breast cancer,especially in anthracycline and taxus,which is resistant to metastatic breast cancer.Multiple clinical trials also demonstrated the efficacy of capecitabine in multilinear treatment of advanced breast cancer:objective remission rate(ORR)of 20%-45%,no progress survival(PFS)4.0-4.8 months.In this paper,the efficacy and safety of capecitabine for the recurrence and metastatic tri-negative breast cancer were discussed.【Methods】:A retrospective,randomized,controlled study was conducted.Selected from September 1,2014 to March 31,2017,the first affiliated hospital of zhengzhou university three negative breast cancer recurrence,transfer cases,60 patients with physical state(the performance status,PS)are < 2 left ventricular ejection fraction(left ventricular ejection fraction,LVEF)were > 50%.The 30 cases were randomly divided into experimental group and control group 30 cases,the experimental group was in the process of treatment should include capecitabine combination chemotherapy regimens and effective treatment,after the treatment with combination chemotherapy to continue using capecitabine for maintenance treatment,until the disease progress again.The control group stopped chemotherapy after effective treatment and stable condition.The experimental group: the first-line combined chemotherapy regimens were administered with the drug instruction manual,and the reference guide was used,and capecitabine was administered 2 times per day,with a dose of 1250mg/m2,and 0 after the meal.5h oral administration,1 week after 2 weeks of treatment,1 cycle for 3 weeks.Evaluation of efficacy was performed after every 2 cycles.After 4 ~ 8 cycles of chemotherapy,the condition was reduced to a stable condition,and capecitabine was carried out to maintain the treatment,and the use of the drug was followed until the disease progressed again.The dosage should be adjusted according to the hematology or non-hematologic toxicity in the treatment process,and the treatment should be stopped once the toxic reaction may be life-threatening.The treatment cannot include simultaneous radiotherapy,if the disease progresses,the treatment program is aborted.Control group: the dose of first-line combined chemotherapy was used according to the drug instructions,or the reference guide was used,and the dosage,usage and treatment precautions of capecitabine were the same as those in the experimental group.After 4 ~ 8 cycles of chemotherapy,the condition was reduced to stable and stopped chemotherapy.The clinical efficiency of the two groups of patients was statistically analyzed,and the adverse reactions during the time of redevelopment and the duration of the treatment were observed.Analysis of clinical benefit rate(CBR),adverse reactions and unprogression-free survival(PFS).PFS is calculated from the date of treatment until the date of the disease progression or the date of death.SPSS17.0 statistical software was used for statistical analysis,and the clinical results were statistically analyzed.Evaluation data,t test used to compare group parameters and quantitative data and descriptive statistical methods(mean,standard deviation,frequency).Chi square test and Fisher exact chi-square test are used to compare qualitative data.There was a statistical significance p<0.05.【Results】1.Comparison of therapeutic effects between the two groups: the effectiveness of the experimental group(50.0%)significantly higher than the control group(40.Thedifference was statistically significant.329,P = 0.039).2.The time of progression of the two groups of patients: PFS in the experimental group was 2.3 ~ 19.3 months,the average PFS was 6.6 months,and the median PFS was 10.6 months.In the control group,PFS was 4.3 months,and the time difference between the two groups was statistically significant(P=0).026).3.Group maintenance therapy in patients with adverse reactions: the experimental group in the maintenance treatment of patients with adverse reactions mainly in bone marrow suppression,the brotherhood of syndrome,liver and kidney function damage,gastrointestinal tract reaction,withdrawal or treatment all can be improved accordingly.36.6%Bone marrow suppression was found in of patients,46.7% of the patients had sibling syndrome,40.0%Liver and kidney function damage in of patients,The digestive tract reaction occurred in 60.0% of patients.【Conclusion】:1.Capecitabine,as a maintenance treatment for the recurrence of tri-negative breast cancer,can effectively improve the symptoms and delay the progression of the disease.2.The adverse reaction of capecitabine maintenance therapy was mainly the digestive tract reaction.