Efficacy And Prognosis Analysis Of Pemetrexed Combined With Cisplatin/Carboplatin For Patients With Metastatic Breast Cancer Not Responding To Anthracycline And Taxane

Objective:To assess antitumor activity and toxicity of pemetrexed combined with cisplatin/carboplatin in treating patients with metastatic breast cancer(MBC)who failed to respond to anthracycline and taxane.Methods:Collections of 58 patients with pemetrexed and cisplatin/carboplatin in metastatic breast cancer who failed to respond to anthracycline and taxane from December 2010 to November 2014 of The Tumor Affiliated Hospital of Guangxi Medical University.The patients were treated with pemetrexed 500mg/m2(intravenous;on day 1)and cisplatin 25 mg/m2(intravenous;on day 1～3)/carboplatin target area under the curve(AUC)5.0(intravenous;on day 1)with 21 days as a cycle.Efficacy and side effects were evaluated after two cycles of chemotherapy.Results:58 patients received pemetrexed and cisplatin/carboplatin chemotherapy,all of them were assessable for efficacy.13 cases(22.4%)got PR,27 cases(46.6%)were SD,18 cases(31.0%)had PD and no case achieved CR.The objective response rate(ORR)was 22.4%,the disease control rate(DCR)was 69.0%,and the median progression free survival(mPFS)was 5.8 months.one-year and two-year survival rate,was 69.0%and 49.3%,respectively.Univariate analysis showed that:HER-2/neutral assay、line of treatment and the number of metastatic sites associate with RR,HER-2 positive,the first-line treatment,and the number of metastatic sites<3 A have a higher RR;line of treatment and HER-2 Positive patients whether to use Herceptin affect PFS,Patient who have the first-line treatment and HER-2 Positive patients to use Herceptin have a longer PFS.The multivariate analysis revealed that line of treatment、the number of metastatic sites are the independent impactive factor of ORR,line of treatment and HER-2 Positive patients whether to use Herceptin are independent prognostic factors of PFS.Patients who got disease stabilization or response in combination chemotherapy continued receiving maintenance therapy,got mPFS of 11.7 months,and the patients who do not continue to receiving maintenance therapy,got mPFS of 6.5 months,the difference was statistically significant.The main toxic reactions were myelosuppression(75.9%),digestive tract reaction(67.2%),elevated transaminase(53.4%)and fatigue(43.1%).CTC hematologic toxicities were grade Ⅲ/Ⅳ leukopenia(15.5%/1.7%)and grade Ⅲ/Ⅳ neutropenia(6.9%/1.7%).Grade III thrombocytopenia and anemia were seen in 3.4%and 5.2%of patients,respectively.No grade IV non-hematologic toxicities occurred.Grade III non-hematologic toxicities were elevated transaminase(1.7%).Conclusion:1.Useing pemetrexed and cisplatin/carboplatin combination chemotherapy to treat metastatic breast cancer failed to previous chemotherapy with anthracycline and taxane,produced a good curative effect,adverse reactions can be tolerated.2.Line of treatment,the number of metastatic sites are the independent impactive factor of ORR.,line of treatment and HER-2 Positive patients whether to use Herceptin are independent prognostic factors of PFS.3.Patients’age,menopause status,Hormonal receptor status,ki-67 status,breast cancer molecular classification,ECOG PS and Visceral disease had no strong correlations with chemotherapeutic effect and mPFS.4.Patients who got disease stabilization or response continued receiving maintenance therapy,can obviously prolong the patient’s disease free survival time.