帕妥珠单抗与曲妥珠单抗联合化疗在早期乳腺癌新辅助治疗中的疗效评价

doi:10.3877/cma.j.issn.1674-0785.2020.05.005

中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 344 -348. doi: 10.3877/cma.j.issn.1674-0785.2020.05.005

所属专题：乳腺疾病；文献；

乳腺癌·临床研究

帕妥珠单抗与曲妥珠单抗联合化疗在早期乳腺癌新辅助治疗中的疗效评价

程元甲¹, 徐玲¹, 叶京明¹, 张虹², 张爽², 刘荫华¹, 李宗翰¹^,^†(

)

^1. 100034　北京大学第一医院乳腺疾病中心
^2. 100034　北京大学第一医院病理科

收稿日期:2020-02-04 出版日期:2020-05-15
通信作者: 李宗翰
基金资助:
国家重点研发计划(2016YFC0901302); 北京医学奖励基金会基金项目(YXJL-2016-0040-0065)

Therapeutic effects of chemotherapy combined with pertuzumab and trastuzumab in neoadjuvant treatment of early breast cancer

Yuanjia Cheng¹, Ling Xu¹, Jingming Ye¹, Hong Zhang², Shuang Zhang², Yinhua Liu¹, Zonghan Li¹^,^†()

^1. Breast Disease Center, Peking University First Hospital, Beijing 100034, China
^2. Department of Pathology, Peking University First Hospital, Beijing 100034, China

Received:2020-02-04 Published:2020-05-15
Corresponding author: Zonghan Li
About author:
Corresponding author: Li Zonghan, Email: lzhan0315@163.com

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引用本文：

程元甲, 徐玲, 叶京明, 张虹, 张爽, 刘荫华, 李宗翰. 帕妥珠单抗与曲妥珠单抗联合化疗在早期乳腺癌新辅助治疗中的疗效评价[J]. 中华临床医师杂志(电子版), 2020, 14(05): 344-348.

Yuanjia Cheng, Ling Xu, Jingming Ye, Hong Zhang, Shuang Zhang, Yinhua Liu, Zonghan Li. Therapeutic effects of chemotherapy combined with pertuzumab and trastuzumab in neoadjuvant treatment of early breast cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(05): 344-348.

目的

探讨人表皮生长因子受体2（HER-2）阳性早期乳腺癌患者采用曲妥珠单抗（H）＋帕妥珠单抗（P）联合多西他赛（T）＋卡铂(C），即TCHP方案新辅助治疗的临床疗效。

方法

回顾性分析2019年3月至2019年12月北京大学第一医院乳腺疾病中心接受TCHP方案新辅助治疗并完成手术的HER-2阳性乳腺癌患者的临床资料。新辅助治疗期间利用MRI行临床疗效评价，手术后病理采用Miler-Payne标准评价。分析TCHP方案在HER-2阳性乳腺癌患者中的疗效。

结果

10例HER-2阳性患者符合入组标准，均为女性，中位年龄48岁。初始TCHP方案9例，TCH方案1周期后因帕妥珠单抗临床可及更改为TCHP方案1例。病理完全缓解率（pCR/G5）80.0%（8/10），未出现影响治疗的严重不良反应。

结论

TCHP方案是HER-2阳性乳腺癌患者有效的新辅助治疗方案，不良反应可控。

关键词: 乳腺肿瘤, 受体，表皮生长因子, 靶向治疗, 帕妥珠单抗

Objective

To investigate the clinical effects of docetaxel (T)+ carboplatin (C) combined with trastuzumab (H)+ pertuzumab (P) in the treatment of human epidermal growth factor receptor-2 (HER-2) positive early breast cancer.

Methods

From March 2019 to December 2019, the clinical data of HER-2 positive breast cancer patients who received new adjuvant treatment of TCHP and underwent surgery at the Breast Disease Center of Peking University First Hospital were analyzed retrospectively. During the neoadjuvant treatment, magnetic resonance imaging was used to evaluate the clinical effects, and the Miler-Payne grading system was used to evaluate the postoperative pathology. The clinical effects of TCHP in HER-2 positive breast cancer patients were analyzed.

Results

A total of 10 HER-2 positive patients were enrolled in this study. All of them were female, with a median age of 48 years old. There were nine cases who received TCHP treatment initially, and one case was switched to the TCHP regimen after the first cycle of TCH treatment. The pathologic complete response rate was 80% (8/10).

Conclusion

TCHP is an effective new adjuvant therapy for HER-2 positive breast cancer patients, with controllable side effects.

Key words: Breast neoplasms, Receptor, epidermal growth factor, Targeted therapy, Pertuzumab

表1 10例HER-2阳性乳腺癌患者的临床病理特征

项目		例数	百分比（%）
年龄（岁）		?	?
?	<30	1	10.0
?	30~<40	1	10.0
?	40~<50	4	40.0
?	50~<60	2	20.0
?	60~<70	2	20.0
月经状态		?	?
?	绝经前	6	60.0
?	绝经后	4	40.0
肿瘤分期		?	?
?	T1	1	10.0
?	T2	7	70.0
?	T3	2	20.0
淋巴结状态		?	?
?	N0	2	20.0
?	N1+N1mi	6	60.0
?	N2	2	20.0
?	N3	0	0.0
分子分型		?	?
?	Luminal B（HER-2阳性）型	4	40.0
?	HER-2阳性型	6	60.0
组织学分级		?	?
?	G1	0	0
?	G2	4	40.0
?	G3	6	60.0

表1 10例HER-2阳性乳腺癌患者的临床病理特征

项目		例数	百分比（%）
年龄（岁）		?	?
?	<30	1	10.0
?	30~<40	1	10.0
?	40~<50	4	40.0
?	50~<60	2	20.0
?	60~<70	2	20.0
月经状态		?	?
?	绝经前	6	60.0
?	绝经后	4	40.0
肿瘤分期		?	?
?	T1	1	10.0
?	T2	7	70.0
?	T3	2	20.0
淋巴结状态		?	?
?	N0	2	20.0
?	N1+N1mi	6	60.0
?	N2	2	20.0
?	N3	0	0.0
分子分型		?	?
?	Luminal B（HER-2阳性）型	4	40.0
?	HER-2阳性型	6	60.0
组织学分级		?	?
?	G1	0	0
?	G2	4	40.0
?	G3	6	60.0

表2 10例HER-2阳性乳腺癌患者新辅助治疗期间不良反应情况

不良反应	1级（例）	2级（例）	3级（例）	百分比（%）
恶心	4	1	1	60
呕吐	4	0	1	50
厌食	2	1	1	40
味觉改变	5	1	0	60
视力下降	1	0	0	10
失眠	4	0	0	40
疲劳乏力	8	1	0	90
肌痛	3	1	0	40
骨痛	4	1	0	50
腹泻	5	3	0	80
便秘	3	2	0	50
口腔溃疡	1	0	0	10
手足麻木	1	2	0	30
心悸	1	0	0	10
骨髓抑制	0	2	1	30

表2 10例HER-2阳性乳腺癌患者新辅助治疗期间不良反应情况

不良反应	1级（例）	2级（例）	3级（例）	百分比（%）
恶心	4	1	1	60
呕吐	4	0	1	50
厌食	2	1	1	40
味觉改变	5	1	0	60
视力下降	1	0	0	10
失眠	4	0	0	40
疲劳乏力	8	1	0	90
肌痛	3	1	0	40
骨痛	4	1	0	50
腹泻	5	3	0	80
便秘	3	2	0	50
口腔溃疡	1	0	0	10
手足麻木	1	2	0	30
心悸	1	0	0	10
骨髓抑制	0	2	1	30

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