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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (11) : 1062 -1067. doi: 10.3877/cma.j.issn.1674-0785.2022.11.006

所属专题: 乳腺疾病

乳腺癌·临床研究

双靶联合化疗药物在HER2阳性乳腺癌新辅助治疗中的疗效及其影响因素
崔军威1, 刘荫华2, 刘晓岭1, 胡艺冰1,(), 胡慧1,()   
  1. 1. 518036 深圳,北京大学深圳医院乳腺外科
    2. 100034 北京,北京大学第一医院乳腺疾病诊疗中心
  • 收稿日期:2022-05-02 出版日期:2022-11-15
  • 通信作者: 胡艺冰, 胡慧
  • 基金资助:
    吴阶平医学基金会临床科研专项资助(320.6750.2021-10-96); 广东省医学科学技术研究项目(A2020288)

Efficacy and safety of trastuzumab and pertuzumab combined with chemotherapy in neoadjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer

Junwei Cui1, Yinhua Liu2, Xiaoling Liu1, Yibing Hu1,(), Hui Hu1,()   

  1. 1. Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
    2. Breast Disease Center, Peking University First Hospital, Beijing 100034, China
  • Received:2022-05-02 Published:2022-11-15
  • Corresponding author: Yibing Hu, Hui Hu
引用本文:

崔军威, 刘荫华, 刘晓岭, 胡艺冰, 胡慧. 双靶联合化疗药物在HER2阳性乳腺癌新辅助治疗中的疗效及其影响因素[J/OL]. 中华临床医师杂志(电子版), 2022, 16(11): 1062-1067.

Junwei Cui, Yinhua Liu, Xiaoling Liu, Yibing Hu, Hui Hu. Efficacy and safety of trastuzumab and pertuzumab combined with chemotherapy in neoadjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1062-1067.

目的

探究曲妥珠单抗和帕托珠单抗联合化疗对人表皮生长因子受体2(HER2)阳性乳腺癌新辅助治疗的效果。

方法

回顾性分析2019年1月至2021年12月在北京大学深圳医院进行新辅助治疗的49例HER2阳性乳腺癌患者的临床资料。根据治疗方式分为2线,2组分别使用TCbHP或EC序贯THP双靶联合化疗方案,所有患者均完成新辅助及手术治疗,对新辅助化疗后获病理完全缓解(PCR)与未完全缓解(非PCR)的两组患者的临床病理指标进行比较。

结果

入组患者年龄(45.22±9.17)岁。25例患者接受TCbHP方案,24例患者接受EC序贯THP方案,其中32例(65.3%)患者化疗后病理评估为PCR。TCbHP方案组PCR率为76.0%(19/25),高于EC序贯THP方案组的54.2%(13/24),但差异无统计学意义(P>0.05)。新辅助化疗后PCR组患者相关临床指标中,雌激素受体(ER)、孕激素受体(PR)阳性比例低于非PCR组患者(均P<0.05),两组患者间年龄、肿瘤分期、Ki67、分子分型以及化疗方案间差异均无统计学意义(均P>0.05);TCbHP方案组和EC序贯THP方案组患者的ER和分子分型之间的差异有统计学意义(均P<0.05)。化疗相关不良反应中,TCbHP方案组患者出现血小板减少及肾功能损伤的比例高于EC序贯THP方案组患者(均P<0.05),其他不良反应两组差异均无统计学意义(均P>0.05)。

结论

双靶药物联合化疗对HER2阳性乳腺癌新辅助治疗的效果较好,TCbHP方案与EC序贯THP方案PCR比率相似,但前者血小板减少及肾功能损伤不良反应较高,两种方案均有较好的心脏安全性。

Objective

To evaluate the efficacy and safety of trastuzumab and pertuzumab combined with chemotherapy in neoadjuvant therapy for human epidermal growth factor receptor 2 (HER2) positive breast cancer.

Methods

A retrospective study was performed on cases of HER2-positive breast cancer treated with neoadjuvant therapy at Peking University Shenzhen Hospital from January 2019 to December 2021. The patients were divided into two groups to receive either the TCbHP regimen or the EC-THP regimen for neoadjuvant chemotherapy, respectively. All patients underwent neoadjuvant and surgical treatment. The clinicopathological parameters were compared between patients with pathological complete response (pCR) and those with non-complete response (non-PCR) after neoadjuvant chemotherapy.

Results

The mean age of the patients was (45.22±9.17) years. Twenty-five patients received the TCbHP regimen and 24 received the EC-THP regimen. The overall pCR rate was 65.3% (32/49). The pCR rate was 76.0% (19/25) among patients receiving the TCbHP regimen and 54.2% (13/24) among those receiving the EC-THP regimen (P>0.05). The proportion of patients with positive ER and PR status in the PCR group was lower than that of the non-PCR group after neoadjuvant chemotherapy (P<0.05 for both), though there was no significant difference in age, tumor stage, Ki67 index, molecular type, or chemotherapy regimens between the two groups (P>0.05 for all). There were significant differences in ER status and molecular type between the TCbHP regimen group and EC-THP regimen group (P<0.05 for both). Compared with the EC-THP group, the incidence of thrombocytopenia and renal injury was higher in the TCbHP group (P<0.05 for both), but there was no significant difference in the incidence of other adverse events between the two groups (P>0.05 for all).

Conclusion

Both the TCbHP and EC-THP regimens may be useful neoadjuvant treatments for HER2-positive breast cancer. The pCR rate to the TCbHP regimen was higher than that to the EC-THP regimen. The incidence of thrombocytopenia and renal injury is higher in the TCbHP regimen. Both regimens have very good cardiac safety.

表1 不同化疗效果HER2阳性乳腺癌患者临床病理指标差异
表2 不同治疗方案HER2阳性乳腺癌患者临床病理指标差异
表3 不同新辅助治疗方案HER2阳性乳腺癌患者不良反应比较
1
赫捷, 陈万青, 李霓, 等. 中国女性乳腺癌筛查与早诊早治指南(2021,北京) [J].中华肿瘤杂志, 2021, 43(4): 357-382.
2
Klocker EV, Suppan C. Biomarkers in Her2- positive disease [J]. Breast Care (Basel), 2020, 15(6): 586-593.
3
Iqbal N, Iqbal N. Human epidermal growth factor receptor 2 (HER2) in cancers: overexpression and therapeutic implications [J]. Mol Biol Int, 2014, 2014: 852748.
4
Sorokin M, Ignatev K, Barbara V, et al. Molecular pathway activation markers are associated with efficacy of trastuzumab therapy in metastatic HER2-positive breast cancer better than individual gene expression levels [J]. Biochemistry (Mosc), 2020, 85(7): 758-772.
5
Pernas S, Tolaney SM. Targeting HER2 heterogeneity in early-stage breast cancer [J]. Curr Opin Oncol, 2020, 32(6): 545-554.
6
Shintia C, Endang H, Diani K. Assessment of pathological response to neoadjuvant chemotherapy in locally advanced breast cancer using the Miller-Payne system and TUNEL [J]. Malays J Pathol, 2016, 38(1): 25-32.
7
张雅聪, 吕章艳, 宋方方, 等. 全球及我国乳腺癌发病和死亡变化趋势 [J].肿瘤综合治疗电子杂志, 2021, 7(2): 14-20.
8
Hamilton E, Shastry M, Shiller SM, et al. Targeting HER2 heterogeneity in breast cancer [J]. Cancer Treat Rev, 2021, 100: 102286.
9
Pernas S, Barroso-Sousa R, Tolaney SM. Optimal treatment of early stage HER2-positive breast cancer [J]. Cancer, 2018, 124(23): 4455-4466.
10
Nakashoji A, Hayashida T, Yokoe T, et al. The updated network meta-analysis of neoadjuvant therapy for HER2-positive breast cancer [J]. Cancer Treat Rev, 2018, 62: 9-17.
11
Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer [J]. N Engl J Med, 2017, 377(7): 702.
12
Piccart M, Procter M, Fumagalli D, et al. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer in the APHINITY trial: 6 years' follow-up [J]. J Clin Oncol, 2021, 39(13): 1448-1457.
13
Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial [J]. Lancet Oncol, 2012, 13(1): 25-32.
14
Bianchini G, Pusztai L, Pienkowski T, et al. Immune modulation of pathologic complete response after neoadjuvant HER2-directed therapies in the NeoSphere trial [J]. Ann Oncol, 2015, 26(12): 2429-2436.
15
Venet D, Rediti M, Maetens M, et al. Copy number aberration analysis to predict response to neoadjuvant anti-HER2 therapy: results from the NeoALTTO phase Ⅲ clinical trial [J]. Clin Cancer Res, 2021, 27(20): 5607-5618.
16
Weiss A, Campbell J, Ballman KV, et al. Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance) [J]. Ann Surg Oncol, 2021, 28(11): 5960-5971.
17
Swain SM, Tang G, Brauer HA, et al. NSABP B-41, a Randomized neoadjuvant trial: genes and signatures associated with pathologic complete response [J]. Clin Cancer Res, 2020, 26(16): 4233-4241.
18
Schneeweiss A, Chia S, Hegg R, et al. Evaluating the predictive value of biomarkers for efficacy outcomes in response to pertuzumab- and trastuzumab-based therapy: an exploratory analysis of the TRYPHAENA study [J]. Breast Cancer Res, 2014, 16(4): R73.
19
中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版) [J]. 中国癌症杂志, 2021, 31(10): 954-1040.
20
Valachis A, Nearchou A, Polyzos NP, et al. Cardiac toxicity in breast cancer patients treated with dual HER2 blockade [J]. Int J Cancer, 2013, 133(9): 2245-2252.
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