TCH方案治疗老年HER-2阳性乳腺癌安全性分析

The safety of TCH regimen for elderly patients with HER- 2 positive breast cancer

目的:观察TCH方案(多西紫杉醇+卡铂+赫赛汀)治疗老年人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)阳性乳腺癌的近期化疗毒性及远期心脏毒性。方法:24例老年HER-2阳性乳腺癌包括新辅助化疗5例及辅助化疗19例。采用TCH方案化疗,多西他赛75mg/m2,第1天;卡铂AUC=6,第1天;赫赛汀6mg/kg(首次8mg/kg),第1天,每3周1次。计划化疗6个疗程。按NCI-CTC3.0抗癌药物毒副反应标准评定化疗近期毒性。化疗结束后继续使用赫赛汀,赫赛汀6mg/kg,第1天,每3周1次,共使用1年。应用心脏彩超评估心功能,分别于赫赛汀使用前的1周内(基线水平)及赫赛汀使用期间的第3、6、9、12及18个月检查1次,采集左室射血分数(left ventricular ejection fraction,LVEF)数据。结果:24例患者共接受142个疗程TCH方案化疗,中位疗程数为6个。Ⅲ+Ⅳ度白细胞减少症为37.5%,粒缺性发热为8.33%,外周神经毒性为29.41%,无化疗相关性死亡。使用赫赛汀后LVEF即开始下降,12个月时达最低值,18个月基本恢复正常。中位随访27个月,无充血性心衰发生。结论:TCH方案血液学及非血液学毒性可耐受,心脏安全性良好,是老年HER-2阳性乳腺癌患者较为理想的治疗选择之一。

Objective：To investigate chemotherapy-induced toxicity and Herceptin-associated cardiac adverse effect of TCH regimen（ docetaxel cycolohosphate plus Herceptin ）in elderly patients with HER -2 positive breast cancer. Methods：All 24 elderly HER-2 positive breast cancer patients,including 5 patients with neoadjuvant chem-otherapy and 19 patients with adjuvant chemotherapy,were treated at most 6 cycles with TCH regimen[ docetaxel 75 mg/m2 ,d1 ,plus carboplatin AUC=6,d1 ,plus Herceptin 6mg/kg（ first dose 8mg/kg）every 21 days]. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria（NCI-CTC）,version 3. 0. The Herceptin was continued until one year every 3 weeks with 6mg/kg after chemotherapy. Assessment of LVEF by echocardio-graphy was performed at baseline,3,6,9,12,18 months. Results：A total of 142 cycles of TCH regimen were delivered with median number of 6 cycles. GradeⅢ/Ⅳleukopienia was 37. 5%,neutropenia febrile 8. 33%,peripheral neuro-toxicity 29. 41%,no chemotherapy-related death. LVEF declined during Herceptin treatment. The nadir of LVEF oc-curred at 12 months and returned approximately to baseline level at 18 months. At median 27 months follow up,no pa-tient suffered congestive heart failure. Conclusion：The hematotoxicity and nonhematotoxicity of TCH regimen were well tolerated,and cardiac dysfunction was uncommon. TCH regimen was one of good choice for elderly patients with HER-2 positive breast cancer.