DC-CIK联合靶向治疗及化疗在局部晚期乳腺癌新辅助治疗中的临床疗效分析

Dendritic cell-cytokine induced killer cells combined with neoadjuvant chemotherapy and targeted therapy in treatment of advanced breast cancer patients:the clinical effectiveness

目的研究DC-CIK联合靶向治疗及化疗在局部晚期乳腺癌新辅助治疗中的临床疗效及安全性。方法选取2013年4月-2014年9月就诊于湖南省郴州市第一人民医院肿瘤科的30例局部晚期乳腺癌患者,采用DC-CIK联合靶向治疗及化疗(表柔比星+环磷酰胺4周期—曲妥珠单抗+多西他赛4周期)为联合治疗组;选取临床资料相近的同期进行靶向治疗及化疗(表柔比星+环磷酰胺4周期—曲妥珠单抗+多西他赛4周期)的30例局部晚期乳腺癌患者为对照组;比较两组患者治疗后的免疫功能、近期疗效、1年生存率、生活质量,并观察DC-CIK细胞治疗的安全性。结果成功培养患者的DC-CIK细胞,其中的CD3^+CD8^+、CD3^+CD56^+细胞比例较培养前显著提高(P<0.05)。与对照组比较,联合治疗组患者治疗后外周血细胞CD3^+CD8^+、CD3^+CD56^+细胞比例显著升高(P<0.05)。与治疗前比较,联合治疗组患者治疗后T细胞分泌IFN-γ、IL-2水平显著升高(P<0.05)。对照组患者治疗后外周血各T细胞亚群较治疗前降低,但差异无统计学意义(P>0.05)。对照组患者IL-2、IFN-γ水平较治疗前稍降低。联合治疗组患者的RR为70%,显著高于对照组的56.6%(P<0.05);联合治疗组患者1年生存率为62%,与对照组56%的差异无统计学意义(P>0.05)。联合治疗组患者的不良反应(包括骨髓抑制、恶心呕吐、周围神经毒性)明显轻于对照组(P<0.05),联合治疗组患者治疗后体力食欲较对照组改善明显(P<0.05)。结论与对照组比较,DC-CIK联合靶向治疗及化疗晚期乳腺癌安全有效,可以提高缓解率,改善患者的生活质量。

【Objective】 To evaluate the safety and therapeutic effect of dendritic cell（DC）-cytokine induced killer cells（CIKs） combined with neoadjuvant chemotherapy and targeted therapy in treatment of advanced breast cancer. 【Methods】 Thirty patients with advanced breast cancer（stage Ⅲ）, who were admitted to the First People＇s Hospital of Chenzhou from Apr. 2013 to Sep. 2014, were treated by DC-CIKs combined with neoadjuvant chemotherapy and targeted therapy（Epirubicin ＋ Cyclophosphamide- Paclitaxel ＋ Herceptin）and taken as the combined treatment group. And thirty advanced breast cancer patients treated with neoadjuvant chemotherapy and targeted therapy（Epirubicin ＋ Cyclophosphamide- Paclitaxel ＋ Herceptin） during the same period were taken as the control group. The immune function, therapeutic effect, 1-year survival, life quality and side effects were compared between the two groups. Furthermore, the safety and therapeutic effects of DC-CIK therapy were observed. 【Results】 DC-CIKs from advanced colon cancer patients were successfully induced, the ratios of CD3~＋CD8~＋and CD3~＋CD56~＋cells in DC-CIKs were significantly increased after culture（P 0.05）. Compared with the control group, the ratios of CD3~＋CD8~＋and CD3~＋CD56~＋cells in the peripheral blood after combined therapy were significantly increased after culture（ P 0.05）. The combined therapy increased IFN-γ and IL-2 levels（P 0.05）. In the control group, the ratios of CD3~＋CD8~＋, CD3~＋CD4~＋, CD3~＋CD56~＋cells and IFN-γ, IL-2 levels decreased after culture without significant differences（P 0.05）. The disease remission rate（RR） of the combined therapy group was higher than that of the control group（70% vs 56.6%, P 0.05）. The 1-year survival rate of the combined therapy group and control group was 62% and 56% respectively, showing no significant difference（P 0.05）. The combined therapy group had fewer side effects（including bone marrow suppression, nausea and vomiting, and peripheral nerve toxicity） compared with the control group.（P 0.05）. 【Conclusions】 Treatment with DC-CIK cells combined with chemotherapy and targeted therapy is safe and effective for advanced breast cancer. It can also raise the remission rate and survival, and improve the quality of life of the patients.