跨线曲妥珠单抗治疗HER2阳性乳腺癌疗效分析

Therapeutic effect of trans-line trastuzumab on HER2-positive breast cancer

目的:评价应用曲妥珠单抗治疗后进展的人类表皮生长因子受体2(human epidermal growth factor receptor2,HER2)阳性乳腺癌继续曲妥珠单抗治疗的疗效。方法:回顾性分析中国癌症基金会赫赛汀援助项目中接受曲妥珠单抗治疗进展的HER2阳性乳腺癌患者的临床资料,以疾病进展后是否继续应用曲妥珠单抗治疗为分组标准,通过组间显著性差异比较评价跨线曲妥珠单抗治疗疗效。结果:在符合纳入标准的195例HER2阳性晚期乳腺癌患者中,一线继续曲妥珠单抗治疗可延长患者无进展生存期(progression free survival,PFS)及总生存期(overall survival,OS)(继续曲妥珠单抗或不用2组PFS分别为9个月和6个月,P=0.027;OS分别为20个月和16个月,P=0.031),二线继续曲妥珠单抗治疗可延长PFS(用或不用2组PFS分别为9个月和5个月,P=0.026),对OS无明显影响,三线继续曲妥珠单抗治疗对PFS、OS均无明显改善。基于辅助阶段存在曲妥珠单抗原发耐药,一线继续曲妥珠单抗治疗可延长PFS,而对OS无明显影响。对于一线治疗存在曲妥珠单抗原发耐药的患者,二线继续曲妥珠单抗治疗对PFS、OS均无明显改善。结论:经曲妥珠单抗治疗进展的HER2阳性乳腺癌患者,跨线曲妥珠单抗治疗有较好的临床获益。

Objective:To evaluate the clinical efficacy of trastuzumab retreatment for the HER2-positive advanced breast cancer(ABC)patients who progressed after initial trastuzumab-based regimens.Methods:We retrospectively analyzed the clinical data of HER2-positive ABC patients treated with trastuzumab in the herceptin aid project from Chinese Cancer Foundation.To evaluate the efficacy of trans-Line trastuzumab therapy by comparing the significant differences between groups based on whether trastuzumab should continue to be used after disease progression.Results:Among the 195 HER2-positive ABC patients,continuous first-line trastuzumab therapy prolonged progression free survival(PFS)and overall survival(OS)(PFS in continued trastuzumab group and no trastuzumab group was 9 months and 6 months respectively,P=0.027;OS in continued trastuzumab group and no trastuzumab group was 20 months and 16 months respectively,P=0.031).Continuous second-line trastuzumab treatment prolonged PFS(9 months and 5 months respectively,P=0.026),and there was no significant impact on OS.No statistical improvement in PFS and OS was found in continuous third-line trastuzumab therapy.According to the presence of trastuzumab monoantigen resistance in the adjuvant phase,continuous first-line trastuzumab treatment prolonged PFS,but has no significant impact on OS.For the first-line treatment of patients with trastuzumab monoantigen resistance,the second-line treatment of trastuzumab did not significantly prolong PFS and OS.Conclusion:Trans-line trastuzumab therapy has better clinical benefits for HER2-positive ABC patients who have been treated with trastuzumab.