基于循环肿瘤DNA观察疏肝益肾方治疗内分泌耐药晚期乳腺癌的临床效果

Clinical efficacy of Shugan Yishen prescription treating endocrine-resistant advanced breast cancer based on circulating tumor DNA

目的基于循环肿瘤DNA观察疏肝益肾方联合依西美坦治疗内分泌耐药相关基因突变的激素受体阳性、人类生长因子受体2阴性晚期乳腺癌的临床效果。方法选择2015年10月至2018年1月就诊于中国中医科学院广安门医院肿瘤科的乳腺癌患者31例,均给予疏肝益肾方联合依西美坦治疗,观察患者的无进展生存期(PFS)和临床疗效,对患者基线和治疗8、16周后的卡氏评分、FACT-B评分、骨关节相关疼痛评分和血脂水平进行比较。结果疏肝益肾方联合依西美坦治疗后患者总体的中位PFS为8个月,客观缓解率为19.4%(6/31),疾病控制率为58.1%(18/31)。治疗16周后的卡氏评分高于治疗前[(93.5±2.8)分比(89.0±2.7)分](P=0.03)。治疗8周后FACT-B评分中情感状况评分高于治疗前[(16.3±1.9)分比(13.3±2.7)分],骨关节平均疼痛评分低于治疗前[(4.2±0.4)分比(4.7±0.3)分];治疗16周后,各项FACT-B评分均高于治疗前,骨关节相关疼痛评分均低于治疗前(均P<0.05)。治疗16周后31例患者三酰甘油水平低于治疗前,治疗8、16周后总胆固醇水平均低于治疗前(均P<0.05)。结论疏肝益肾方可延长内分泌耐药基因突变的晚期乳腺癌患者的PFS,提高临床疗效及生活质量。

Objective To analyzed the clinical effect of Shugan Yishen prescription combined with exemestane on hormone receptor-positive and human growth factor receptor-2-negative advanced breast cancer.Methods From October 2015 to January 2018,31 breast cancer patients were treated with Shugan Yishen decoction and exemestane in Guang’anmen Hospital,Chinese Academy of Chinese Medical Sciences.Progress-free survival(PFS)and clinical efficacy were observed.Karnofsky score,FACT-B score,bone/joint pain score and blood lipids were analyzed before and 8,16 weeks after treatment.Results The median PFS was 8 months;the objective response rate was 19.4%(6/31)and the disease control rate was 58.1%(18/31).Karnofsky score at 16 weeks after treatment was higher than that before treatment[(93.5±2.8)vs(89.0±2.7)](P=0.03).At 8 weeks after treatment,FACT-B emotional state score was higher and bone/joint pain score was lower than those before treatment[(16.3±1.9)vs(13.3±2.7),(4.2±0.4)vs(4.7±0.3)];at 16 weeks after treatment,scores of each item in FACT-B were higher and bone/joint pain scores were lower than those before treatment(all P<0.05).Serum level of triacylglycerol at 16 weeks and total cholesterol levels at 8,16 weeks after treatment were significantly lower than those before treatment(all P<0.05).Conclusion Shugan Yishen prescription can improve the clinical efficacy,prolong PFS and improve quality of life in breast cancer patients with endocrine resistance gene mutation.