恩美曲妥珠单抗治疗HER2阳性乳腺癌致血小板下降的临床特点

Clinical characteristics of thrombocytopenia induced by Trastuzumabemtansine in HER2-positive breast cancers

目的探讨恩美曲妥珠单抗(Trastuzumabemtansine,T-DM1)治疗HER2阳性乳腺癌致血小板下降的临床特点。方法回顾性分析北京市朝阳区三环肿瘤医院2020年4—11月接受恩美曲妥珠单抗治疗的HER2阳性乳腺癌患者,观察不良反应发生情况及所致血小板下降的临床特点。结果共有10例乳腺癌患者使用了恩美曲妥珠单抗。曲妥珠单抗治疗周期2~9个周期,中位治疗4个周期。3/4级血小板下降6例,2例患者输注血小板,所有患者均未使用重组人白介素-11及重组人血小板生成素升血小板治疗。血小板开始下降时间为用药后第5~11天,中位时间第8天;血小板最低值发生时间为用药后第7~14天,中位时间第11天;血小板下降持续时间5~14 d(5例患者持续5~7 d),中位下降持续时间8 d。因血小板下降致T-DM1减量2例,治疗延迟1例,其余血小板下降均在下一周期治疗前恢复。粒细胞下降2例,丙氨酸氨基转移酶/天冬氨酸氨基转移酶增高3例,疲乏2例,关节痛1例,均为1级;无治疗相关性出血等严重不良反应。结论恩美曲妥珠单抗总体安全性良好,最重要的不良事件是血小板减少,大多数为一过性,不良反应可控。

Objective To investigate the common adverse events and the clinical characteristics of thrombocytopenia induced by Trastuzumabemtansine(T-DM1)in HER2-positive breast cancers. Method The HER2-positive breast cancer patients received T-DM1 treatment in Beijing ChaoyangSanhuan Cancer Hospital from April 2020 to November 2020 were retrospectively observed. The adverse reactions and the clinical characteristics of thrombocytopenia was analyzed. Results A total of 10 patients with breast cancer were treated with T-DM1. T-DM1 treatment lasted for 2-9 cycles,with a median of 4 cycles. There were 6 cases grade 3/4 thrombocytopenia,and 2 cases received platelet transfusion. None of the patients received the treatment of recombinant human interleukin-11 and recombinant human thrombogenin. The onset time of thrombocytopenia was on day 5 th to 11 th,and the median time was the day 8 th. The minimum of thrombocytopenia was on day 7 th to 14 th,with the median of day 11 th. The duration time of thrombocytopenia was on day 5 th to 14 th(5 cases with 5-7 days),the median was day 8 th. One case was treated delayed,and the rest of thrombocytopenia recovered before the next treatment cycle.There were 2 cases of granulocytopenia,3 cases of elevated alanine/aspartate aminotransferase,2 cases of fatigue,and 1 case of joint pain with grade 1. There was no serious adverse reactions such as treatment-related bleeding. Conclusion T-DM1 is generally safe. The most important adverse event was thrombocytopenia,most of which are transient and can be controlled.