吡咯替尼联合全脑放疗对人表皮生长因子受体2阳性乳腺癌多发脑转移患者的疗效和安全性

Curative efficacy and safety of pyrotinib combined with whole brain radiotherapy on patients with human epidermal growth factor receptor 2 positive breast cancer multiple brain metastases

目的探讨吡咯替尼联合全脑放疗对人表皮生长因子受体2(HER2)阳性乳腺癌多发脑转移患者的疗效和安全性。方法回顾性分析陆军军医大学大坪医院2018年10月至2020年5月收治的8例HER2阳性乳腺癌多发脑转移患者临床资料,脑转移病灶均接受三维放射治疗,5例行全脑常规分割放疗,2 Gy/次,5次/周,共20次;3例行大分割放疗,3 Gy/次,5次/周,共10次;全脑放疗同时口服吡咯替尼400 mg,并依据患者毒副作用发生情况调整药物剂量。治疗后每2个周期对患者全身病灶或颅内病灶进行疗效评估,记录治疗过程中毒副反应发生的时间、严重程度分级、处理方法及处理结果等。结果治疗4个周期后,8例患者中部分缓解4例、稳定3例、疾病进展1例,无进展生存期为4~14个月,中位无进展生存期为8个月。治疗过程中发生腹泻者7例,恶心、疲劳各5例,手足综合征4例,中性粒细胞减少、口腔炎各3例,皮疹、肝功能改变各2例,严重程度分级均为1~3级。因为腹泻,5例患者吡咯替尼减量至320 mg,1例减量至240 mg。结论吡咯替尼联合全脑放疗对HER2阳性乳腺癌多发脑转移患者具有一定效果,且无严重毒副作用发生。

Objective To investigate the curative efficacy and safety of pyrotinib combined with whole brain radiotherapy on patients with human epidermal growth factor receptor 2( HER2) positive breast cancer multiple brain metastases. Methods From October 2018 to May 2020,clinical data of 8 cases of patients with HER2 positive breast cancer multiple brain metastases admitted to Daping Hospital,Army Medical University were retrospectively analyzed. Brain metastases lesions received three-dimensional radiotherapy. Five patients received whole brain conventional fractionated radiotherapy,2 Gy/time,5 times/week,totally 20 times;3 patients received large fractionated radiotherapy,3 Gy/time,5 times/week,totally 10 times;whole brain radiotherapy was combined with pyrotinib 400 mg orally at the same time,and the dosage was adjusted according to the occurrence of toxicity in patients. After treatment,the curative efficacy of systemic or intracranial lesions were evaluated every 2 cycles,and the occurrence time,severity grade,treatment methods and treatment results of toxicity were recorded.Results After 4 cycles of treatment,there were 4 cases of partial remission,3 cases of stability and 1 case of disease progression in 8 patients. The progression-free survival was 4-14 months,and the median was 8 months.There were 7 cases of diarrhea,5 cases of nausea,5 cases of fatigue,4 cases of hand foot syndrome,3 cases of neutropenia,3 cases of stomatitis,2 cases of skin rash and 2 cases of liver function changes,with severity grade1-3. Because of diarrhea,the dosages of pyrotinib in 5 patients reduced to 320 mg and 1 patient to 240 mg.Conclusion Pyrotinib combined with whole brain radiotherapy has a certain effect on patients with HER2 positive breast cancer multiple brain metastases,and has no serious adverse reactions.