局部晚期HER-2^(+)/HR^(+)乳腺癌新辅助化疗后T-DM1治疗致血小板减少2例并文献复习

Thrombocytopenia induced by T-DM1 therapy after neoadjuvant therapy of locally advanced HER-2^(+)/HR^(+)breast cancer:2 cases report and literature review

目的:探讨局部晚期HER-2^(+)/HR^(+)乳腺癌患者新辅助化疗后恩美曲妥珠单抗(T-DM1)辅助强化治疗的安全性以及导致血小板减少的高危因素。方法:本研究随访了2例局部晚期HER-2^(+)/HR^(+)乳腺癌患者经过新辅助TCbHP方案治疗,术后病理为non-pCR,采用T-DM1辅助强化治疗后出现顽固性Ⅳ度血小板减少的临床特征及综合原因分析。结果:2例患者均为国内中老年HER-2^(+)/HR^(+)女性、局部晚期乳腺癌,既往连续接受过≥5次含卡铂方案化疗及辅助放疗,疗程中发生过≥Ⅱ度血小板减少,连续接受过≥3次T-DM1的治疗。患者骨髓巨核细胞减少,反复刺激骨髓的效果均不佳,血小板下降到恢复的时间累计超过5个月。结论:我们认为,局部晚期HER-2^(+)/HR^(+)乳腺癌患者新辅助治疗后,T-DM1辅助强化从低剂量、或辅助放疗结束1个月后再开始其治疗,可能患者的耐受性及安全性会更好。

Objective:To investigate the safety of T-DM1 adjuvant intensive therapy for patients after neoadjuvant therapy and the risk factors for thrombocytopenia.Methods:Two patients suffered locally advanced HER-2^(+)/HR^(+)breast cancer treated with neoadjuvant TCbHP regimen,postoperative pathological non-pCR,and T-DM1 adjuvant intensive therapy with refractory Ⅳ degree thrombocytopenia were researched and followed up.The clinical features and comprehensive reasons were analyzed.Results:Both patients belonged to the domestic population,middle-aged and elderly HER-2^(+)/HR^(+)women,locally advanced patients,received≥5 consecutive times of carboplatin-containing chemotherapy and adjuvant radiotherapy,had≥Ⅱ degree thrombocytopenia during the course of treatment,and received≥3 consecutive times of T-DM1 treatment.The patient's bone marrow-producing megakaryocytes were reduced,and the effect of repeated stimulation of the bone marrow was not well.The cumulative time from platelet decline to recovery was more than 5 months.Conclusion:We believe that the T-DM1 adjuvant intensive therapy for locally advanced HER-2^(+)/HR^(+)breast cancer patients after neoadjuvant therapy can be started at a low dose,or T-DM1 therapy can be started 1 month after adjuvant radiotherapy,which may be tolerated by patients and the treatment safety will be better.