曲妥珠单抗与帕妥珠单抗双靶向联合化疗药物在人表皮生长因子受体2阳性乳腺癌新辅助治疗中的效果以及影响因素

Clinical effect and affecting factors of trastuzumab and pertuzumab dual target combined with chemotherapeutic drug in neoadjuvant therapy of human epidermal growth factor receptor-2 positive breast cancer

目的分析曲妥珠单抗与帕妥珠单抗双靶向联合化疗药物(紫杉类+卡铂)在人表皮生长因子受体2(HER-2)阳性乳腺癌新辅助治疗中的效果以及影响因素。方法收集2020年6月1日至2022年3月31日在首都医科大学附属北京妇产医院乳腺科诊断为HER-2阳性的Ⅰ~Ⅲ期乳腺癌的41例女性患者的临床资料进行回顾性分析。观察临床疗效,评估新辅助治疗后手术切除标本的病理学完全缓解(pCR)状态并通过残余肿瘤负荷分级评估病理疗效,评价用药安全性;分析影响新辅助治疗后pCR的相关因素。结果41例患者临床总缓解率为90.2%(37/41),病理有效率为78.0%(32/41)。未出现严重不良事件。单因素分析结果显示淋巴结转移、组织学分级、脉管癌栓、孕激素受体、激素受体水平是影响pCR的相关因素,差异均有统计学意义(均P<0.05)。多因素分析结果显示,激素受体阳性(比值比=5.625)、高组织学分级(比值比=4.278)、淋巴结转移(比值比=7.333)及脉管癌栓(比值比=6.000)是影响HER-2阳性乳腺癌患者新辅助治疗后pCR的独立危险因素(均P<0.05)。结论曲妥珠单抗与帕妥珠单抗双靶向联合化疗药物新辅助治疗HER-2阳性乳腺癌患者效果显著,激素受体阳性、高组织学分级、淋巴结转移与脉管癌栓是影响pCR的独立危险因素。

Objective To analyze the effect and affecting factors of trastuzumab and pertuzumab dual target combined with chemotherapeutic drug(taxanes+carboplatin)in neoadjuvant therapy(NAT)of human epidermal growth factor receptor-2(HER-2)positive breast cancer.Methods From June 1,2020 to March 31,2022,the clinical data of 41 female patients with stageⅠtoⅢbreast cancer diagnosed as HER-2 positive in the Department of Breast,Beijing Obstetrics and Gynecology Hospital,Capital Medical University were collected and analyzed retrospectively.Clinical efficacy was observed,pathological complete response(pCR)and residual cancer burden of surgically resected specimens after NAT were used to evaluate the pathological efficacy.The safety of medication was evaluated.The relevant factors affecting the pCR after NAT were analyzed.Results The total clinical response rate of 41 patients was 90.2%(37/41),and the pathological response rate was 78.0%(32/41).No serious adverse events occurred.The results of univariate analysis showed that lymph node metastasis,histological grading,vascular cancer thrombus,progesterone receptor,and hormone receptor levels were related factors affecting pCR(all P<0.05).Multivariate analysis showed that hormone receptor positive(odds ratio=5.625),high histological grade(odds ratio=4.278),lymphatic metastasis(odds ratio=7.333)and vessel carcinoma embolus(odds ratio=6.000)were independent risk factors affecting pCR of HER-2 positive breast cancer patients after NAT(all P<0.05).Conclusions Trastuzumab and pertuzumabdual target combined with chemotherapyis are effective in NAT HER2-positive breast cancer patients.Hormone receptor positive,high histological grade,lymphatic metastasis and vessel carcinoma embolus are independent risk factors affecting pCR.