双靶向新辅助药物联合不同化疗治疗HER-2阳性乳腺癌临床疗效比较

Comparison of Clinical Efficacy of Dual-Targeted Neoadjuvant Drugs Combined with Different Chemotherapy Regimens in the Treatment of HER-2 Positive Breast Cancer

目的探讨双靶向新辅助药物联合不同化学药物治疗(简称化疗)的方案治疗人类表皮生长因子受体-2(HER-2)阳性乳腺癌的临床疗效。方法选取凉山彝族自治州第一人民医院2019年1月至2022年12月收治的HER-2阳性乳腺癌患者110例,按治疗方案的不同分为TcbHP组和AC-THP组,各55例。TcbHP组患者予曲妥珠单抗和帕妥珠单抗联合紫杉类(多西他赛或紫杉醇)和卡铂治疗,以21 d为1个周期,共治疗6个周期;AC-THP组患者予曲妥珠单抗和帕妥珠单抗联合蒽环类药物(吡柔比星或表柔比星)和环磷酰胺治疗,以21 d为1个周期,曲妥珠单抗和帕妥珠单抗及其他药物分别治疗4个周期,共8个周期。结果TcbHP组患者病理完全缓解率为61.80%,稍高于AC-THP组的50.90%(P>0.05)。治疗后,TcbHP组恶心,呕吐,腹泻,心脏毒性及手足综合征程度均显著低于AC-THP组(P<0.05);各肿瘤标志物[糖类抗原(CA19-9,CA125,CA153),癌胚抗原(CEA)]水平均显著低于AC-THP组(P<0.05);左心室射血分数(LVEF)及血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)、氨基末端脑钠肽前体(NT-proBNP)水平均无明显变化(P>0.05),且均显著优于AC-THP组(P<0.05)。结论TcbHP方案治疗HER-2阳性乳腺癌的疗效与AC-THP方案相当,但前者降低肿瘤标志物生成的作用更明显,且心脏毒性风险相对更低。

Objective To investigate the clinical efficacy of dual-targeted neoadjuvant drugs combined with different chemotherapy regimens in the treatment of human epidermal growth factor receptor-2(HER-2)positive breast cancer.Methods A total of 110 patients with HER-2 positive breast cancer admitted to the First People′s Hospital of Liangshan Yi Autonomous Prefecture from January 2019 to December 2022 were selected and divided into the TcbHP group and the AC-THP group based on different treatment methods,with 55 cases in each group.The patients in the TcbHP group were treated with trastuzumab and pertuzumab combined with taxanes(docetaxel or paclitaxel)and carboplatin for six cycles,with 21 d as a cycle.The patients in the AC-THP group were treated with trastuzumab and pertuzumab combined with anthracyclines(pirarubicin or epirubicin)and cyclophosphamide for eight cycles(trastuzumab and pertuzumab for four cycles,other drugs for four cycles),with 21 d as a cycle.Results The pathological complete remission rate in the TcbHP group was 61.80%,which was slightly higher than 50.90%in the AC-THP group(P>0.05).After treatment,the degree of nausea,vomiting,diarrhea,cardiotoxicity and hand-foot syndrome in the TcbHP group was significantly lower than that in the AC-THP group(P<0.05);the various tumor markers[carbohydrate antigens(CA19-9,CA125,CA153),carcinoembryonic antigen(CEA)]levels were significantly lower than those in the AC-THP group(P<0.05);the left ventricular ejection fraction(LVEF),serum cardiac troponin I(cTnI),creatine kinase isoenzyme-MB(CK-MB),and amino-terminal pro B-type natriuretic peptide(NT-proBNP)levels showed no significant changes(P>0.05),and those were significantly better than those in the AC-THP group(P<0.05).Conclusion The efficacy of TcbHP regimen in the treatment of HER-2 positive breast cancer is similar to that of AC-THP regimen,but the former is more effective in decreasing the tumor marker levels and has lower risk of cardiotoxicity.