曲妥珠单抗治疗后进展的转移性乳腺癌继续曲妥珠单抗治疗的疗效及安全性分析

摘要

Objective To determine the efficacy and safety of trastuzumab retreatment beyond progression in HER2 positive metastatic breast cancer. Method In this retrospective trial, 30 cases of HER2 positive metastatic breast cancer (MBC) patients received trastuzumab-based regimen. After progression, they were retreated with trastuzumab, only with the different chemotherapy regimen. Result 30 patients with HER2 positive MBC had received trastuzumab-based regi-men during the metastasis and relapse period, with a median treatment duration of 6.0 months (95%CI:1.7-10.3);after progression, 30 patients were retreated with trastuzumab administered as altered chemotherapy regimen. Objective re-sponse was evaluable in all patients, in which there were 7 (23.3%) with partial response (PR), 12 (40.0%) with stable dis-ease (SD), and 11 (36.7%) with progressive disease (PD), while none achieved complete response (CR). The objective re-sponse rate in the patient cohort was 23.3%and the clinical benefit rate was 43.3%, and the overall median PFS was 5.0 months (95%CI:3.0-7.0). 13 patients with clinical benefit had improved PFS compared with those without (9.0 months vs 3.0 months, P<0.001). The main adverse effects were hematologic toxicities, which were considered to be chemotherapy-related. Conclusions Trastuzumab-based retreatment is effective for women with HER2 positive metastatic breast can-cer after prior exposure to trastuzumab, with considerable clinical benefit.%目的：评价曲妥珠单抗治疗后进展的转移性乳腺癌患者继续行曲妥珠单抗治疗的疗效及安全性。方法回顾性分析曲妥珠单抗治疗过程中出现疾病进展，继续行曲妥珠单抗治疗，仅更换化疗方案的30例HER2阳性转移性乳腺癌患者的临床资料，并评价疗效及不良反应。结果30例HER2阳性转移性乳腺癌患者，均在复发转移阶段接受过曲妥珠单抗治疗，中位治疗时间6.0个月（95%CI为1.7~10.3个月）；30例患者在出现疾病进展后，均继续进行曲妥珠单抗治疗，仅更换联合的化疗方案。30例患者均可评价疗效，其中部分缓解（PR）7例（23.3%），疾病稳定（SD）12例（40.0%），疾病进展（PD）11例（36.7%），无完全缓解（CR）患者。客观缓解率为23.3%，临床获益率为43.3%。总无进展生存期（PFS）为5.0个月（95%CI为3.0~7.0个月）。有临床获益的13例患者的PFS明显长于17例无临床获益者（9.0个月vs 3.0个月，P﹤0.001）。最常见的不良反应为血液学不良反应，考虑主要与化疗药物相关。结论对于曲妥珠单抗治疗过程中出现疾病进展的患者，继续使用曲妥珠单抗，更换化疗方案有较好的临床获益。