曲妥珠单抗和帕妥珠单抗联合TEC新辅助治疗中晚期HER-2阳性乳腺癌对保乳成功率的影响

Effect of trastuzumab and pertuzumab combined with TEC neoadjuvant therapy on the success rate of breast conservation in advanced HER2-positive breast cancer

摘要:

目的 探讨曲妥珠单抗和帕妥珠单抗联合TEC（多西他赛+表柔比星+环磷酰胺）新辅助治疗中晚期人类表皮生长因子受体2（HER-2）阳性乳腺癌对保乳成功率的影响。方法 回顾性选取2019年3月—2021年3月在南通市肿瘤医院就诊的92例中晚期HER-2阳性乳腺癌患者，根据不同治疗方案分为研究组和对照组，每组46例。对照组接受TEC方案进行新辅助化疗+曲妥珠单抗，研究组在对照组基础上接受帕妥珠单抗治疗。对比两组肿瘤标志物多肽特异性抗原（TPS）血清多肽特异性抗原（TPS）、癌胚抗原（CEA）、临床疗效、保乳成功率、不良反应及预后情况。结果 研究组治疗前后TPS、CEA的差值均高于对照组（P <0.05）。研究组客观缓解率、疾病控制率均高于对照组（P <0.05）。研究组保乳成功率高于对照组（P <0.05）。两组中性粒细胞Ⅰ、Ⅱ级和Ⅲ、Ⅳ级减少率、血小板Ⅰ、Ⅱ级和Ⅲ、Ⅳ级减少率、胃肠道Ⅰ、Ⅱ级和Ⅲ、Ⅳ级反应发生率、肾功能损伤Ⅰ、Ⅱ级和Ⅲ、Ⅳ级反应发生率比较，差异均无统计学意义（P >0.05）。两组无进展生存期（PFS）生存曲线比较，差异无统计学意义（P >0.05）。结论 曲妥珠单抗和帕妥珠单抗联合TEC新辅助治疗HER-2阳性乳腺癌的效果显著，降低TPS、CEA，有利于提高保乳成功率，较为安全，但随访1年PFS差异较小。

Abstract:

Objective To observe the effect of trastuzumab and pertuzumab combined with TEC (docetaxel + epirubicin + cyclophosphamide) neoadjuvant therapy on the success rate of breast preservation in advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer.Methods Ninety-two patients with advanced HER2-positive breast cancer diagnosed and treated in our hospital from March 2019 to March 2021 were retrospectively selected. They were divided into the study group and the control group according to different treatment plans, with 46 cases in each group. The control group received the TEC regimen as neoadjuvant chemotherapy, combined with trastuzumab. The study group received pertuzumab in addition to the treatment in the control group. The serum levels of tissue polypeptide specific antigen (TPS) and carcinoembryonic antigen (CEA), clinical efficacy, success rate of breast conservation, adverse reactions and prognosis of the two groups were compared.Results The differences in the levels of TPS and CEA before and after treatment in the study group were higher than those in the control group (P < 0.05). The objective response rate and disease control rate of the study group were higher than those of the control group (P < 0.05). The success rate of breast conservation in the study group was higher than that in the control group (P < 0.05). There was no significant difference between the study group and the control group in terms of the rates of grades I and II as well as grades III and IV of neutropenia, thrombocytopenia, gastrointestinal reactions and renal injury (P > 0.05). There was no significant difference in the progression-free survival (PFS) between the two groups (P > 0.05).Conclusions The combination of trastuzumab and pertuzumab with TEC as neoadjuvant therapy for HER2-positive breast cancer demonstrates significant efficacy, effectively reducing TPS and CEA levels, improving the success rate of breast conservation, and showing a favorable safety profile. However, the difference in the 1-year PFS was minimal during follow-up.