乳腺癌患者曲妥珠单抗治疗的耐受性及心功能监测  

Tolerance and Cardiac Function Monitoring During Trastuzumab Treatment for Breat Cancer Patient

作　　者：黄平[1] 陈俊英[1] 陈占红[1] 黄健[1] 郑如珍[1] 曹文明[1] 邵喜英[1] 蔡菊芬[1] 王晓稼[1] 

机构地区：[1]浙江省肿瘤医院,浙江杭州310022

出　　处：《肿瘤学杂志》2012年第12期930-934,共5页Journal of Chinese Oncology

摘　　要：[目的]观察乳腺癌患者曲妥珠单抗治疗过程中的临床耐受性及心脏安全性。[方法]对Her-2基因过表达82例女性乳腺癌患者在曲妥珠单抗使用过程中进行心电图监测。记录出现的心脏相关症状。采用超声心动图法,分别于曲妥珠单抗使用前1个月及使用后每3个月监测1次左室射血分数(LVEF)。[结果]曲妥珠单抗使用过程中心脏相关症状主要为胸闷、心悸及呼吸困难。心电图异常主要表现为ST-T段改变、窦性心动过速、传导阻滞、窦性心动过缓。以上不良事件的程度绝大多数为Ⅰ～Ⅱ度。监测3、6、9、12、15个月时的LVEF均值分别为69.93%±5.72%、70.64%±5.12%、71.03%±5.31%、70.29%±5.10%、69.08%±5.84%,与基线时比较均有下降,但均未出现低于50%的病例。在监测15个月过程中,LVEF平均下降幅度介于4.35%～2.10%之间。监测3、6、9、12、15个月时LVEF下降幅度≥16%患者的比例分别为4.00%、2.99%、2.17%、2.78%和4.35%。蒽环类药物经治的患者在曲妥珠单抗使用第3、6、9、12、15个月监测到LVEF下降≥10%的比例分别为15.40%、11.90%、14.30%、22.7%和20.00%。并没有发现明显高于未使用过蒽环类的患者。[结论]乳腺癌患者在曲妥珠单抗治疗期间都伴随着LVEF水平的降低,但是随着治疗时间的延长并没有发现LVEF的进行性下降,患者的总体耐受性良好,说明治疗期间的定期监测十分重要。[Purpose]： To observe the clinical tolerance and cardiac safety of trastuzumab in the treatment for breast cancer patients. [Methods] ECG monitoring were carried out in the process of the treatment of trastuzumab in 82 female cases with breast cancer with Her-2 gene overex- pression,and heart associated symptoms were recorded. Left ventricular ejection fraction （LVEF）was monitored by echocardiography 1 month before treatment of trastuzumab and every 3 months after treatment of trastuzumab. [Results] Trastuzumab related cardiac symptoms were mainly chest distress,palpitation and dyspnea. The common electrocardiographic abnormalities were ST-T segment change, sinus tachycardia,conduction block, and sinus bradycardia,majority with degrees I or lI. The mean value of LVEF at the time of 3,6,9,12 and 15 months were 69.93 % ±5.72%, 70.64% ±5.12%, 71.03 % ±5.31%, 70.29% ±5.10%, 69.08% ±5.84%, re speetively, lower than the baseline ,but there were no case with LVEF less than 50%. During 15 months of monitoring,LVEF declined average in 4.35%-2.10%. Patients with LVEF decline ≥ 16% in monitoring of 3,6,9,12,15 months accounted for 4.00% ,2.99% ,2.17% ,2.78% and 4.35% respectively. LVEF decline ≥ 10% at monitoring of 3,6,9,12,15 months were found respectively at 15.40%, 11.90%, 14.30% ,22.70% and 20.00% of patients with anthracycline treatment before trastuzumab use. No case with LVEF significantly higher than the patients without anthra- cycline treatment was found. [Conclusion] A decrease in LVEF level might be found in breast cancer patients treated with trastuzumab ,but with the prolonged treatment time ,LVEF progres- sive decrease does not appear,and the patients are well-tolerable. Periodic monitoring during trastuzumab treatment is very important.

关 键 词：曲妥珠单抗 耐受性 心脏毒性 左室射血分数 药物疗法 乳腺肿瘤 

分 类 号：R737.9[医药卫生—肿瘤]