曲妥珠单抗和拉帕替尼在辅助曲妥珠单抗治疗后一线复发的HER2阳性晚期乳腺癌治疗中疗效的比较  

Efficacy comparison of first-line trastuzumab and lapatinib in HER2-positive advanced breast cancer relapsed from prior adjuvant trastuzumab treatment

作　　者：黄文发 严颖[1] 张如艳[1] 冉然[1] 李惠平[1] HUANG Wenfa;YAN Ying;ZHANG Ruyan;RAN Ran;LI Huiping(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Breast Oncology,Peking University Cancer Hospital and Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺肿瘤内科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《肿瘤》2020年第9期641-649,共9页Tumor

摘　　要：目的:比较一线曲妥珠单抗和拉帕替尼在对辅助曲妥珠单抗治疗后复发的人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性晚期乳腺癌(advanced breast cancer,ABC)治疗中的疗效。方法:回顾性分析北京大学肿瘤医院2010年7月—2019年7月收治的73例曲妥珠单抗辅助治疗后复发的HER2阳性ABC患者的资料。73例患者中48例采用曲妥珠单抗治疗(曲妥珠单抗组),25例采用拉帕替尼治疗(拉帕替尼组)。比较2组患者的客观缓解率(objective response rate,ORR)和无进展生存期(progression-free survival,PFS)。结果:中位随访时间为17.3个月(范围:1.5~85.0个月)。曲妥珠单抗组和拉帕替尼组的ORR分别为50%和28%,差异无统计学意义(P=0.071)。继续曲妥珠单抗治疗与换用拉帕替尼治疗相比,继续曲妥珠单抗治疗显著延长了患者的PFS(7.3 vs 4.8个月,P=0.045)。在亚组分析中,辅助曲妥珠单抗治疗停药12个月以后复发(P=0.031)或无内脏转移(P=0.003)的患者继续使用曲妥珠单抗治疗具有更长的PFS,但拉帕替尼用于治疗早期复发并发生内脏转移的患者有延长PFS的趋势(P=0.071)。结论:继续使用曲妥珠单抗仍是辅助曲妥珠单抗治疗后复发的ABC患者的重要方案。但在选择曲妥珠单抗或拉帕替尼用于治疗HER2阳性ABC时,需综合考虑辅助曲妥珠单抗停药时间和内脏转移的情况。Objective:To compare the efficacy of first-line trastuzumab and lapatinib treatment for human epidermal growth factor receptor 2(HER2)-positive advanced breast cancer(ABC)patients who relapsed from prior adjuvant trastuzumab.Methods:Retrospective analysis on clinical date of 73 patients with HER2-positive ABC,who relapsed after adjuvant trastuzumab treatment,admitted to Peking University Cancer Hospital between July 2010 and July 2019.Of the 73 patients,48 patients were treated with trastuzumab(trastuzumab group)and 25 patients received lapatinib(lapatinib group).Objective response rate(ORR)and progression-free survival(PFS)between the two groups were compared.Results:The median follow-up time was 17.3(1.5-85.0)months.The ORR of trastuzumab group and lapatinib group were 50%and 28%respectively,but without significant difference(P=0.071).PFS were significantly improved in patients retreated with trastuzumab compared with those received lapatinib treatment(7.3 vs 4.8 months,P=0.045).In the subgroup analysis,patients relapsed over 12 months after adjuvant trastuzumab(P=0.031)or those without visceral metastases(P=0.003)could benefit more from trastuzumab treatment,while those who had visceral metastases within 12 months after adjuvant trastuzumab showed a trend that favored lapatinib(P=0.071).Conclusion:Trastuzumab retreatment remains an important regimen in the first-line management for ABC patients relapsed after prior adjuvant trastuzumab.The interval from the end of adjuvant trastuzumab treatment and the situation of visceral metastasis should be considered,when choosing trastuzumab or lapatinib to manage HER2-positive ABC patients.

关 键 词：乳腺肿瘤 基因 ERBB-2 分子靶向治疗 曲妥珠单抗 拉帕替尼 

分 类 号：R737.9[医药卫生—肿瘤]