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作 者:蔡阳阳 赵健丽[1] 汪颖[1] 丁林潇潇[1] 柴洁[1] 罗思敏 姚和瑞[1] Cai Yangyang;Zhao Jianli;Wang Ying;Ding Linxiaoxiao;Chai Jie;Luo Simin;Yao Herui(Breast Tumor Center,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China)
机构地区:[1]中山大学孙逸仙纪念医院乳腺肿瘤中心,广东广州510000
出 处:《实用药物与临床》2023年第3期285-288,共4页Practical Pharmacy and Clinical Remedies
摘 要:约10%~30%的乳腺癌患者存在人表皮生长因子受体2(Human epidermal growth factor receptor-2,HER-2)过表达,后者与较差的预后相关。多种抗HER2药物的出现改变了这一现状,其中,曲妥珠单抗仍是一线标准治疗,而曲妥珠单抗治疗失败后的二线及以上治疗靶向药物选择成为新的困难与挑战。伊尼妥单抗是一种优化细胞毒性作用(Antibody-dependent cell-medicated cytotoxicity,ADCC)效应的新型单抗药物,通过改造抗体的Fc段,显示出优于曲妥珠单抗的疾病控制时间及良好的安全性。基础研究显示,小分子酪氨酸激酶抑制剂吡咯替尼在阻断细胞内的HER2 ATP位点的同时,进一步提高了单抗药物的ADCC效应,两药联合的治疗模式具有潜在的临床获益。本文报道了1例曲妥珠单抗原发耐药的HER-2阳性晚期乳腺癌患者,二线治疗失败后应用长春瑞滨联合伊尼妥单抗及吡咯替尼三线治疗,获得了超过19个月的无进展生存期(Progression-free survival,PFS)。Approximately 10%~30%of breast cancer patients have HER2 overexpression,which is associated with poor prognosis.The emergence of anti-HER2 drugs has changed this situation.At present,trastuzumab is still the first-line standard treatment,and the selection of targeted drugs for second-line and above treatment after trastuzumab treatment failure has become a new difficulty and challenge.Inetetamab is a new type of monoclonal antibody drug that optimizes the ADCC effect.By engineering the Fc segment of the antibody,it has shown a better disease control time than trastuzumab,and has shown good safety.Basic research shows that the small molecule tyrosine kinase inhibitor pyrotinib can further improve the ADCC effect of monoclonal antibodies while blocking the intracellular HER2 ATP site.The two-drug combination treatment mode has potential clinical benefits.This paper reports a HER-2 positive advanced breast cancer patient with primary trastuzumab resistance in whom second-line therapy failed and inetetamab combined with pyrotinib and Changchun vinorelbine was used as the third-line therapy,which achieved PFS over 19 months.
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