紫杉醇联合Herceptin或表阿霉素治疗Her-2／neu阳性乳腺癌患者的临床疗效

目的 比较Herceptin联合紫杉醇（TAX）的生物化疗组和表阿霉素（EPI）联合TAX单纯化疗组治疗Her-2／neu阳性表达的乳腺癌患者的疗效评估以及前者血清肿瘤标志物的变化及意义。方法 选择免疫组化法检查Her-2／neu为阳性的乳腺癌患者为人选对象，以32例接受Herceptin联合TAX方案治疗者为研究组，41例接受EPI联合TAX方案治疗者为对照组，分别观察上述两组病人的疗效、研究组病人Her-2／neu表达强度与疗效之间的关系及该组患者血清肿瘤标志物的变化。结果 Herceptin联合TAX治疗乳腺癌的客观有效率（RR％）、临床受益率（RR＋SD％）均明显高于EPI联合TAX组；生物化疗组中，免疫组化检测结果为Her-2／neu（＋）、Her-2／neu（H）、Her-2／neu（＋＋＋）的患者的临床有效率分别为0％、44．4％和63．6％；单纯化疗组分别为8．3％、36．4％和38．9％；Herceptin联合TAX方案化疗后，血清肿瘤标志物水平与化疗前比较有不同程度降低，CA153、TPS及CEA与治疗前相比有显著性差异（P〈0．05），而CA125则无显著性差异（P〉0．05）。结论 对于Her-2／neu阳性的晚期乳腺癌患者，Herceptin联合TAX方案组的疗效明显优于TAX联合EPI方案组，对Her-2／neu（＋＋＋）的乳腺癌患者，Herceptin联合TAX治疗的有效率高于Her-2／neu（＋＋）的患者。肿瘤标志物CEA、TPS、CA153在判定疗效上也有一定的临床价值。

Therapeutic effect of TAX combined with Herceptin or epirubicin against breast cancer positive for Her-2/neu

OBJECTIVE: To compare the therapeutic effects of biochemotherapy regimen with Herceptin plus taxol (TAX) and the chemotherapy regimen with epirubicin plus TAX against Her-2/neu-positive breast cancer and observe the changes in serum tumor markers in patients receiving biochemotherapy. METHODS: Seventy-three patients with advanced breast cancer positive for Her-2/neu as revealed by immunohistochemistry were divided into the study group (n=32) to receive treatment with the regimen of Herceptin plus TAX and control group (n=41) with the regimen of epirubicin(EPI) plus TAX. The therapeutic effects of the regimens were observed and in the study group, the relationship of the therapeutic effect with Her-2/neu positivity and changes in serum tumor markers were examined. RESULTS: The objective response rate and clinical benefit response rate were obviously higher in the study group than in the control group. In the study group, the clinical response rate of patients with positive immunostaining for Her-2/neu of grades 1+, 2+ and 3+ were 0%, 44.4% and 63.6%, respectively, as compared with those in the control group of 8.3%, 36.4%, and 38.9%, respectively, and the treatment resulted in lowered levels of serum tumor markers without significant changes in CA153, tps and CEA (P<0.05) after treatment, but CA125 showed no significant difference (P>0.05). CONCLUSIONS: In patients with advanced breast cancer with positive immunostaining for Her-2/neu of grade 3+, the regimen of Herceptin plus TAX can be more effective than the chemotherapeutic regimen of EPI plus TAX. Patients with Her-2/neu (+++) benefit more from the treatment than those with Her-2/neu (++). Serum CEA, CA153 and TPS levels also possess some value in evaluating the therapeutic effects of the regimens.