HER2-targeted treatment for older patients with breast cancer: An expert position paper from the International Society of Geriatric Oncology

HER2-positive (HER2+) breast cancer (BC) affects older women nearly as frequently as younger ones. Many older patients have cardiovascular comorbidity and risk greater toxicity from therapy. Treatment therefore requires careful consideration, especially since trials include few patients over 65 and so provide limited guidance. A multidisciplinary task force of the International Society of Geriatric Oncology conducted a literature review to make specific recommendations. In the absence of impaired left ventricular ejection fraction, older patients with HER2+ advanced or metastatic BC (MBC) should receive HER2-targeted therapy adjusted to their general condition. Although trastuzumab combined with pertuzumab and docetaxel or paclitaxel is recommended first-line in fit patients, taxanes are difficult in vulnerable ones, making a better-tolerated chemotherapy partner highly desirable. Hormonal therapy with anti-HER2 treatment is an alternative with hormone sensitive tumours. T-DM1 is the standard for fit trastuzumab- and taxane-exposed patients. Lapatinib activity differs from trastuzumab and causes more side effects and drug interactions that are at higher risk in older patients. For fit HER2+ early BC (EBC) patients, chemotherapy plus one year trastuzumab is standard, dual blockade being restricted to high risk and fit patients. Although there is a low level of evidence, using trastuzumab alone (omitting chemotherapy) or enhancing its action through multiple blockade of HER2 and/or the oestrogen receptor pathway may suit vulnerable and frail MBC and EBC patients. Introducing adjuvant therapy lasting less than one year or harnessing neoadjuvant exposure to assess tumour sensitivity and adjust potential rescue treatment accordingly are other key approaches for older patients. These would be particularly helpful for less robust patients or in health systems with limited resources but need further evaluation.     

78例曲妥珠单抗联合多西他赛治疗Ⅲ期乳腺癌临床疗效观察

[目的]评价曲妥珠单抗联合多西他赛化疗对Ⅲ期乳腺癌的治效果和毒副作用。[方法]对2004年5月～2009年6月普外科78例Ⅲ期乳腺癌患者采用多也赛75mg/m2静滴,曲妥珠单抗6mg/kg静滴方法治疗进行分析。[结果]本组78例总有效率82.05%(64/78),且毒副反应可以耐受。[结论]曲妥珠单抗联合多西他赛化疗是治疗Ⅲ期乳腺癌的有效治疗手段,不良反应轻,患者可以耐受。     

曲妥珠单抗对30例Her2阳性中国乳腺癌患者术后辅助治疗安全性的初步观察

背景与目的:国际多中心研究已经证实,曲妥珠单抗对Her2阳性的晚期乳腺癌和早期乳腺癌术后辅助治疗均有良好的疗效.本文中我们主要探讨Her2阳性中国乳腺癌患者术后完成辅助治疗后应用曲妥珠单抗的安全性.方法:早期乳腺癌患者术后完成辅助化疗和/或放疗后接受3周一次的曲妥珠单抗治疗,首次以负荷剂量8 mg/kg给药,然后每3周给予6 mg/kg静脉滴注,至少接受治疗4疗程,最长35疗程,观察其不良反应.特别是对心脏功能的影响.结果:共30例Her2阳性的乳腺癌患者术后接受曲妥珠单抗治疗,中位治疗疗程数是18个(4～35个),有2例在第一次用药时出现寒战和发热.18例患者治疗后LVEF下降,其中9例下降超过10%.24例治疗过程中曾出现轻度ST-T波改变,但未出现心力衰竭.结论:曲妥珠单抗对Her2阳性中国乳腺癌患者心脏功能有一定影响,应在治疗中注意监测观察,但总体安全性良好.     

曲妥珠单抗致不良反应分析

目的：探讨曲妥珠单抗（trastuzumab）致不良反应的特点,为临床合理用药提供参考。方法：选择本院乳腺内科应用曲妥珠单抗所致不良反应38例,又检索到中国期刊全文数据库、万方数据库、维普资讯网和PubMed筛选出的曲妥珠单抗相关不良反应的文献10篇（39例）,合并作为研究对象,针对患者的一般情况、合并化疗方案、不良反应出现时间及临床表现、治疗及转归进行分析。结果：我院38例患者中不良反应发生在给药后0～90 min者21例（55%）,1~2 d者9例（24%）,3~7 d者8例（21%）;最常见不良反应为输液反应,严重不良反应为2例,表现为严重输液反应（过敏反应）,永久终止曲妥珠单抗的治疗。在数据库检索到的39例中,不良反应发生在给药后0～90 min者30例（77%）,大于7 d者4例（10%）,未报道发生时间5例（13%）;最常见不良反应为输液反应,严重不良反应为9例,包括非感染性肺炎和心脏毒性,未影响治疗。结论：曲妥珠单抗最常见的不良反应为输液反应,多在第一次输注时发生;用药前先给予苯海拉明、地塞米松预防,可降低其发生率;加强监测,预防心脏毒性,保证治疗的顺利进行。     

Tyrosine kinase inhibitors and human epidermal growth factor receptor-2 positive breast cancer

The body of evidence investigating human epidermal growth factor receptor-2 (HER2) directed therapy in patients with breast cancer (BC) has been growing within the last decade. Recently, the use of tyrosine kinase inhibitors (TKIs) has been of particular interest in the treatment of human malignancies. This literature commentary is intended to highlight the most recent findings associated with the widely-studied TKI agents and their clinical significance in improving the outcomes of HER2 positive BC.     

Patients’ satisfaction in early breast cancer treatment: Change in treatment over time and impact of HER2-targeted therapy

Although breast cancer remains a major cause of cancer death, its related death rate has dropped in the last years through early tumor detection and better available treatments. With the development of innovative techniques and new molecules as well as new routes of administration, local treatment and adjuvant therapy of early breast cancer have evolved, from mutilating, time-consuming and/or painful procedures to breast-conservative ones, sparing healthy tissues, reducing the total dose of treatment and the treatment time which in turn reduce the occurrence and severity of toxicity. In parallel with these improvements leading to an increase in survival rate, patients’ health-related quality of life has become a major concern. This review aims at describing the evolution of early breast cancer treatment, and its impact on patients’ quality of life, convenience, and satisfaction, including a special insight into emerging human epidermal growth factor receptor 2 (HER2)-targeted therapy.     

嗜酸性粒细胞作为乳腺癌病人曲妥珠单抗相关输注反应的预测指标价值分析

目的探讨嗜酸性粒细胞作为乳腺癌病人曲妥珠单抗相关输注反应的预测价值。方法回顾性分析黄山市人民医院 2019年 1月至 2021年 12月 174例连续住院女性病人，均接受初始 8 mg/kg曲妥珠单抗治疗量，评估输注反应(IRs)发生情况。结果 136例病人符合纳入研究条件，在 27.9%(38/136)病人中观察到 IRs，多因素 logistic分析结果显示体质量指数 ≥24 kg/m2和嗜酸性粒细胞百分比 ≤2%是病人发生 IRs的危险因素，嗜酸性粒细胞百分比预测 IRs的曲线下面积为 0.75［95%CI:(0.65，0.85)］，当截断值为 2.05时，灵敏度和特异度分别为 86.4%和 54.5%；联合 BMI后预测 IRs的曲线下面积提高至 0.80(0.72，0.88)，其对应的灵敏度和特异度分别为 78.8%和 72.8%。结论低嗜酸性粒细胞百分比可作为乳腺癌病人曲妥珠单抗相关输注反应的预测因素。