曲妥珠单抗治疗失败的HER-2阳性乳腺癌患者不同后续治疗方案的疗效及影响因素分析

目的:观察人表皮生长因子受体2（human epidermal growth factor receptor-2，HER-2）阳性乳腺癌患者曲妥珠单抗治疗失败后不同后续治疗方案的疗效，分析影响因素。方法:回顾性分析2014年1月至2016年12月在我院肿瘤科治疗的曲妥珠单抗治疗失败的94例HER-2阳性晚期乳腺癌患者，根据其后续治疗方案不同将其分为A组（接受单纯化疗）、B组（接受曲妥珠单抗+化疗）和C组（接受拉帕替尼+化疗）；比较三组患者治疗效果，并分析可能影响抗HER-2治疗效果的相关因素。结果:94例患者均完成随访，中位随访时间22.3个月。三组患者中位无进展生存期（median progression free survival，mPFS）分别为3个月、4.5个月及6个月，差异有统计学意义（P<0.000 1）；C组PFS较A组及B组均明显延长，B组PFS较A组明显延长。A、B、C三组客观有效率（objective response rate，ORR）分别为8.7%、29.7%、38.2%，三组的临床获益率（clinical benefit rate，CBR）分别为21.7%、54.1%、64.7%，以上差异均有统计学意义（P<0.05）。对可能影响PFS的单因素进行分析，拉帕替尼、一线疗程（曲妥珠单抗）获益时间≥6个月、无内脏转移是PFS的影响因素；而拉帕替尼、一线疗程（曲妥珠单抗）获益时间≥6个月是PFS的独立影响因素。结论:对于曲妥珠单抗治疗失败的HER-2阳性晚期乳腺癌患者，后续治疗方案中含抗HER-2靶向药物可改善患者预后。

Efficacy of different follow up treatment regimens and prognostic factors of trastuzumab failure in HER-2 positive breast cancer patients

Objective:To study the effect of different follow-up treatment regimens after trastuzumab treatment failure in HER-2 positive breast cancer patients and analyze the prognostic factors.Methods:94 patients with HER-2 positive advanced breast cancer who had failed trastuzumab treatment from January 2014 to December 2016 were analyzed retrospectively.According to their different follow-up treatment regimens,they were divided into group A,group B and group C,respectively,who received simple chemotherapy,trastuzumab+chemotherapy,and lapatinib+chemotherapy.The therapeutic effects of three groups were compared,and the clinical factors that may affect the therapeutic effect of anti HER-2 were analyzed.Results:94 patients were followed up.The median follow-up time was 22.3 months.There were significant differences in PFS among the three groups(P<0.0001).The mPFS in three groups were 3 months,4.5 months and 6 months.Compared with group A and group B,the PFS of group C was significantly prolonged.Compared with group A,the PFS of group B was significantly prolonged.The ORR of group A,B and C were 8.7%,29.7%and 38.2%,and the CBR of group A,B and C were 21.7%,54.1%and 64.7%.The above differences were statistically significant(P<0.05).The analysis of clinical factors that may affect PFS showed that lapatinib,first-line treatment(trastuzumab)with a benefit time of≥6 months and no visceral metastasis were the influencing factors of PFS,while lapatinib and first-line treatment(trastuzumab)with a benefit time of≥6 months were the independent influencing factors of PFS.Conclusion:For the patients with HER-2 positive advanced breast cancer who failed trastuzumab treatment,the follow-up treatment with targeted drugs of anti HER-2 can improve the prognosis of the patients.