Lancet oncol:多西他赛、卡铂化疗,联合曲妥珠单抗和帕托珠单抗治疗HER2阳性乳腺癌患者的疗效与副反应。

2017-11-25 MedSci MedSci原创

HER2靶向治疗在新辅助、辅助治疗甚至已发生转移的情况下,均可提高HER2阳性的乳腺癌患者的预但部分患者在疾病早期进行治疗后多年里仍有复发或死亡的风险。

HER2靶向治疗在新辅助、辅助治疗甚至已发生转移的情况下,均可提高HER2阳性的乳腺癌患者的预但部分患者在疾病早期进行治疗后多年里仍有复发或死亡的风险。

2014年6月25日-2015年6月15日,Sara A Hurvitz等人在多个国家的68个肿瘤研究中心进行一随机性、非盲的3期KRISTINE试验,招募了444名满18岁的、HER2阳性的II-III期可进行手术治疗的乳腺癌患者(肿瘤直径>2cm),且满足肿瘤组织状态评分0-1分、左心室射血分数≥55%。将患者按1:1随机分组,A组223人,接受曲妥珠单抗(3.6 mg/kg)联合帕托珠单抗(负荷剂量840mg、维持剂量420mg)治疗,B组221人,接受多西他赛(75mg/m2)、卡铂(6mg/mL·min)和曲妥珠单抗(负荷剂量8mg/kg、维持剂量6mg/kg)联合帕托珠单抗(同A组)治疗,并分局激素受体水平、肿瘤分期和肿瘤分区进行分层。治疗每3周一疗程,共6个疗程。主要评估指标是对比两组获得病理完全反应(ypT0/is,ypN0)的患者数量。

A组和B组获得病理完全反应的人数分别是99人(44.4%)和123人(55.7%)(绝对差-11.3%,95% CI -20.5~-2.0;p=0.016)。与B组患者相比,A组患者3-4级不良反应事件和严重的不良反应的发生率更低(A组 vs B组:29[13%]vs 141[64%];11[5%]vs 63[29%])。A组最常见的3-4级不良反应是血小板计数减少(3[1%],B组11[5%])、疲乏(3[1%] vs 7[3%])、丙氨酸转氨酶升高(3[1%] vs 4[2%])和低钾血症(3[1%] vs 5[2%])。B组最常见的3-4级不良反应是中性粒细胞减少(55[25%],A组1[<1%])、腹泻(33[15%] vs 2[<1%])和发热性中性粒细胞减少(33[15%] vs 0)。无治疗相关的死亡。

与HER2靶向化疗联合HER2靶向阻滞(即A组)相比,传统新辅助系统化疗联合双重HER2靶向阻滞剂(即B组)可显着增加获得病理完全反应的患者数量,但同时发生更多的3-4级不良反应。需要进一步探索可提高治疗效果但不增加毒副作用的治疗方案。

原始出处:


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    2017-12-02 minlingfeng
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    2018-03-27 huagfeg
  4. [GetPortalCommentsPageByObjectIdResponse(id=1737543, encodeId=cea41e3754302, content=<a href='/topic/show?id=292f965e5b5' target=_blank style='color:#2F92EE;'>#铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96575, encryptionId=292f965e5b5, topicName=铂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ca4034296500, createdName=ms3153534357578991, createdTime=Fri Jan 19 17:14:00 CST 2018, time=2018-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865210, encodeId=2626186521095, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Dec 02 10:14:00 CST 2017, time=2017-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1937360, encodeId=1f29193e360bf, content=<a href='/topic/show?id=8cb632e8025' target=_blank style='color:#2F92EE;'>#副反应#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32780, encryptionId=8cb632e8025, topicName=副反应)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1dbc2500219, createdName=huagfeg, createdTime=Tue Mar 27 20:14:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648111, encodeId=f861164811143, content=<a href='/topic/show?id=d5c560226fc' target=_blank style='color:#2F92EE;'>#曲妥珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Tue Nov 28 21:21:15 CST 2017, time=2017-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571090, encodeId=f33515e109076, content=<a href='/topic/show?id=f42823e48d7' target=_blank style='color:#2F92EE;'>#乳腺癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23748, encryptionId=f42823e48d7, topicName=乳腺癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37bc15724202, createdName=hanhaisha2013, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490070, encodeId=039814900e03f, content=<a href='/topic/show?id=bf08965e9a7' target=_blank style='color:#2F92EE;'>#铂化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96579, encryptionId=bf08965e9a7, topicName=铂化疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=67238689175, createdName=drj2006, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396284, encodeId=cfb2139628459, content=<a href='/topic/show?id=9dc636545a4' target=_blank style='color:#2F92EE;'>#卡铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36545, encryptionId=9dc636545a4, topicName=卡铂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308499, encodeId=f918130849932, content=<a href='/topic/show?id=240f8e3234' target=_blank style='color:#2F92EE;'>#HER2阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8732, encryptionId=240f8e3234, topicName=HER2阳性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8409354, createdName=闆锋旦, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1737543, encodeId=cea41e3754302, content=<a href='/topic/show?id=292f965e5b5' target=_blank style='color:#2F92EE;'>#铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96575, encryptionId=292f965e5b5, topicName=铂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ca4034296500, createdName=ms3153534357578991, createdTime=Fri Jan 19 17:14:00 CST 2018, time=2018-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865210, encodeId=2626186521095, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, 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topicList=[TopicDto(id=60226, encryptionId=d5c560226fc, topicName=曲妥珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a67b23554000, createdName=linlin2320, createdTime=Tue Feb 27 15:14:00 CST 2018, time=2018-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829338, encodeId=6aee1829338aa, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Oct 19 04:14:00 CST 2018, time=2018-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=265117, encodeId=014426511eb0, content=学习啦!谢谢分享!学习啦!谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Tue Nov 28 21:21:15 CST 2017, time=2017-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571090, encodeId=f33515e109076, content=<a href='/topic/show?id=f42823e48d7' target=_blank style='color:#2F92EE;'>#乳腺癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23748, encryptionId=f42823e48d7, topicName=乳腺癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37bc15724202, createdName=hanhaisha2013, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490070, encodeId=039814900e03f, content=<a href='/topic/show?id=bf08965e9a7' target=_blank style='color:#2F92EE;'>#铂化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96579, encryptionId=bf08965e9a7, topicName=铂化疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=67238689175, createdName=drj2006, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396284, encodeId=cfb2139628459, content=<a href='/topic/show?id=9dc636545a4' target=_blank style='color:#2F92EE;'>#卡铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36545, encryptionId=9dc636545a4, topicName=卡铂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308499, encodeId=f918130849932, content=<a href='/topic/show?id=240f8e3234' target=_blank style='color:#2F92EE;'>#HER2阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8732, encryptionId=240f8e3234, topicName=HER2阳性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8409354, createdName=闆锋旦, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=)]
    2018-10-19 howi
  6. [GetPortalCommentsPageByObjectIdResponse(id=1737543, encodeId=cea41e3754302, content=<a href='/topic/show?id=292f965e5b5' target=_blank style='color:#2F92EE;'>#铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96575, encryptionId=292f965e5b5, topicName=铂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ca4034296500, createdName=ms3153534357578991, createdTime=Fri Jan 19 17:14:00 CST 2018, time=2018-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865210, encodeId=2626186521095, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, 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topicList=[TopicDto(id=60226, encryptionId=d5c560226fc, topicName=曲妥珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a67b23554000, createdName=linlin2320, createdTime=Tue Feb 27 15:14:00 CST 2018, time=2018-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829338, encodeId=6aee1829338aa, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Oct 19 04:14:00 CST 2018, time=2018-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=265117, encodeId=014426511eb0, content=学习啦!谢谢分享!学习啦!谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Tue Nov 28 21:21:15 CST 2017, time=2017-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571090, encodeId=f33515e109076, content=<a href='/topic/show?id=f42823e48d7' target=_blank style='color:#2F92EE;'>#乳腺癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23748, encryptionId=f42823e48d7, topicName=乳腺癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37bc15724202, createdName=hanhaisha2013, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490070, encodeId=039814900e03f, content=<a href='/topic/show?id=bf08965e9a7' target=_blank style='color:#2F92EE;'>#铂化疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96579, encryptionId=bf08965e9a7, topicName=铂化疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=67238689175, createdName=drj2006, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396284, encodeId=cfb2139628459, content=<a href='/topic/show?id=9dc636545a4' target=_blank style='color:#2F92EE;'>#卡铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36545, encryptionId=9dc636545a4, topicName=卡铂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308499, encodeId=f918130849932, content=<a href='/topic/show?id=240f8e3234' target=_blank style='color:#2F92EE;'>#HER2阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8732, encryptionId=240f8e3234, topicName=HER2阳性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8409354, createdName=闆锋旦, createdTime=Mon Nov 27 03:14:00 CST 2017, time=2017-11-27, status=1, ipAttribution=)]
    2017-11-28 tanxingdoctor

    学习啦!谢谢分享!学习啦!谢谢分享!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1737543, encodeId=cea41e3754302, content=<a href='/topic/show?id=292f965e5b5' target=_blank style='color:#2F92EE;'>#铂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96575, encryptionId=292f965e5b5, topicName=铂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ca4034296500, createdName=ms3153534357578991, createdTime=Fri Jan 19 17:14:00 CST 2018, time=2018-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865210, encodeId=2626186521095, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, 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  8. 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    2017-11-27 drj2006
  9. 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人类表皮生长因子受体2(HER2)-阳性乳腺癌患者在术前接受帕妥珠单抗治疗使得病理完全反应的速率增加了,而采用帕妥珠单抗辅助曲妥珠单抗和化疗治疗可增加转移性疾病患者的整体生存率。近日,在权威杂志NEW ENGL J MED上发表了一篇研究文章,研究人员研究帕妥珠单抗辅助曲妥珠单抗和化疗治疗是否能改善HER2阳性早期乳腺癌患者的预后。

CLIN CANCER RES:DC疫苗可以增强免疫反应及诱导HER2阳性DCIS病情缓解

HER-2抗原冲击DC1制备的疫苗可以刺激HER-2特异性T细胞反应。CLIN CANCER RES近期发表了一篇文章,评估该疫苗的安全性以及通过不同途径给药的免疫反应及临床效果

[ABC4圆桌会] HER2阳性晚期乳腺癌:以抗HER2为基础,从一线到维持治疗

适才ABC4圆满落下帷幕,徐兵河教授已为读者解读了HER2阳性晚期乳腺癌治疗的新进展;《肿瘤瞭望》邀请了天津肿瘤医院佟仲生教授、中国医科大学附属第一医院滕月娥教授、江苏省肿瘤医院张莉莉和河南省肿瘤医院闫敏教授等梳理和讨论HER2阳性晚期乳腺癌一线到维持治疗内容。

CSCO 2017:把握驱动,精准治疗—— 江泽飞教授谈HER2阳性乳腺癌治疗现状

年包括曲妥珠单抗在内的靶向药物大幅降价,进入国家医保目录,基层医生对学习靶向药物的使用方法和规范化治疗的需求非常强烈,本次CSCO大会的乳腺癌专场会议的主题是“把握驱动,精准治疗”,对乳腺癌抗HER2治疗进行了深入的解读。【肿瘤资讯】特别采访了CSCO乳腺癌专业委员会江泽飞教授,为我们解读乳腺癌在真实世界的治疗现状和对CSCO乳腺癌指南的推广的想法。

[ABC4]徐兵河教授:HER2阳性晚期乳腺癌治疗的“变”与“不变”

第四届国际晚期乳腺癌专家共识大会在葡萄牙里斯本如约而至,作为参与ABC4共识指南投票的唯一中国专家,中国医学科学院肿瘤医院徐兵河教授对HER2阳性乳腺癌诊治的“变”与“不变”深有体会,《肿瘤瞭望》有幸邀请徐教授就此话题展开探讨。