摘要
目的研究帕妥珠单抗和曲妥珠单抗(双靶向治疗)联合化学治疗(简称“化疗”)或内分泌治疗对老年人类表皮生长因子受体2(human epidermal factor receptor 2,HER2)阳性乳腺癌患者的临床疗效及T淋巴细胞亚群的影响。方法纳入康复大学青岛中心医院2021年3月至2024年9月收治的138例老年HER2阳性乳腺癌患者,使用随机数字表法分为化疗组(双靶向治疗+白蛋白紫杉醇+卡铂)和内分泌治疗组(双靶向治疗+来曲唑),每组69例。2组均在接受6个周期的新辅助双靶向治疗后行手术治疗。比较2组患者的客观缓解率(objective remission rate,ORR)、病理学完全缓解(pathologic complete response,pCR)、不良反应发生率、生活质量[乳腺癌特异性生命质量测定问卷(Breast Cancer-Specific Quality of Life Questionnaire,QLQ-BR23)量表]及T淋巴细胞亚群[CD3阳性T细胞(cluster of differentiation 3 positive T cell,CD3^(+)T)比例、CD4^(+)T比例、CD4^(+)T/CD8^(+)T比值]变化。结果内分泌治疗组中性粒细胞减少、白细胞减少等不良反应发生率较化疗组更低(P<0.05)。2组患者治疗6个周期后,QLQ-BR23中的功能维度评分升高、症状维度评分下降(P<0.05)。2组患者治疗6个周期后的CD3^(+)T比例、CD4^(+)T比例和CD4^(+)T/CD8^(+)T比值较治疗前升高;内分泌治疗组治疗6个周期后的CD3^(+)T比例、CD4^(+)T比例和CD4^(+)T/CD8^(+)T比值较化疗组升高更为显著(P<0.05)。结论双靶向治疗联合内分泌治疗对老年HER2阳性乳腺癌患者的近期疗效与双靶向治疗联合化疗相当,但不良反应更少,且能更好地改善患者生活质量和免疫功能。
Objective To investigate the clinical efficacy of pertuzumab and trastuzumab(dual-targeted therapy)combined with chemotherapy or endocrine therapy in elderly patients with human epidermal growth factor receptor 2(HER2)-positive breast cancer,and its impact on T lymphocyte subset effects.Methods A total of 138 elderly patients with HER2-positive breast cancer admitted to Qingdao Central Hospital of Rehabilitation University from March 2021 to September 2024 were included.They were assigned using a random number table method into two groups:a chemotherapy group(dual-targeted therapy+albumin-bound paclitaxel+carboplatin)and an endocrine therapy group(dual-targeted therapy+letrozole),with 69 patients in each.Both groups received 6 cycles of neoadjuvant dual-targeted therapy followed by surgical intervention.This study compared the objective remission rate(ORR),pathologic complete response(pCR),incidence of adverse reactions,quality of life[using the Breast Cancer-Specific Quality of Life Questionnaire(QLQ-BR23)],and T lymphocyte subsets(the proportion of CD3^(+)T cells,CD4^(+)T cells,and the CD4^(+)T/CD8^(+)T ratio)between the two groups of patients.Results The incidence of adverse reactions,such as neutropenia and leukopenia,was significantly lower in the endocrine therapy group than in the chemotherapy group(P<0.05).After 6 cycles of treatment,the functional domain scores of the QLQ-BR23 increased,while the symptom domain scores decreased in both groups(P<0.05).Furthermore,the proportions of CD3^(+)T cells,CD4^(+)T cells,and the CD4^(+)T/CD8^(+)T ratio were significantly increased after 6 treatment cycles compared to baseline in both groups.Notably,the increases in CD3^(+)T cells,CD4^(+)T cells,and CD4^(+)T/CD8^(+)T ratio were more pronounced in the endocrine therapy group compared to the chemotherapy group after 6 cycles of treatment(P<0.05).Conclusion Dual-targeted therapy combined with endocrine therapy demonstrates comparable short-term efficacy to dual-targeted therapy combined with chemotherapy in elderly patients with HER2-positive breast cancer.However,the endocrine therapy combination is associated with fewer adverse reactions and leads to better improvement in patients,quality of life and immune function.
作者
吴群玫
孙海波
张辉
刘超
栾晓东
WU Qunmei;SUN Haibo;ZHANG Hui;LIU Chao;LUAN Xiaodong(Health Management Center,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao 266042,China;Department of Breast Surgery,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao 266042,China)
出处
《药学进展》
2025年第10期909-913,共5页
Progress in Pharmaceutical Sciences
基金
青岛市医药卫生科研指导项目(No.2022-WJZD084)。
