摘要
目的:研究HER2阳性乳腺癌患者应用曲妥珠单抗治疗的心脏远期毒性反应。方法:收集31例可手术且HER2阳性表达乳腺癌患者,HER2阳性表达定义为免疫组织化学方法(3+)或荧光原位杂交方法确认HER2基因扩增,其中26例接受每3周1次的曲妥珠单抗治疗,首次以负荷剂量8 mg/kg给药,后每3周6 mg/kg维持治疗;采用心脏二维超声定期监测左心射血分数(LVEF),评估心脏毒性反应。结果:曲妥珠单抗首次用药后随访期79～104个月,中位随访90个月,26例患者接受曲妥珠单抗治疗6个月和12个月为2例,1年治疗为14例,2年为10例。2例出现症状性左心射血分数下降,降幅超过10%,且1例伴有高血压患者出现心衰症状,经对症处理1年后LVEF值仍为41%。辅助化疗使用过蒽环类对比未使用过蒽环类药物LVEF均值治疗前为(64.38±5.25)%,使用1年后为(61.58±4.97)%,使用5年后为(60.04±5.73)%(P>0.05)。结论:曲妥珠单抗总体安全性良好,心脏毒性虽为可逆性,但对具有高血压及心脏疾患的老年乳腺癌患者,仍须注意评估与监测。
Objective： To investigate long-term cardiotoxicity in patients with human epidermal growth factor receptor 2 （HER2）-positive breast cancer treated with trastuzumab. Methods： We gathered operable, HER2- positive breast cancer patients in Tongji Hospital from January 2002 to January 2005. HER2 positive was defined protein expression （3＋） measured by immunohistochemistry or Her2 gene amplification by fluorescence in situ hybridization. A total of 26 cases received 6 mg/kg of trastuzumab every 3 weeks after a loading dose of 8 mg/kg. The left ventricular ejection fraction （LVEF） was measured for regular monitoring and assessment of cardiotoxicity. Results： All cases were followed up 79 months to 104 months after the first trastuzumab administration. The median follow-up time was 90 months. Two patients were treated with trastuzumab for less than 1 year, 14 cases were treated for 1 year, and 10 cases were treated for 2 years. A symptomatic decline in LVEF occurred in 2 cases, representing a decrease of more than 10%. In addition, 1 case with hypertension manifested symptoms of heart failure and an LVEF value at 41% after 1 year of cardiac treatment. Comparison between adjuvant che- motherapy with anthracycline and chemotherapy without anthracycline obtained the baseline mean LVEF value of 64.38%± 5.25%. The value was 61.58% ± 4.97% after 1 year of trastuzumab treatment and 60.04% ± 5.73% after 5 years of trastuzumab treatment （P〉0.05）. Conclusion： Trastuzumab administration was generally safe, with reversible cardiac toxicity. However, this treatment should be evaluated and monitored in elderly breast cancer patients with hypertension and heart disease.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2012年第23期1952-1955,共4页
Chinese Journal of Clinical Oncology
