| 97 | 0 | 28 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨真实世界三阴型乳腺癌患者新辅助免疫治疗联合化疗方案的疗效及安全性。方法 采用回顾性研究，分析2023年11月至2024年11月北京市朝阳区三环肿瘤医院肿瘤内科收治的接受新辅助免疫治疗联合化疗方案治疗的14例三阴型乳腺癌患者临床资料。所有患者均完成4～8个周期新辅助治疗后行手术治疗，根据患者用药情况、年龄、月经状态、肿瘤大小、淋巴结转移情况、激素受体情况、 Ki-67表达水平分析评价患者疗效和安全性。结果 14例接受新辅助免疫治疗的三阴型乳腺癌患者中，经影像学评估，完全缓解7例（50%），部分缓解7例（50%），客观缓解率为100%，疾病控制率为100%。术后病理评价为病理完全缓解（pCR） 9例（64.3%），非pCR5例（35.7%）。患者的主要不良反应包括胃肠道反应、骨髓抑制、周围神经病变、免疫性甲状腺炎、免疫性肝炎、免疫性心肌炎及肌炎等。不良反应多为1～2级，3～4级不良反应少见，经对症治疗均恢复正常。结论 三阴型乳腺癌患者新辅助免疫治疗联合化疗方案治疗疗效显著，不良反应可控可管理。
Abstract：Objective To investigate the efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in patients with triple-negative breast cancer in real-world practice. Methods This retrospective study analyzed the clinical data of 14 female TNBC patients admitted to Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital between November 2023 and November 2024 who received neoadjuvant immunotherapy combined with chemotherapy. All patients underwent surgery after completing 4 ～ 8 cycles of neoadjuvant therapy. Treatment efficacy and safety were assessed based on medication regimen, age, menstrual status, tumor size, lymph node metastasis, hormone receptor status, and Ki-67 expression levels. Results Radiographic assessments demonstrated complete response in 7 patients(50%) and partial response in 7 patients(50%), yielding an objective response rate of 100% and disease control rate of 100%. Pathological evaluation post-surgery revealed pathological complete response(pCR) in 9 patients(64.3%) and non-pCR in 5 patients(35.7%). Common adverse reactions included gastrointestinal symptoms, myelosuppression, peripheral neuropathy, immune thyroiditis, immune hepatitis, immune myocarditis, and myositis. Most adverse reactions were grade 1 ～ 2, and grade 3 ～ 4 events were rare, resolving with symptomatic treatment. Conclusion Neoadjuvant immunotherapy combined with chemotherapy shows significant clinical efficacy and manageable toxicity in triple-negative breast cancer patients.
[1]World,Health,Organization.World,cancer,report,2020[EB/OL].[2021-11-01].https：//www.iarc.fr/cards_page/world-cancer-report/.
[2]Dawood S.Triple-negative breast cancer:epidemiology and management options[J].Drugs,2010,70(17):2247-2258.DOI:10.2165/11538150-000000000-00000.
[3]刘子梅，沈赞．三阴性乳腺癌靶向治疗最新进展[J].中国癌症杂志，2017(1):36-40.DOI:10.19401/j.cnki.1007-3639.2017.01.007.
[4]Budd GT,Barlow WE,Moore HCF,et al.SWOG S0221:aphaseⅢtrial comparing chemotherapy schedules in high-risk early-stage breast cancer[J].J Clin Oncol,2015,33(1):58-64.DOI:10.1200/JCO.2014.56.3296.
[5]Foulkes WD,Smith IE,Reis-Filho JS.Triple-negative breast cancer[J].N Engl J Med,2010,363(20):1938-1948.DOI:10.1056/NEJMra1001389.
[6]刘伟，王燕荣，王永兴.新辅助化疗后的病理完全缓解及其对不同分子亚型乳腺癌的预后价值[J].现代肿瘤医学，2018,26(13):2118-2122.DOI:10.3969/j.Issn.1672-4992.2018.13.038.
[7]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.DOI:10.1016/j.ejca.2008.10.026.
[8]CTEP cancer therapy evaluation program.Common Terminology Criteria for Adverse Events(CTCAE).[ED/OL].[2021-04-19].https：//ctep.cancer.gov/protocol Development/electronic_applications/ctc.htm#ctc_archive.
[9]Schmid P,Salgado R,Park YH,et al.Pembrolizumab plus chemotherapy as neoadjuvant treatment of high-risk,earlystage triple-negative breast cancer:results from the phase 1b open-label,multicohort KEYNOTE-173 study[J].Ann Oncol,2020,31(5):569-581.DOI:10.1016/j.annonc.2020.01.072.
[10]Schmid P,Cortes J,Dent R,et al.VP7-2021:KEYNOTE-522:phaseⅢstudy of neoadjuvant pembrolizumab+chemotherapy vs.placebo+chemotherapy,followed by adjuvant pembrolizumab vs.placebo for earlystage TNBC[J].Ann Oncol,2021,32(9):S1198-S1200.DOI:10.1016/j.annonc.2021.06.014.
[11]Mittendorf EA,Zhang H,Barrios CH,et al.Neoadjuvant atezolizumab in combination with sequential nabpaclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031):a randomised,doubleblind,phase 3 trial[J].Lancet,2020,396(10257):1090-1100.DOI:10.1016/S0140-6736(20)31953-X.
[12]Nanda R,Liu MC,Yau C,et al.Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer:an analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial[J].JAMA Oncol,2020,6(5):676-684.DOI:10.1001/jamaoncol.2019.6650.
[13]Schmid P,Rugo HS,Adams S,et al.Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable,locally advanced or metastatic triple-negative breast cancer (IMpassion130):updated efficacy results from a randomised,double-blind,placebo-con-trolled,phase3 trial[J].Lancet Oncol,2020,21(1):44-59.DOI:10.1016/S1470-2045(19)30689-8.
[14]Jiang YZ,Liu Y,Xiao Y,et al.Molecular subtyping and genomic profiling expand precision medicine in refractory metastatic triplenegative breast cancer:the FUTURE trial[J].Cell Res,2021,31(2):178-186.DOI:10.1038/s41422-020-0375-9.
[15]Mougalian SS,Soulos PR,Killelea BK,et al.Use of neoadjuvant chemotherapy for patients with stageⅠtoⅢbreast cancer in the United States[J].Cancer,2015,121(15):2544-2552.DOI:10.1002/cncr.29348.
[16]Masuda N,Lee SJ,Ohtani S,et al.Adjuvant capecitabine for breast cancer after preoperative chemotherapy[J].N Engl J Med,2017,376(22):2147-2159.DOI:10.1056/NEJMoa1612645.
[17]中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会（CSCO）乳腺癌诊疗指南2021[M].北京：人民卫生出版社，2021.DOI:10.3760/cma.j.cn112137-20210421-00954.
[18]Cardoso F,Kyriakides S,Ohno S,et al.Early breast cancer:ESMO clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2019,30(10):1674.DOI:10.1093/annonc/mdz173.
[19]Sikov WM,Berry DA,Perou CM.Impact of the addition of carboplatinand/or bevacizumab to neoadjuvant onceper-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stageⅡtoⅢtriple-negative breast cancer:CALGB 40603 (Alliance)[J].J Clin Oncol,2015,33(1):13-21.DOI:10.1200/JCO.2014.57.0572.
[20]Jiang YZ,Ma D,Suo C,et al.Genomic and transcriptomic landscape of triple-negative breast cancers:subtypes and treatment strategies[J].Cancer Cell,2019,35 (3):428-440.DOI:10.1016/j.ccell.2019.02.001.
[21]魏继武.溶瘤免疫治疗的机遇与挑战[J].医学研究生学报，2018,31(7):678-682.DOI:10.16571/j.cnki.1008-8199.2018.07.002.
[22]Schmid P,Cortes J,Pusztai L,et al.Pembrolizumab for early triple-negative breast cancer[J].N Engl J Med,2020,382 (9):810-821.DOI:10.1056/NEJMoa1910549.
[23]Mittendorf EA,Philips AV,Meric-Bernstam F,et al.PD-L1 expression in triple-negative breast cancer[J].Cancer Immunol Res,2014,2(4):361-370.DOI:10.1158/2326-6066.CIR-13-0127.
[24]Loibl S,Untch M,Burchardi N,et al.A randomised phaseⅡstudy investigating durvalumab in addition to an anthra-cycline taxane-based neoadjuvant therapy in early triple-negative breast cancer:clinical results and biomarker analysis of Gepar Nuevo study[J].Ann Oncol,2019,30 (8):1279-1288.DOI:10.1093/annonc/mdz158.
基本信息:
DOI：10.13455/j.cnki.cjcor.113494-20250409-0155
中图分类号:R737.9
引用信息:
[1]马玉洁,赵美庆,杨帅,等.三阴型乳腺癌新辅助免疫治疗联合化疗方案疗效及安全性的真实世界研究[J].中国肿瘤临床与康复,2025,32(11):713-719.DOI:10.13455/j.cnki.cjcor.113494-20250409-0155.