The Clinical Observation Of Trastuzumab In First-line Treatment Of Her-2 Positive Metastatic Breast Cancer

Objective:To compare the clinical effects and adverse reactions in the first-line treatment between chemotherapy alone and chemotherapy combined with trastuzumab in the HER-2 positive metastatic breast cancer,and to discuss trastuzumab combined with different chemotherapy regimens of the first-line treatment,metastatic sites,Baseline levels of CA153,level of first-diagnosis PLR,trastuzumab resistance,trastuzumab cardiotoxicity and adverse effects.Methods: Retrospective analysis the data of breast cancer patients treated by Dalian Medical University during the year 2010.01.01 to 2014.12.31,whose Immunohistochemical confirmed Her-2(+++)or Her-2(++)but furthermore gene detection confirmed to be amplification type.21 cases of first-line recurrence of pure chemotherapy group,19 cases of recurrence of first-line chemotherapy combined trastuzumab,According to the therapeutic effect evaluation standard of solid tumor(RECIST1.0)evaluating curative effect,evaluate objective remission rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and evaluate the treatment related adverse effects according to CTCAE4.0 toxicant classification standard.And to discuss trastuzumab combined with different chemotherapy regimens of the first-line treatment,metastatic sites,Baseline levels of CA153,level of first-diagnosis PLR,trastuzumab resistance,trastuzumab cardiotoxicity and adverse effects.The Kaplan-Melen method,the Log-rank test and chi-square test were used for the statistical data analysis.Results:1.The ORR of Trastuzumab in combination group and chemotherapy group O RR was 37.5%,14.3%,DCR was 68.75%,71.4%,no statistical difference.Medi an PFS was 15.97 months and 15.97 months and the median OS was 75.23 mo nths and 43.70 months,differences were statistically significant.According to the results,Trastuzumab in first-line treatment with combination chemotherapy for HER-2 positive MBC can improve survival.2.Trastuzumab in combination with Docetaxel(not joint anthracycline-based)w ith two kinds of medicine at the same time,ORR was 22.22%,25.00%,DCR is 66.67%,50%,no statistical difference.Median PFS was 14.90 months and 12.50 months;The median OS 78.03 months and 66.00 months,there were no statist ical differences.According to the results,for HER-2 positive MBC first-line tr eatment,Trastuzumab in combination with different chemotherapy regimens has no difference in the curative effect.3.In group of Trastuzumab in combination with chemotherapy,visceral transfe r(lung,liver)and non visceral transfer(lymph nodes,chest wall,bone)ORR w as 33.33%,50.00%,DCR are 66.67% and 66.67% respectively,no statistical diff erence.Median PFS was 11.20 months and 35.50 months;The median OS 66.00 months and 87.03 months,there were no statistical differences.According to th e results,Trastuzumab in combination with chemotherapy treat for HER-2 posi tive MBC,non visceral transfer has better progression-free surial,have extended trend for overall survival.4.In group of Trastuzumab in combination with chemotherapy,normal group of baseline CA153 and higher group ORR was 33.33%,42.86%,DCR is 66.67%,71.43%,had no statistical difference.The median PFS was 14.90 months an d 15.97 months,no statistical difference,the median OS 87.03 months and 43.37 months,the difference was statistically significant.The result shows: the first op tion baseline CA153 normal range of HER-2 positive MBC has longer overall s urvival.5.In group of Trastuzumab in combination with chemotherapy,platelet lymph ocyte ratio(PLR)< 150 and PLR of 150 or more ORR was 44.44%,28.57%,DCR is 66.67%,71.43%,no statistical difference.Median PFS was 18.33 months and 15.97 months;The median OS 80.43 months and 36.10 months,there were no statistical differences.The result shows: for HER-2 positive MBC first-line treatment,first option PLR < 150 has longer overall survival.6.In group of Trastuzumab in combination with chemotherapy,recurrence ear ly(4 cycles)or recurrence after the Trastuzumab,treatment,the median PFS was 18.33 months and 12.50 months,statistically significant,the median OS 75.23 months and 78.03 months,no statistical difference.Results show that the first-lin e treatment in HER-2 positive MBC,whether Trastuzumab resistance had no effec t on overall survival.7.Trastuzumab in combination group and chemotherapy group patients experi enced major adverse reactions include bone marrow suppression(31.58%,38.09%),nausea and vomiting(52.63%,23.81%),hepatic damage(10.53%,4.76%),r ash(5.26%,4.76%),alopecia(5.26%,0),pain(5.26%,0),(0,4.76%)of the oral mucosa reaction.No cardiac toxicity events occur,consider Trastuzumab has a good tolerance.Conclusion: 1.Trastuzumab in first-line treatment in combination with chemotherapy for HER-2 positive MBC can improve survival.2.For HER-2 positive MBC first-line treatment,Trastuzumab in combination with different chemotherapy regimens has no difference in the curative effect.3.Trastuzumab in combination with chemotherapy treat for HER-2 positive MBC,non visceral transfer has better progression-free surial,have extended tren d for overall survival.4.The first option baseline CA153 normal range of HER-2 positive MBC h as longer overall survival.5.For HER-2 positive MBC first-line treatment,first option PLR < 150 has longer overall survival.6.For the first-line treatment in HER-2 positive MBC,whether the Trastuzuma b resistance occur has no effect on overall survival.7.Trastuzumab in first-line treatment combined with chemotherapy for HER-2 positive MBC compare to single chemotherapy group,adverse reactions did n ot increase,no cardiac toxicity events occur,consider Trastuzumab has a good tol erance.