新辅助化疗联合PD-1抑制剂治疗三阴性乳腺癌的临床疗效

doi:10.11958/20221554

天津医药 ›› 2023, Vol. 51 ›› Issue (8): 847-850.doi: 10.11958/20221554

新辅助化疗联合PD-1抑制剂治疗三阴性乳腺癌的临床疗效

张晓宇¹(), 任悦¹^,², 刘伟¹, 苗彦玲³, 张辉¹, 靳丽君¹, 张恒乐¹^,², 康晓宁³, 白杰¹, 王遵义¹^,^△()

1 沧州市中心医院甲乳外三科（邮编061000）
2 河北医科大学研究生院
3 沧州市中心医院超声二科

收稿日期:2022-10-08 修回日期:2023-02-10 出版日期:2023-08-15 发布日期:2023-08-10
通讯作者: ^△E-mail：181176788@qq.com
作者简介:张晓宇（1983），男，副主任医师，主要从事甲状腺与乳腺诊治方面研究。E-mail：93956466@qq.com
基金资助:
河北省医学科学研究课题(20220400)

Clinical efficacy of neoadjuvant chemotherapy combined with PD-1 inhibitor in the treatment of triple negative breast cancer

ZHANG Xiaoyu¹(), REN Yue¹^,², LIU Wei¹, MIAO Yanling³, ZHANG Hui¹, JIN Lijun¹, ZHANG Hengle¹^,², KANG Xiaoning³, BAI Jie¹, WANG Zunyi¹^,^△()

1 Department of Thyroid and Breast Surgery Ⅲ, Cangzhou Central Hospital, Cangzhou 061000, China
2 Graduate School, Hebei Medical University
3 Department of Ultrasound Ⅱ, Cangzhou Central Hospital

Received:2022-10-08 Revised:2023-02-10 Published:2023-08-15 Online:2023-08-10
Contact: ^△E-mail：181176788@qq.com

张晓宇, 任悦, 刘伟, 苗彦玲, 张辉, 靳丽君, 张恒乐, 康晓宁, 白杰, 王遵义. 新辅助化疗联合PD-1抑制剂治疗三阴性乳腺癌的临床疗效[J]. 天津医药, 2023, 51(8): 847-850.

ZHANG Xiaoyu, REN Yue, LIU Wei, MIAO Yanling, ZHANG Hui, JIN Lijun, ZHANG Hengle, KANG Xiaoning, BAI Jie, WANG Zunyi. Clinical efficacy of neoadjuvant chemotherapy combined with PD-1 inhibitor in the treatment of triple negative breast cancer[J]. Tianjin Medical Journal, 2023, 51(8): 847-850.

摘要/Abstract

摘要：

目的探讨新辅助化疗联合PD-1抑制剂治疗三阴性乳腺癌的临床疗效及其对免疫功能的影响。方法将80例三阴性乳腺癌患者随机分为对照组和观察组，每组40例。对照组接受多柔比星脂质体+环磷酰胺+白蛋白紫杉醇（AC-T）序贯化疗，观察组在对照组的基础上联合PD-1抑制剂治疗。所有患者完成免疫治疗及新辅助化疗3周后无手术禁忌证，均行乳腺癌改良根治术。比较2组患者的生活质量、临床疗效、手术时间、术中出血量、免疫指标及不良反应。结果治疗后，观察组生活质量评分高于对照组（84.55±6.09 vs. 75.93±6.12，P<0.05）。治疗8个周期后，观察组完全缓解率（CRR）、CD4⁺、CD8⁺、CD4⁺/CD8⁺、IgG、IgA和IgM水平均优于对照组（P<0.05）。观察组手术时间[（43.25±6.85）min vs. （82.53±8.53）min]和术中出血量[（136.52±8.74）mL vs. （241.63±8.32）mL]均少于对照组（P<0.05）；2组不良反应发生率差异无统计学意义（P>0.05）。结论三阴性乳腺癌采用新辅助化疗联合PD-1抑制剂治疗可以有效改善患者免疫功能和生活质量，保证临床治疗的安全性。

关键词: 免疫检查点抑制剂, 放化疗, 辅助, 三阴性乳腺癌, 生活质量, 免疫, 主动

Abstract:

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with PD-1 inhibitor in the treatment of triple negative breast cancer and its effect on immune function. Methods Eighty patients with triple negative breast cancer were randomly divided into the control group and the observation group, with 40 cases in each group. The control group received sequential chemotherapy of doxorubicin liposome + cyclophosphamide + albumin paclitaxel (AC-T), and the observation group was treated with PD-1 inhibitor on the basis of the control group. The quality of life, clinical efficacy, operation time, intraoperative blood loss, immune function and adverse reactions were compared between the two groups. Results After treatment, the SF-36 score was significantly higher in the observation group (84.55±6.09) than that of the control group (75.93±6.12, P<0.05). After 8 courses of treatment, the complete response rate (CRR), CD4⁺, CD8⁺, CD4⁺/CD8⁺, immunoglobulin IgG, IgA and IgM levels were significantly better in the observation group than those in the control group (P<0.05). The operative time [(43.25±6.85) min vs. (82.53±8.53) min] and intraoperative bleeding [(136.52±8.74) mL vs. (241.63±8.32) mL] were significantly decreased in the observation group than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Neoadjuvant chemotherapy combined with PD-1 inhibitor in the treatment of triple negative breast cancer can improve the immune function and quality of life of patients, and ensure the safety of clinical treatment.

Key words: immune checkpoint inhibitors, chemoradiotherapy, adjuvant, triple negative breast neoplasms, quality of life, immunity, active

中图分类号:

R737.9

图/表 5

参考文献 19

[1]	YIN L, DUAN J J, BIAN X W, et al. Triple-negative breast cancer molecular subtyping and treatment progress[J]. Breast Cancer Res, 2020, 22(1):61. doi:10.1186/s13058-020-01296-5.
[2]	KWAPISZ D. Pembrolizumab and atezolizumab in triple-negative breast cancer[J]. Cancer Immunol Immunother, 2021, 70(3):607-617. doi:10.1007/s00262-020-02736-z.
[3]	WON K A, SPRUCK C. Triple-negative breast cancer therapy:current and future perspectives (Review)[J]. Int J Oncol, 2020, 57(6):1245-1261. doi:10.3892/ijo.2020.5135.
[4]	LEON-FERRE R A, HIEKEN T J, BOUGHRY J C. The landmark series:neoadjuvant chemotherapy for triple-negative and HER2-positive breast cancer[J]. Ann Surg Oncol, 2021, 28(4):2111-2119. doi:10.1245/s10434-020-09480-9.
[5]	KEENAN T E, TOLANEY S M. Role of immunotherapy in triple-negative breast cancer[J]. J Natl Compr Canc Netw, 2020, 18(4):479-489. doi:10.6004/jnccn.2020.7554.
[6]	EMENS L A. Breast cancer immunotherapy:facts and hopes[J]. Clin Cancer Res, 2018, 24(3):511-520. doi:10.1158/1078-0432.CCR-16-3001.
[7]	BERGIN A R T, LOI S. Triple-negative breast cancer:recent treatment advances[J]. F1000Res, 2019, 8:F1000 Faculty Rev-1342. doi:10.12688/f1000research.18888.1.
[8]	LYONS T. Targeted therapies for triple-negative breast cancer[J]. Curr Treat Options Oncol, 2019, 20(11):82. doi:10.1007/s11864-019-0682-x.
[9]	ZHU Y, ZHU X, TANG C, et al. Progress and challenges of immunotherapy in triple-negative breast cancer[J]. Biochim Biophys Acta Rev Cancer, 2021, 1876(2): 188593. doi:10.1016/j.bbcan.2021.188593.
[10]	MARRA A, CURIGLIANO G. Adjuvant and neoadjuvant treatment of triple-negative breast cancer with chemotherapy[J]. Cancer J, 2021, 27(1):41-49. doi:10.1097/PPO.0000000000000498.
[11]	NEDELJKOVIĆ M, DAMJANOVIĆ A. Mechanisms of chemotherapy resistance in triple-negative breast cancer-how we can rise to the challenge[J]. Cells, 2019, 8(9):957. doi:10.3390/cells8090957.
[12]	GARRIDO-CASTRO A C, LIN N U, POLYAK K. Insights into molecular classifications of triple-negative breast cancer:improving patient selection for treatment[J]. Cancer Discov, 2019, 9(2):176-198. doi:10.1158/2159-8290.CD-18-1177.
[13]	TARANTINO P, GANDINI S, TRAPANI D, et al. Immunotherapy addition to neoadjuvant chemotherapy for early triple negative breast cancer:a systematic review and meta-analysis of randomized clinical trials[J]. Crit Rev Oncol Hematol, 2021, 159:103223. doi:10.1016/j.critrevonc.2021.103223.
[14]	SPORIKOVA Z, KOUDELAKOVA V, TROJANEC R, et al. Genetic markers in triple-negative breast cancer[J]. Clin Breast Cancer, 2018, 18(5):e841-e850. doi:10.1016/j.clbc.2018.07.023.
[15]	WAKS A G, WINER E P. Breast cancer treatment:a review[J]. JAMA, 2019, 321(3):288-300. doi:10.1001/jama.2018.19323.
[16]	CHAUDHARY L N, WILKINSON K H, KONG A. Triple-negative breast cancer:who should receive neoadjuvant chemotherapy?[J]. Surg Oncol Clin N Am, 2018, 27(1),141-153. doi:10.1016/j.soc.2017.08.004.
[17]	POGGIO F, BRUZZONE M, CEPPI M, et al. Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer:a systematic review and meta-analysis[J]. Ann Oncol, 2018, 29(7):1497-1508. doi:10.1093/annonc/mdy127.
[18]	EMENS L A. Immunotherapy in triple-negative breast cancer[J]. Cancer J, 2021, 27(1):59-66. doi:10.1097/PPO.0000000000000497.
[19]	BORRI F, GRANAGLIA A. Pathology of triple negative breast cancer[J]. Semin Cancer Biol, 2021, 72:136-145. doi:10.1016/j.semcancer.2020.06.005.

组别	CR	手术时间/min	术中出血量/mL
对照组	8（20.0）	82.53±8.53	241.63±8.32
观察组	19（47.5）	43.25±6.85	136.52±8.74
χ²或t	6.765^＊＊	22.706^＊＊	55.097^＊＊

组别	CR	手术时间/min	术中出血量/mL
对照组	8（20.0）	82.53±8.53	241.63±8.32
观察组	19（47.5）	43.25±6.85	136.52±8.74
χ²或t	6.765^＊＊	22.706^＊＊	55.097^＊＊

组别	CD4⁺/%					CD8⁺/%
组别	治疗前			治疗后		治疗前		治疗后
对照组	32.42±2.25			34.73±2.32		31.53±2.61		28.94±2.33
观察组	32.65±2.17			38.42±2.85		31.86±2.76		22.86±2.16
t	0.466			6.342^＊＊		0.540		12.115^＊＊
组别		CD4⁺/CD8⁺			IgG/（g/L）
组别		治疗前	治疗后		治疗前		治疗后
对照组		1.19±0.22	1.22±0.32		15.53±1.72		13.52±1.54
观察组		1.23±0.17	1.61±0.35		15.82±3.64		11.57±1.65
t		1.062	5.235^＊＊		0.444		5.439^＊＊
组别		IgA/（g/L）				IgM/（g/L）
组别		治疗前		治疗后		治疗前		治疗后
对照组		2.11±0.38		2.15±0.37		1.85±0.29		1.55±0.23
观察组		2.09±0.43		1.92±0.42		1.88±0.42		1.39±0.27
t		0.221		2.630^＊＊		0.374		2.830^＊＊

组别	CD4⁺/%					CD8⁺/%
组别	治疗前			治疗后		治疗前		治疗后
对照组	32.42±2.25			34.73±2.32		31.53±2.61		28.94±2.33
观察组	32.65±2.17			38.42±2.85		31.86±2.76		22.86±2.16
t	0.466			6.342^＊＊		0.540		12.115^＊＊
组别		CD4⁺/CD8⁺			IgG/（g/L）
组别		治疗前	治疗后		治疗前		治疗后
对照组		1.19±0.22	1.22±0.32		15.53±1.72		13.52±1.54
观察组		1.23±0.17	1.61±0.35		15.82±3.64		11.57±1.65
t		1.062	5.235^＊＊		0.444		5.439^＊＊
组别		IgA/（g/L）				IgM/（g/L）
组别		治疗前		治疗后		治疗前		治疗后
对照组		2.11±0.38		2.15±0.37		1.85±0.29		1.55±0.23
观察组		2.09±0.43		1.92±0.42		1.88±0.42		1.39±0.27
t		0.221		2.630^＊＊		0.374		2.830^＊＊

组别	胃肠道反应	白细胞减少	肝功能障碍	静脉炎	总计
对照组	10	9	3	2	21
观察组	8	7	1	0	16
χ²					1.257

新辅助化疗联合PD-1抑制剂治疗三阴性乳腺癌的临床疗效

Clinical efficacy of neoadjuvant chemotherapy combined with PD-1 inhibitor in the treatment of triple negative breast cancer

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 5

参考文献 19

相关文章 15

编辑推荐

Metrics

本文评价

组别	n	治疗前	治疗后
对照组	40	67.25±5.74	75.93±6.12
观察组	40	67.83±5.82	84.55±6.09
t		0.445	6.319^＊＊

[1]	白梦刻, 杨晓青, 李航, 王龙, 马继伟. 过敏性紫癜肾炎伴新月体形成患儿的实验室指标和病理特征分析[J]. 天津医药, 2024, 52(8): 820-824.
[2]	满祎, 许娅, 何先成, 宋少锋, 刘爱国. 三阴性乳腺癌EGFR、Ki-67、P53及CTC表达与预后的关系研究[J]. 天津医药, 2024, 52(8): 862-867.
[3]	张国华, 张令令, 高兰, 罗俊丽, 申雅文, 刘磊, 王玉华. 结缔组织病相关间质性肺病合并肺癌16例临床分析[J]. 天津医药, 2024, 52(7): 687-690.
[4]	刘青青, 李宜蔷, 石玉士, 陆海颂, 程纬民. TGF-β信号通路在骨髓增生异常综合征中作用机制的研究进展[J]. 天津医药, 2024, 52(7): 781-784.
[5]	谢汶甫, 韦明勇, 张姗, 刘海英, 雷浩, 邹芳媛. 橡皮圈与牙线牵引辅助内镜黏膜下剥离术治疗消化道早癌的疗效比较[J]. 天津医药, 2024, 52(6): 599-603.
[6]	霍晶辰, 王悦, 李华, 邱嵘, 苏景伟, 王卓凡, 杨洁. 系统免疫炎症指数对根治性放疗Ⅲ期肺鳞癌患者长期生存的预测价值[J]. 天津医药, 2024, 52(6): 634-638.
[7]	吴倩, 王意, 陈念, 周凯, 田昕, 徐晖, 苟小霞. 诱导化疗对鼻咽癌患者免疫功能及炎症指标的影响[J]. 天津医药, 2024, 52(4): 397-402.
[8]	单子鸿, 胡晓青, 李峰, 黄永坤. 5-羟色胺在胃肠道疾病中的作用及其机制研究进展[J]. 天津医药, 2024, 52(4): 438-442.
[9]	李晓卫, 高静, 刘寅, 高明东, 肖健勇. 早期与晚期支架内血栓致4b型急性心肌梗死患者临床结局比较[J]. 天津医药, 2024, 52(3): 290-296.
[10]	张玉龙, 张静, 李树军, 马龙, 祖建兵, 孙丹丹. 再生障碍性贫血患者血清sFasL、SDF-1与免疫抑制疗效的相关性[J]. 天津医药, 2024, 52(12): 1270-1273.
[11]	姚茜, 王晶, 程娜. 神曲消食口服液治疗小儿轮状病毒感染性腹泻的疗效观察[J]. 天津医药, 2024, 52(12): 1296-1300.
[12]	卢鑫怡, 杜伟坡, 李景刚, 郭芳芳, 张晓雷, 刘静. 血清miR-193a-3p、ATF5水平与三阴性乳腺癌患者化疗疗效的相关性[J]. 天津医药, 2024, 52(12): 1313-1316.
[13]	屠昌明, 田园, 汪鹏程, 任鹏, 赵寅生. SII、RAR与AECOPD患者病情严重程度及并发呼吸衰竭的关系[J]. 天津医药, 2024, 52(12): 1317-1321.
[14]	张婕, 苗耐英, 李欢, 刘新建. 奥曲肽对新生儿坏死性小肠结肠炎患儿粪便性状及体液免疫的影响[J]. 天津医药, 2024, 52(12): 1331-1334.
[15]	宫秀娟, 赵慧霞, 张小庆, 张连霞. 重症社区获得性肺炎患者PIV、IL-6、HBP、PAB水平对疗效的评估价值[J]. 天津医药, 2024, 52(11): 1216-1220.