HER-2阳性晚期胃癌二线治疗的临床疗效分析

Clinical Efficacy Analysis of Second-Line Treatment for HER-2-Positive Advanced Gastric Cancer

摘要: 目的：探讨HER-2阳性晚期胃癌适宜的二线治疗方案。方法：回顾性分析2017年1月至2024年5月于安徽医科大学第二附属医院以单纯化疗和化疗联合曲妥珠单抗或联合程序性细胞死亡受体-1 (programmed cell death protein 1, PD-1)单抗，以及ADC类靶向药物作为二线治疗的HER-2阳性晚期胃癌的临床资料。结果：收集63例患者，中位随访时间为11.3个月，中位无进展生存期(PFS)为3.8个月。曲妥珠单抗联合化疗组(17例)、ADC类靶向药物组(16例)、免疫 + 化疗组(13例)以及单纯化疗组(17例)的客观缓解率(overall response rate, ORR)分别为23.5%、62.5%、23.1%、17.7%，疾病控制率(disease control rate, DCR)分别为70.6%、81.3%、46.2%、41.2%，中位无进展生存期(progression-free survival, PFS)分别为3.32个月、4.94个月、3.10个月、2.90个月，ADC类靶向药物治疗组与其他三组对比差异均具有统计学意义(P < 0.05)；单因素分析显示性别、分化程度、ECOG评分、治疗方案对患者PFS有显著影响(P < 0.05)；多因素分析显示性别、治疗方案为患者PFS的独立影响因素(P < 0.05)。结论：在HER-2阳性晚期胃癌的二线治疗中，ADC类靶向药物临床疗效显著，是可选择的方案。

Abstract: Objective: To explore the appropriate second-line treatment options for HER-2-positive advanced gastric cancer. Methods: A retrospective analysis was conducted on the clinical data of HER-2-positive advanced gastric cancer treated with chemotherapy alone or in combination with trastuzumab, or with programmed cell death protein 1 (PD-1) monoclonal antibodies, as well as ADC-targeted drugs as second-line treatments at the Second Affiliated Hospital of Anhui Medical University from January 2017 to May 2024. Results: A total of 63 cases were collected, with a median follow-up time of 11.3 months and a median progression-free survival (PFS) of 3.8 months. The objective response rate (ORR) for the trastuzumab plus chemotherapy group (17 cases), ADC-targeted drug group (16 cases), immunotherapy plus chemotherapy group (13 cases), and chemotherapy alone group (17 cases) were 23.5%, 62.5%, 23.1%, and 17.7%, respectively. The disease control rate (DCR) was 70.6%, 81.3%, 46.2%, and 41.2%, respectively. The median PFS was 3.32 months, 4.94 months, 3.10 months, and 2.90 months, respectively. The differences in PFS between the ADC-targeted drug group and the other three groups were all statistically significant (P < 0.05). Univariate analysis showed that gender, differentiation degree, ECOG score, and treatment regimen had a significant impact on patient PFS (P < 0.05). Multivariate analysis showed that gender and treatment regimen were independent factors affecting patient PFS (P < 0.05). Conclusion: In the second-line treatment of HER-2-positive advanced gastric cancer, ADC-targeted drugs have significant clinical efficacy and are a viable option.