■吡罗替尼是一种新型的不可逆泛HER酪氨酸激酶抑制剂(TKI)。然而,在人类表皮生长因子受体2(HER2)阳性转移性乳腺癌(MBC)和发展中的脑转移(BMs)中,含有吡唑替尼的疗法的现实数据有限,这个亚群的基因组图谱几乎是不确定的。
■接受含吡唑替尼治疗的HER2阳性MBCBM患者(n=35)纳入本分析。无进展生存期(PFS),总生存期(OS),客观反应率(ORR),疾病控制率(DCR),和毒性概况进行了评估。使用Cox比例风险模型估计疾病进展的风险比(HR)和95%置信区间(CI)。对来自患有BM和没有BM的患者的血浆和原发性乳腺肿瘤进行618个癌症相关基因的靶向下一代测序。
■中位PFS时间为8.00(95%CI,5.98-10.017)个月,中位OS时间为23个月(95%CI,10.412-35.588)。ORR为45.7%,DCR为74.3%。在Cox多变量分析中,先前暴露于脑放疗(HR=3.268),接受pyrotinib作为三线或更高线治疗(HR=4.949),幕下脑转移(HR=6.222),幕上和幕下脑转移(HR=5.863)与进展风险增加独立相关.常见的3-4级不良事件是直接胆红素升高(14.3%),两名患者患有3-4级腹泻。在探索性基因组分析中,BM组FGFR3、CD276、CDC73和EPHX1的改变频率较高。BM组血浆和原发灶突变谱的一致性显著降低(30.4%vs.65.5%;p=0.0038)。
■含有吡罗替尼的疗法在HER2阳性MBC的BM患者中显示出良好的有效性和可耐受的安全性,特别是在大脑放射治疗的人群中,接受吡唑替尼作为一线或二线治疗,并发展为幕上脑转移。在探索性基因组分析中,有BM的患者与无BM的患者表现出不同的基因组特征.
UNASSIGNED: Pyrotinib is a novel irreversible pan-HER tyrosine kinase inhibitor (TKI). However, real-world data of pyrotinib-containing therapy in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and developing brain metastases (BMs) are limited, and the genomic profile of this subpopulation is almost undefined.
UNASSIGNED: Patients with BM of HER2-positive MBC (n = 35) treated with pyrotinib-containing therapy were enrolled in this analysis. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and toxicity profiles were evaluated. Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease progression were estimated using the Cox proportional hazards models. Targeted next-generation sequencing of 618 cancer-relevant genes was performed on plasma and primary breast tumors from patients with BM and without BM.
UNASSIGNED: The median PFS time was 8.00 (95% CI, 5.98-10.017) months, and the median OS time was 23 (95% CI, 10.412-35.588) months. The ORR was 45.7%, and the DCR was 74.3%. In the Cox multivariate analysis, prior exposure to brain radiotherapy (HR = 3.268), received pyrotinib as third- or higher-line treatment (HR = 4.949), subtentorial brain metastasis (HR = 6.222), and both supratentorial and subtentorial brain metastases (HR = 5.863) were independently associated with increased risk of progression. The frequent grade 3-4 adverse event was increased direct bilirubin (14.3%), and two patients suffered from grade 3-4 diarrhea. In the exploratory genomic analysis, altered frequencies of FGFR3, CD276, CDC73, and EPHX1 were higher in the BM group. The consistency of mutated profiles of plasma and primary lesion in the BM group was significantly lower (30.4% vs. 65.5%; p = 0.0038).
UNASSIGNED: Pyrotinib-containing therapy shows favorable effectiveness and tolerable safety in patients with BM of HER2-positive MBC, particularly in a population that is brain radiotherapy-naïve, received pyrotinib as first- or second-line treatment, and developed supratentorial brain metastasis. In the exploratory genomic analysis, patients with BM showed distinct genomic features from patients without BM.