1.Establishment and verification of a time-resolved fluorescence immunochromatographic detection method for S100B protein based on double-antibody sandwich method
Chinese Journal of Biologicals 2026;39(06):715-722
Objective To establish and verify a time-resolved fluorescence immunochromatographic assay for the detection of S100B protein content based on double-antibody sandwich method,so as to provide a reliable method for the auxiliary diagnosis of neurological disorders and tumors.Methods Time-resolved fluorescent microspheres were used to label mouse anti-human S100B protein IgG2a monoclonal antibody(labeled antibody,clone number 22G7-3) and goat anti-chicken IgY antibody,respectively,and NC membranes were coated with mouse anti-human S100B protein IgG2a monoclonal antibody(coating antibody,clone number 5H2-3) and chicken IgY antibody as detection line(T line) and quality control line(C line),respectively,to prepare fluorescent immunochromatographic test strips.The coating antibody concentration(0.5,1,1.5,2 mg/mL),labeled antibody concentration(5,10,15,20 μg/mL) and detection time(5,8,10,12,15,18,20,22 min) were optimized.Serum and EDTA anticoagulated plasma from the same donor were used as samples to analyze the matrix effects.The linear range,limit of blank,precision,accuracy,anti-interference capability and stability of the method were verified.In addition,the established method and electrochemiluminescence method were used to detect 30 serum samples respectively,and the results were compared.Results The optimal conditions were coating antibody concentration of 2 mg/mL,labeled antibody concentration of 15 μg/mL,and detection time of 12 min.There was a significant matrix effect between serum and EDTA plasma,and plasma T/C was significantly lower than serum(t = 5.075,P < 0.01).Adding 2.5,5,and 10 mmol/L Ca~(2+) could improve the consistency of the two detection results,with R~2 of 0.846 0,0.724 1,and 0.723 9,respectively,while R~2 was 0.154 8 when Ca~(2+) was not added.There was a good linear relationship between S100B antigen concentration and T/C in the range of 0.01-10 ng/mL,and the linear equation was y = 3.857 81 x + 0.483 37,R~2 = 0.997 4.The limit of blank was 0.003 ng/mL.The coefficients of variation(CVs) of precision verification were less than 10%,and the relative deviations of accuracy verification were also less than 10%.Compared with the corresponding control group,bilirubin,hemoglobin,lipids,neuron specific enolase(NSE),glial fibrillary acid protein(GFAP) and ubiquitin carboxyl-terminal hydrolase isozyme L1(UCHL1) exhibited no significant effect on the test results(t = 0.660,0.141,1.691,1.875,0.091 and 0.274,respectively,each P > 0.05).Compared with 0 d,there was no significant difference in the test results of the test strips stored at 37 ℃ for 7,14,21,28,35 and 42 d(t = 0.197,0.451,0.199,1.506,0.074 and 0.768,respectively,each P > 0.05).There was no significant difference in the results of the 30 serum samples detected by the established method and electrochemilumine-scence method(difference range was-0.93-0.88,W =-2.000,P > 0.05).Conclusion The established time-resolved fluorescence immunochromatography method based on the double-antibody sandwich method has good linearity,precision,accuracy,anti-interference ability and stability,which has good correlation with commonly used clinical methods and can be used for the rapid quantitative detection of S100B protein in serum samples.
2.Progress in role of PANoptosis and programmed cell deaths in renal cell carcinoma
Shufen ZHOU ; Yaming LÜ ; Yangyang HAN
Chinese Journal of Pathophysiology 2025;41(7):1400-1406
Renal cell carcinoma(RCC)is a malignant tumor that originates from the epithelial cells of the re-nal tubules,comprising 80%to 90%of all malignant renal tumors.With the dual pressures of population growth and ag-ing,both the incidence and mortality rates of RCC are on the rise.PANoptosis is a newly identified form of cell death,con-trolled by the PANoptosome complex,and exhibits characteristics of three programmed cell death pathways,pyroptosis,apoptosis,and necroptosis.Increasing research indicates that the occurrence of PANoptosis is associated with tumor devel-opment,suggesting its potential as a new therapeutic strategy for renal carcinoma.This article reviews the definition of PANoptosis,the structure of the PANoptosome protein complex,and its impact on the PANoptosis process.Additionally,it explores the interactions between PANoptosis,pyroptosis,apoptosis and necroptosis,and their effects on RCC.
3.Inhibitory effect of combined application of active components of Paeoniae Rubra Radix on Enterococcus faecalis and its mechanism
Jiani ZHANG ; Jie SAI ; Yu ZHOU ; Miao YANG ; Shufen SUN
Journal of Jilin University(Medicine Edition) 2025;51(3):680-690
Objective:To discuss the inhibitory effects of combined application of chlorogenic acid(CA),procyanidin(PC),and paeoniflorin(PF),the active components of Paeoniae Radix Rubra,on Enterococcus faecalis(E.faecalis)and its biofilm,and to clarify the mechanism.Methods:The minimal inhibitory concentration(MIC)and minimal bactericidal concentration(MBC)of CA,PC,and PF against E.faecalis were detected by microdilution method;the fractional inhibitory concentration index(FICI)and fractional bactericidal concentration index(FBCI)of the three active components of Paeoniae Radix Rubra in combination were detected by checkerboard dilution method.The experiment was divided into control group,high concentration of single-drug groups(PF-10 group,PC-6 group,and CA-10 group),and drug combination groups(CA-2+PC-1 group,CA-2+PC-2 group,PF-4+PC-2 group,PF-6+PC-2 group,PF-4+CA-4 group,and PF-6+CA-4 group).Crystal violet staining was used to detect the biofilm formation of E.faecalis in various groups after treated with three active components in combination;scanning electron microscope(SEM)was used to observe the morphology of E.faecalis biofilm in various groups after treated with three active components in combination;spot assay was used to detect the inhibitory effects of three active components in combination on E.faecalis planktonic bacteria and biofilm in various groups;SEM was used to observe the damage to E.faecalis cell membrane in various groups after treated with three active components in combination;kit was used to detect the adenosine triphosphate(ATP)levels in E.faecalis planktonic bacteria and biofilm in various groups after treated with three active components in combination.Results:Among the three active components of Paeoniae Radix Rubra,the MIC of PC was 4 g·L?1 and the MBC was 6 g·L?1;the MIC of CA was 8 g·L?1 and the MBC was 10 g·L?1;the MIC and MBC of PF were both>10 g·L?1,and the concentration of PF was selected as 10 g·L?1.The combination of PC and CA showed synergistic effects,the combination of PC and PF showed additive effects,and the combination of CA and PF showed additive effects.The crystal violet staining results showed that compared with control group,the biofilm formations of E.faecalis in PF-10 group,PC-6 group,CA-10 group,and drug combination groups were significantly decreased(P<0.05);compared with PF-10 group,the biofilm formations of E.faecalis in PC-6 group,CA-10 group,CA-2+PC-1 group,CA-2+PC-2 group,PF-4+PC-2 group,PF-6+PC-2 group,and PF-6+CA-4 group were significantly decreased(P<0.05 or P<0.01).The SEM results showed that in control group,the E.faecalis biofilm was thick,with tightly connected bacteria,regular morphology,and intact cell membranes;in PF-10 group,PC-6 group,and CA-10 group,the thickness of E.faecalis biofilm was significantly reduced,and the arrangement of bacteria became relatively loose;in all drug combination groups,the E.faecalis biofilm was significantly reduced or even completely disappeared,and under high magnification,the biofilm structure was completely absent,with bacterial fragments adhering and aggregating,losing their original bacterial morphology.The spot assay results showed that compared with control group,the colonies of E.faecalis planktonic bacteria in PF-10 group,PC-6 group,and CA-10 group were significantly reduced after treated for 5,10,and 30 min,indicating gradually enhanced bactericidal effects;among drug combination groups,the combination of CA and PC significantly reduced the colonies of E.faecalis planktonic bacteria within 5 min,showing strong bactericidal effects.Compared with CA group and PC group,the colonies of E.faecalis planktonic bacteria in all drug combination groups showed no significant reduction after treated for 5,10,and 30 min;compared with control group,the colonies of E.faecalis biofilm in PF-10 group,PC-6 group,and CA-10 group were gradually decreased after the treated for 30 and 60 min,suggesting that the high concentration of single-drug groups exhibited gradually enhanced bactericidal effects on E.faecalis in biofilm.Among them,the biofilm-killing effect of PC-6 group was the most significant,with no colony formation observed after treated for 30 min;in drug combination groups,only a few colonies of E.faecalis biofilm were observed in CA-2+PC-2 group after treated for 30 min,indicating effective killing of bacteria in biofilm;compared with PC-6 group and CA-10 group,all drug combination groups achieved the bactericidal effects of high concentration of single-drug groups at low concentrations.The SEM results showed that in control group,E.faecalis exhibited an oval shape with intact cell membranes;in PF group,bacterial morphology was altered,and cell membrane integrity was damaged;in CA group,most bacterial cell membranes remained relatively intact,but the bacterial surface showed shrinkage and depression,with a few bacteria exhibiting disrupted cell membrane integrity;in PC group,the integrity of bacterial cell membranes was most severely damaged,leading to leakage of cellular contents and aggregation of cell fragments into flocculent structures;in all drug combination groups,E.faecalis exhibited ruptured cell membranes,leakage of contents,and aggregation of bacterial debris,especially in the combination of CA and PC,where the most severe disruption of bacterial cell membrane integrity and complete leakage of contents were observed;in the combination of PF and CA,bacterial surface pits and shrinkage were observed,with occasional cell membrane rupture.The kit results showed that compared with control group,the ATP levels in E.faecalis planktonic bacteria and biofilm in various groups were significantly decreased(P<0.01);compared with PF-10 group,the ATP levels in E.faecalis planktonic bacteria in CA-10 group,CA-2+PC-2 group,PF-4+CA-4 group,and PF-6+CA-4 group were significantly decreased(P<0.05 or P<0.01),and the ATP levels in E.faecalis biofilm in CA-10 group and CA-2+PC-2 group were significantly decreased(P<0.05 or P<0.01).Conclusion:The combined application of PF,PC,and CA,the active components of Paeoniae Radix Rubra,exhibits significant inhibitory effects on E.faecalis and its biofilm formation.The pairwise combinations of three active components show synergistic or additive effects,with the combination of CA and PC demonstrating the most significant synergistic effect.The underlying mechanism may be related to the disruption of E.faecalis cell membrane integrity and inhibition of bacterial ATP levels.
4.Type 2 Diabetes Mellitus Exacerbates Pathological Processes of Parkinson's Disease: Insights from Signaling Pathways Mediated by Insulin Receptors.
Shufen LIU ; Tingting LIU ; Jingwen LI ; Jun HONG ; Ali A MOOSAVI-MOVAHEDI ; Jianshe WEI
Neuroscience Bulletin 2025;41(4):676-690
Parkinson's disease (PD), a chronic and common neurodegenerative disease, is characterized by the progressive loss of dopaminergic neurons in the dense part of the substantia nigra and abnormal aggregation of alpha-synuclein. Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by chronic insulin resistance and deficiency in insulin secretion. Extensive evidence has confirmed shared pathogenic mechanisms underlying PD and T2DM, such as oxidative stress caused by insulin resistance, mitochondrial dysfunction, inflammation, and disorders of energy metabolism. Conventional drugs for treating T2DM, such as metformin and glucagon-like peptide-1 receptor agonists, affect nerve repair. Even drugs for treating PD, such as levodopa, can affect insulin secretion. This review summarizes the relationship between PD and T2DM and related therapeutic drugs from the perspective of insulin signaling pathways in the brain.
Humans
;
Parkinson Disease/drug therapy*
;
Diabetes Mellitus, Type 2/pathology*
;
Signal Transduction/physiology*
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Receptor, Insulin/metabolism*
;
Animals
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Insulin Resistance/physiology*
;
Insulin/metabolism*
5.Role of Drp1 in A1 activation of astrocytes
Longyun ZHOU ; Xuqing CHEN ; Lu FANG ; Min YAO ; Shufen LIU
Chinese Journal of Pathophysiology 2025;41(1):64-71
AIM:This study aims to investigate the role of dynamin-related protein 1(Drp1)in the A1 type activation of astrocytes and elucidate the underlying mechanism of abnormal astrocyte activation.METHODS:Rat astro-cyte line CTX-TNA2 was divided into control group,astrocyte-conditioned medium(ACM)group,and 5,10 and 25 μmol/L mitochondrial division inhibitor-1(Mdivi-1;a selective inhibitor of Drp1)+ACM group.The cells in ACM group were exposed to ACM containing interleukin-1α(IL-1α),tumor necrosis factor-α(TNF-α)and complement 1q(C1q)for 24 h to induce type A1 activation,while those in Mdivi-1+ACM group were pre-treated with various concentrations of Mdi-vi-1 for 2 h before stimulation with ACM for 24 h.RT-qPCR was used to detect the expression levels of A1 type activation-related indicators IL-1β,TNF-α and IL-10 mRNA in each group.Immunofluorescence was utilized to assess the expres-sion levels of A1 type activation marker molecules C3,inducible nitric oxide synthase(iNOS)and S100 calcium binding protein A10(S100A10).The level of mitochondrial reactive oxygen species(ROS)was measured using MitoSOX Red staining and flow cytometry analysis.The mitochondrial morphology was observed using the MICA full-field imaging analy-sis platform.Lastly,the expression level of mitochondrial fission protein 1(FIS1)and the activation level of Drp1 in each group were evaluated through immunoblotting analysis.RESULTS:The RT-qPCR and immunofluorescence results indi-cated that the ACM group exhibited significantly elevated levels of IL-1β and TNF-α mRNA,and C3 protein expression compared with control group,along with increased iNOS protein expression and reduced IL-10 mRNA and S100A10 pro-tein expression(P<0.05).Interventions with 10 and 25 μmol/L Mdivi-1 effectively inhibited the rise in IL-1β and TNF-α mRNA,and C3 and iNOS protein expression induced by ACM,while promoting S100A10 expression.MitoSOX Red staining revealed a significant increase in mitochondrial ROS levels in astrocytes stimulated by ACM,which was effectively re-versed by Mdivi-1 intervention.The MICA full-field imaging analysis platform demonstrated that ACM induced the forma-tion of round-shaped mitochondria in astrocytes,while 10 and 25 μmol/L Mdivi-1 interventions facilitated the restoration of their tubular shape.Additionally,Western blot results confirmed that Mdivi-1 intervention effectively reversed the acti-vation of Drp1 and FIS1.CONCLUSION:The Drp1-mediated mitochondrial fission represents one of the intrinsic molecu-lar mechanisms underlying A1 type activation of astrocytes,and Mdivi-1,as a selective inhibitor of Drp1,can effectively inhibit abnormal astrocyte activation.
6.Recent advances in activation mechanisms of A1 and A2 astrocytes and their relationships with different CNS diseases
Longyun ZHOU ; Shufen LIU ; Xiao LU
Chinese Journal of Neuromedicine 2025;24(4):407-414
Astrocytes are the most important glial cell type in the central nervous system (CNS), which play an important role in maintaining homeostasis, regulating synaptic plasticity and protecting neurons. During pathological damage, astrocytes can differentiate into A1 and A2 subtypes, which play a dual role in blocking or repairing nerve damage and participate in the pathological changes of a variety of CNS diseases such as stroke, Alzheimer's disease, Parkinson's disease, spinal cord injury and cervical spondylotic myelopathy. This review focuses on the phenotype characteristics and activation mechanisms of A1 and A2 astrocytes and their relationships with different CNS diseases, in order to provide reference for treatment of CNS diseases.
7.Efficacy and immunological mechanisms of pegylated interferon α-2b in treatment-naive patients with chronic hepatitis B
Shufen SONG ; Fengxian JIN ; Yu LAN ; Gongchang ZHANG ; Zhiguo WU ; Yao ZHOU ; Qiong XIE ; Long YANG ; Shuilin SUN
Chinese Journal of Infectious Diseases 2025;43(1):14-23
Objective:To evaluate the efficacy and immunological mechanisms of pegylated interferon α-2b (Peg-IFNα-2b) antiviral therapy in treatment-naive patients with chronic hepatitis B(CHB).Methods:A total of 166 treatment-naive CHB patients, who were treated at Department of Infectious Diseases, the Second Affiliated Hospital of Nanchang University from March 2021 to March 2023, were enrolled in this study. All the patients received Peg-IFNα-2b therapy for 48 weeks. Serum hepatitis B virus (HBV) DNA, HBV serological markers, biochemical parameters, peripheral blood lymphocyte subsets and serum cytokine levels were detected and compared before and after treatment. Chi-square test, Mann-Whitney U test and paired sample t test were used for statistical comparison. Multivariate logistic regression analysis was used to analyze the influencing factors of hepatitis B surface antigen (HBsAg) seroconversion by stepwise regression method, and the receiver operator characteristic curve (ROC curve) was used to evaluate the predictive efficacy of immune indicators on HBsAg seroconversion. Results:Among the 166 treatment-naive CHB patients, the rate of HBV DNA negativity following 48 weeks of Peg-IFNα-2b therapy was 71.08%(118/166), the rate of hepatitis B e antigen (HBeAg) negativity was 32.05%(25/78), and the rate of HBsAg negativity was 20.48%(34/166). HBsAg negativity rate was 52.17%(24/46) in patients with baseline HBsAg<200 IU/mL, 10.26%(4/39) in patients with baseline HBsAg 200 to <1 200 IU/mL, and 7.41%(6/81) in patients with baseline HBsAg≥1 200 IU/mL, and the difference was statistically significant( χ2=39.37, P<0.001). After 48 weeks of treatment, serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil), and alpha-fetoprotein (AFP) were significantly lower than those before treatment ( Z=9.33, 8.58, 5.99, 2.36, respectively, all P<0.05). lmmune indicators were detected in 58 patients, and the proportion of peripheral blood lymphocytes increased significantly post-treatment, with notable increases in CD3 + CD8 + T/CD3 + T, CD3 + CD4 + DR + /CD3 + CD4 + , CD3 + CD8 + DR + /CD3 + CD8 + , CD3 + CD8 + CD38 + /CD3 + CD8 + , CD3 + CD8 + CD28 + /CD3 + CD8 + , and CD19 + B cells, and the differences were all statistically significant ( t=-2.56, t=-8.65, Z=-3.58, t=-3.66, Z=-3.04, t=-3.62, t=-3.87, respectively, all P<0.05). Conversely, the proportion of CD3 + , CD3 + CD4 + T/CD3 + T, CD3 + CD4 + CD45RO + /CD3 + CD4 + , CD3 + CD8 + CD45RO + /CD3 + CD8 + and the CD4 + /CD8 + ratio decreased significantly post-treatment ( t=3.13, t=5.61, t=3.69, Z=3.95, Z=7.33, respectively, all P<0.05). No significant differences were observed in the proportion of CD16 + CD56 + natural killer (NK) cells, CD3 + CD4 + CD28 + /CD3 + CD4 + , CD3 + CD4 + CD38 + /CD3 + CD4 + cells before and after treatment (all P>0.05). Serum levels of interleukin(IL)-8, IL-12P70, and IL-17 significantly decreased post-treatment ( Z=2.85, 3.26, 4.12, respectively, all P<0.05), while IL-2, IL-1β, and interferon(IFN)-α levels were significantly elevated compared to baseline ( Z=-4.92, -4.85, -9.01, respectively, all P<0.001). There were no significant differences in IL-4, IL-6, and IL-10 levels before and after treatment (all P>0.05). Logistic regression analysis identified CD3 + CD8 + T/CD3 + T(odd ratios ( OR)=1.198, 95%confidence interval( CI) 1.003 to 1.432, P=0.046), CD3 + CD4 + DR + /CD3 + CD4 + ( OR=1.185, 95% CI 1.035 to 1.357, P=0.014), CD3 + CD8 + DR + /CD3 + CD8 + ( OR=0.813, 95% CI 0.690 to 0.958, P=0.013), CD3 + CD4 + CD38 + /CD3 + CD4 + ( OR=0.678, 95% CI 0.488 to 0.940, P=0.020), CD3 + CD8 + CD38 + /CD3 + CD8 + ( OR=1.272, 95% CI 1.069 to 1.512, P=0.007), CD19 + B cells( OR=0.752, 95% CI 0.582 to 0.971, P=0.029), IL-2( OR=8.568, 95% CI 1.927 to 38.087, P=0.005), and IL-17( OR=0.728, 95% CI 0.535 to 0.989, P=0.042) as independent factors influencing HBsAg seroconversion. The area under the curve (AUC) of the proportion of dCD19 + B cells (the reciprocal of CD19 + B cells) for predicting HBsAg seroconversion was 0.716, the sensitivity was 0.636, and the specificity was 0.809. The AUC of IL-2 was 0.657, the sensitivity was 0.818, and the specificity was 0.404. The AUC of dIL-17 (the reciprocal of IL-17 levels) was 0.624, the sensitivity was 0.727, and the specificity was 0.489. The AUC of IL-2 and dIL-17 as a combined predictor was 0.830, the sensitivity was 0.909, and the specificity was 0.787. Conclusions:Peg-IFNα-2b demonstrates significant antiviral, biochemical, and serological responses in treatment-naive CHB patients, with enhanced efficacy in patients exhibiting HBsAg levels <200 IU/mL. In patients with HBsAg<200 IU/mL, the rate of HBsAg negativity reached 52.17%.Peg-IFNα-2b can regulate the immune function of patients with CHB by increasing the proportion of activated T lymphocyte subsets and functional subsets. The proportion of CD19 + B cells, IL-2 levels, and IL-17 levels hold predictive value for achieving HBsAg seroconversion.
8.The Role of Gait Analysis in Rehabilitation Management of Hemophilia
Wanli TULUNAYI ; Shufen LIU ; Lixia CHEN
Medical Journal of Peking Union Medical College Hospital 2025;16(5):1275-1280
Hemophilia is a hereditary coagulation disorder, in which patients often suffer from joint dysfunction due to recurrent joint bleeding, with the knee joint being particularly susceptible to involvement, thereby significantly impairing their ability to walk.Gait analysis, as an objective, quantitative, and comprehensive assessment tool, can be employed to accurately evaluate the walking function of patients and provide a scientific basis for the rehabilitation management of individuals with hemophilia.With the deepening of medical research, the role of gait analysis in the rehabilitation management of hemophilia is increasingly being recognized.This review article summarizes the application of gait analysis in the rehabilitation management of hemophilia, including changes in gait parameters, kinematic and kinetic characteristics of joints in patients with hemophilia, as well as the relationships between these parameters and the severity of the disease and treatment outcomes in hemophilia patients, exploring the role of gait analysis in the rehabilitation management of hemophilia to better apply it in clinical practice.
9.Combination Therapy of Pyrotinib and Metronomic Vinorelbine in HER2+ Advanced Breast Cancer after Trastuzumab Failure (PROVE): A Prospective Phase 2 Study
Chunfang HAO ; Xu WANG ; Yehui SHI ; Zhongsheng TONG ; Shufen LI ; Xiaodong LIU ; Lan ZHANG ; Jie ZHANG ; Wenjing MENG ; Li ZHANG
Cancer Research and Treatment 2025;57(2):434-442
Purpose:
Approximately 50%-74% of patients with metastatic human epidermal growth factor receptor 2 (HER2)–positive breast cancer do not respond to trastuzumab, with 75% of treated patients experiencing disease progression within a year. The combination of pyrotinib and capecitabine has showed efficacy in these patients. This study evaluates the efficacy and safety of pyrotinib combined with metronomic vinorelbine for trastuzumab-pretreated HER2-positive advanced breast cancer patients.
Materials and Methods:
In this phase 2 trial, patients aged 18-75 years with HER2-positive advanced breast cancer who had previously failed trastuzumab treatment were enrolled to receive pyrotinib 400 mg daily in combination with vinorelbine 40mg thrice weekly. The primary endpoint was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety.
Results:
From October 21, 2019, to January 21, 2022, 36 patients were enrolled and received at least one dose of study treatment. At the cutoff date, 20 experienced disease progression or death. With a median follow-up duration of 35 months, the median PFS was 13.5 months (95% confidence interval [CI], 8.3 to 18.5). With all patients evaluated, an ORR of 38.9% (95% CI, 23.1 to 56.5) and a DCR of 83.3% (95% CI, 67.2 to 93.6) were achieved. The median OS was not reached. Grade 3 adverse events (AEs) were observed in 17 patients, with diarrhea being the most common (27.8%), followed by vomiting (8.3%) and stomachache (5.6%). There were no grade 4/5 AEs.
Conclusion
Pyrotinib combined with metronomic vinorelbine showed promising efficacy and an acceptable safety profile in HER2-positive advanced breast cancer patients after trastuzumab failure.
10.Combination Therapy of Pyrotinib and Metronomic Vinorelbine in HER2+ Advanced Breast Cancer after Trastuzumab Failure (PROVE): A Prospective Phase 2 Study
Chunfang HAO ; Xu WANG ; Yehui SHI ; Zhongsheng TONG ; Shufen LI ; Xiaodong LIU ; Lan ZHANG ; Jie ZHANG ; Wenjing MENG ; Li ZHANG
Cancer Research and Treatment 2025;57(2):434-442
Purpose:
Approximately 50%-74% of patients with metastatic human epidermal growth factor receptor 2 (HER2)–positive breast cancer do not respond to trastuzumab, with 75% of treated patients experiencing disease progression within a year. The combination of pyrotinib and capecitabine has showed efficacy in these patients. This study evaluates the efficacy and safety of pyrotinib combined with metronomic vinorelbine for trastuzumab-pretreated HER2-positive advanced breast cancer patients.
Materials and Methods:
In this phase 2 trial, patients aged 18-75 years with HER2-positive advanced breast cancer who had previously failed trastuzumab treatment were enrolled to receive pyrotinib 400 mg daily in combination with vinorelbine 40mg thrice weekly. The primary endpoint was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety.
Results:
From October 21, 2019, to January 21, 2022, 36 patients were enrolled and received at least one dose of study treatment. At the cutoff date, 20 experienced disease progression or death. With a median follow-up duration of 35 months, the median PFS was 13.5 months (95% confidence interval [CI], 8.3 to 18.5). With all patients evaluated, an ORR of 38.9% (95% CI, 23.1 to 56.5) and a DCR of 83.3% (95% CI, 67.2 to 93.6) were achieved. The median OS was not reached. Grade 3 adverse events (AEs) were observed in 17 patients, with diarrhea being the most common (27.8%), followed by vomiting (8.3%) and stomachache (5.6%). There were no grade 4/5 AEs.
Conclusion
Pyrotinib combined with metronomic vinorelbine showed promising efficacy and an acceptable safety profile in HER2-positive advanced breast cancer patients after trastuzumab failure.


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