目的：评价曲妥珠单抗联合紫杉醇+替吉奥方案二线化疗治疗人表皮生长因子受体2(human epidermal growth factor recetor-2,HER-2)阳性的晚期胃癌的临床效果及安全性。方法: 收集新疆医科大学附属肿瘤医院消化内科2012年1月至2014年3月收治的17例既往一线治疗进展的HER-2阳性转移性晚期胃癌患者的临床资料，患者既往接受奥沙利铂联合氟尿嘧啶方案化疗进展后，观察二线应用曲妥珠单抗联合紫杉醇+替吉奥方案化疗的疗效和不良反应。结果: 17例患者均可评价疗效，部分缓解4例，疾病稳定7例，疾病进展6例，客观有效率4/17，疾病控制率为11/17；中位无进展生存时间和中位总生存时间分别为6.5个月(95%CI为4.9～11.1个月)和11.9个月(95%CI为8.7～13.8个月)。全组患者最常见的不良反应为食欲下降、粒细胞减少、乏力、脱发，且多为1～2级。在曲妥珠单抗可能相关的不良反应方面，未观察到左心室射血分数值明显降低，亦无心脏不良事件发生。结论:曲妥珠单抗联合紫杉醇+替吉奥方案化疗二线治疗HER-2阳性的晚期胃癌安全有效，有必要深入研究。

Objective:To evaluate the clinical efficacy and safety of trastuzumab combined with paclitaxel and “tegafur gimeracil and oteracil potassium” (S-1) chemotherapy in the second-line treatment for HER-2-positive advanced gastric carcinoma．Methods： Seventeen by gone cases of chemo-refractory advanced gastric carcinoma treated in Affiliated Cancer Hospital of Xinjiang Medical University from January 2012 to March 2014 were included in this study. The patients were previously treated with chemotherapy regimen of oxalipaltin combined with fluorouracil. Therapeutic effect and adverse reactions were evaluated in the second-line treatment with trastuzumab combined with paclitaxel and S-1．Results：The therapeutic effect of all the 17 patients were evaluated with partial alleviated in 4 cases, stable disease in 7 cases and disease progression in 6 cases, the objective effective rate was 4/17 and disease control rate was 11/17；The median progress free survival time (PFS) was 6.5 months (95% CI 4.9-11.1) and median overall survival time (OS) was 11.9 months (95% CI 8.7-13.8)．Among the 17 cases，loss of appetite, neutropenia, fatigue and hair loss were the most frequent adverse events, and most of them were at level 1-2．In the aspect of possible trastuzumab-related adverse events, no obvious decreasing in left ventricular ejection fraction and adverse events related to cardiac was observed. Conclusion:Second-line chemotherapy of trastuzumab combined with paclitaxel and S-1 is effective and safe in treating patients with HER2-positive advanced gastric carcinoma.

新疆维吾尔自治区自然科学基金资助项目（ No. 2013211A067）；新疆医科大学科研创新基金资助项目（ No. XJC201384）