2011乳腺癌指南实践共识.ppt

乳腺癌治疗指南 实践 共识 乳癌综合治疗进展 外科手术的发展 放疗地位和新思路 晚期治疗 -- 内科医生的传统领地 辅助治疗 -- 分类治疗策略 St.Gallen 新辅助治疗 – 内外合作的平台 赫赛汀改变了HER2阳性转移性乳腺癌的进程 Avastin in Her-2 Negative Metastatic Breast Cancer Current and Future 贝伐珠单抗治疗乳腺癌 痛苦地思考 如何用? 用不用?? Avastin Regulatory History in US: 2010 / 07 The ODAC vote 12-1 that this indication be removed from bevacizumab’s label, reasons: No overall survival advantage High cost Toxicity NCCN Recommendation Stands Avastin plus Paclitaxel still be recommended as 1st line option in US 复发转移乳腺癌化疗基本原则中国抗癌协会乳腺癌专业委员会 一、复发转移乳腺癌的治疗前评估 1、首先系统评估复发转移乳腺癌患者，明确病变范围为局限性还是全身性疾病。 2、尽可能对复发病灶活检，重新检测激素受体(ER和PR) 和 HER-2状况。 3、确诊骨转移患者，治疗可参考《中国乳腺癌骨转移和骨相关事件专家共识》。 改变临床实践的 AI 临床试验结果 乳癌手术治疗发展 1894年 乳癌根治术 1949年 乳癌扩大根治术 乳癌改良根治术 1973-77年 乳癌保乳手术 1992年 保留腋窝的手术 腋窝也可以不用清扫 Neoadjuvant Systemic Therapy Should neoadjuvant therapy be given only in order to alter the surgical outcome (less than mastectomy)?Yes: 37.2% No: 60.5% A: 2.3% Neoadjuvant Systemic Therapy Is neoadjuvant endocrine therapy alone a reasonable option for postmenopausal pts. with highly endocrine-responsive disease?Yes: 97.8% No 2.2% A: 0.0% If yes, for which duration (choose one)? 3-4 months Yes: 15.2% 4-8 months Yes: 39.1% Maximal response Yes: 45.7% Primary Consideration (agreed on by majority of participants) Primary goal - treatment choice for women with early breast cancer: Integrate tumor biology and tumor extent into an estimate of responsiveness to treatment and risk of relapse Utilize tumor biology, host biology and risk to obtain an optimal management strategy Patient’s preference /articles/january-15-2011/fda-recommends-removal-of-bevacizumabs-breast-cancer-indication/ Questions in Chemotherapy for EBC 2011 Can we avoid chemotherapy? Which regimen is best? Can we avoid anthracyclines? Do we need a taxane? If yes, which one? If yes, concurrent vs sequential? What is the bes