乳腺癌内分泌治疗新思路和临床实践.ppt

乳癌内分泌治疗新思路和临床实践 乳癌的治疗手段 Surgery 手术 Radiation therapy 放疗 Chemotherapy 化疗 Hormone therapy 内分泌治疗 Biotherapy 生物治疗 New therapies 新的治疗 Hormone Therapy Response Rate (%) in Different Receptor Status Survival by Response Arimidex 1 mg Tamoxifen for 5 Years vs No Treatment Tamoxifen Adjuvant Therapy for EBC辅助内分泌治疗的决定因素是激素受体状况ER阳性效果最好  Tamoxifen Adjuvant Therapy for EBC合适的TAM服药时间为5年 Tamoxifen Adjuvant Therapy for EBC ER阳性无论年龄大小都可用TAM Tamoxifen Adjuvant Therapy for EBC降低对侧乳癌发生增加子宫内膜癌的风险 Tamoxifen Adjuvant Therapy for EBC ER阳性TAM和化疗合用比单用TAM更有效CAF与TAM 序贯合用比同时效果更好 TamoxifenIndications in Breast Cancer Survival DataAnastrozole / MA 瑞宁得 (Arimidex)比 MA更有效、更安全 瑞宁得 (Arimidex) 1 mg 在复发转移乳癌治疗中 缓解率 / 临床获益率相当 生存期更长 耐受性更好 Arimidex in Breast Cancer Anastrozole is Superior to Tamoxifen in First Line Therapy（0030） Trial 0030: Kaplan-Meier Curve of Probability of Time to Progression AIs is Superior to Tamoxifenas First-line Therapy for Advanced Breast Cancer 芳香化酶抑制剂 取代三苯氧胺 成为标准的一线内分泌治疗 Arimidex in Breast Cancer Rationale for Adjuvant Therapy With Aromatase Inhibitors (AIs) AIs Effective after tamoxifen Better than tamoxifen first line Well tolerated May overcome tamoxifen “resistance” Ongoing AI Adjuvant Trials:  ATAC (Anastrozole) Predefined adverse events*Hot flushes Predefined adverse eventsVaginal bleeding The ATAC Early breast cancer trial in postmenopausal patientsEndometrial sub-protocol results Demographics 285 women from 31 centres in 10 countries Mean age 60 yrs ( 44 - 80 yrs ) Mean age at menopause 50 years 80% 4 years or more post menopause Baseline Ultrasound Median endometrial thickness Predefined adverse eventsEndometrial cancer ATAC Summary Anastrozole is superior to tamoxifen in terms of: Disease-free survival in:Overall population (HR=0.83)Receptor-positive patients (HR=0.78) Incidence of contralateral breast cancer in: Overall population (OR=0.42) Conclusions Anastrozole is the first