《2016-HER2的标准化检测.pptVIP

HER2 表达在原发肿瘤和转移灶呈高度一致 随着肿瘤的靶向性治疗的发展，以单抗为主的分子靶点药物的不断研制应用，已成为肿瘤靶向治疗的新武器 Herceptin即为一种针对HER2受体的高纯度重组DNA衍生物的人源化单克隆抗体，是乳腺癌治疗领域的第一个分子靶向性药物 意义 靶向药物Heceptin仅对HER2扩增的乳腺癌有效 →准确的检测HER2有无扩增是临床应用Heceptin的绝 对必要条件，也是成功进行靶向治疗的前题和关键 HER-2扩增的乳腺癌往往提示其恶性程度高，进展迅 速，化疗缓解期短，对CMF方案化疗反应降低 → 乳 腺癌化疗药物环磷酰胺、阿酶素、5－氟尿嘧啶等 的主要参考指标 HER-2扩增的乳腺癌对蒽环类药物和紫杉醇类药物化 疗敏感性高 → HER2和拓扑异构酶II-a基因同时扩 增的乳腺癌患者，可以从蒽环类药物为基础的方案 中受益，故同时检测HER2和拓扑异构酶II-a可以筛 选出以蒽环类化疗药为基础的化疗方案候选患者 HER-2扩增的乳腺癌对三苯氧胺易产生耐药性 → 制 定内分泌治疗方案的有力依据 HER-2扩增的乳腺癌无病生存率和总生存率低，并且 与淋巴结阳性、癌的高级别、阴性受体状态及高增 殖活性有关 → 预后判断的参考指标 比值 2.2 提示Her-2无扩增 比值 2.2提示Her-2有扩增 比值介于1.8～2.2临界值 Aneusomy, Not amplified 24 25 26 27 29 Paraffin embedding and loss of immunoreactivity antigen retrieval - ‘over recovery’ or under recovery “Please remember in citing this paper that the single-copy (or non-amplified) overexpressor cases were later shown by us (published in 1996) to be predominantly stromal-rich breast cancers with HER2 gene amplification of tumor cells by FISH (that were not recognized by Southern hybridization due to dilutional artifacts related to stromal DNA diluting out the tumor DNA) ” 31 HER2 testing HER2 HER2 testing recommendations HER2 status FISH 37 38 39 40 HER2 testing HER2 HER2 testing recommendations HER2 status FISH 2+ 3+ Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. C-erbB2 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. HER-2 检测: IHC 抗原修复 有 / 无 组织固定 方法 抗体选择 评分标准 变异性 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 福尔马林固定/石蜡包埋组织 HER 基因扩增2－5倍 （Southern Hybridization） Slamon et al, Science 244:712, 1989 HER2 “阴性” 是由于组织固定后抗原被遮蔽 需要行抗原修复来纠正 Courtesy Michael Press Evaluation only. Created with Aspose.Slides