乳腺癌个体化治疗-多种分子诊断方案比较.pptVIP

NSABP Protocol B20, “A Clinical Trial to Determine the Worth of Chemotherapy and Tamoxifen Over Tamoxifen Alone in the Management of Patients with Primary Invasive Breast Cancer, Negative Axillary Nodes and Estrogen-Receptor-Positive Tumors,” enrolled 2,363 patients between October 17,1988, and March 5, 1993, who were randomly assigned to tamoxifen versus tamoxifen plus either CMF or MF * Kaplan-Meier plots for distant recurrence comparing treatment with tamoxifen (Tam) alone versus treatment with tamoxifen plus chemotherapy (Tam chemo). (A) All patients; (B) low risk (recurrence score [RS] 18); (C) intermediate risk (RS 18-30); (D) high risk (RS 31). The number of patients at risk and the number of distant recurrences (in parentheses) are provided below each part of the figure. Similar trends were seen when analyzed for freedom from locoregional and/or distant recurrence and OS * No interaction of chemotherapy treatment with the clinical variables and with all the individual genes and gene group scores The likelihood ratio test for interaction between chemo and RS (p=0.038) Patients with low recurrence scores derived minimal, if any, benefit from chemo Patients with intermediate risk tumors no substantial benefit..difficult to conclude * Taxane or non-taxane group ? intermediate groups Tailorx was developed by the North American Breast Cancer Intergroup It was developed for ER+/ LN- patients Chemotherapy usually recommended if residual risk of recurrence exceeds 5-10% despite adjuvant hormonal tx Adding chemo reduces the risk of recurrence on average by 25-30%; but absolute benefit is 1-5% Recurrence scores were adjusted so to avoid undertreatment Te intermediate risk group was randomize to hormonal v chemohormonal tx * FFPE – Formalin fixed and paraffin-embedded Of the 60 patients: 28 were LN-, 25 were LN+, and 7 not evaluated In 20 patient cohort, 19 were LN- As Fig. 4 shows, the behavior of the adjusted hazard ratio of the gene signature shows substantial va