乳腺癌辅助治疗规范的解读PPT.ppt

乳腺癌辅助治疗规范的解读;Treatment Guidelines are useful;Adjuvant Therapy for Breast CancerTreatment Guidelines;讨论内容;Adapted from Bonadonna G. Cancer Res. 1992.;Comparative Efficacy of Adjuvant Chemotherapy: EBCTCG Meta-Analyses;2000 Oxford Overview AnalysisA/E+ vs CMF: All Deaths;10;11;HER2 predicts benefit from adjuvant paclitaxel after AC in node-positive breast cancer: CALGB 9344 ;;TAC;Number at Risk;Disease Free Survival byHormonal Status;17;18;19;;Taxit216 multicenter phase III trialSequential Epirubicin-Docetaxel-CMF as adjuvant therapy of early breast cancer ;22;蒽环类+紫杉类可延生存期;蒽环类+紫杉类可延生存期;蒽环类+紫杉类可延生存期;不同紫杉用法的差异;不同紫杉用法的差异;28;NCCTG N9831;NSABP B-31;Combined analysis of B31 / N9831;87%;Hazard Ratio;Annual Hazard of Distant Recurrence;Combined Analysis for OS of NSABP B-31 / NCCTG – N9831 ;Months from randomization;0;赫赛汀可减少三分之一的死亡风险;无论肿瘤大小，赫赛汀均显示DFS获益;无论淋巴结情况，赫赛汀均显示DFS获益;无论年龄大小，赫赛汀均显示DFS获益;Cardiac Monitoring ~ 20% of the patients discontinued Herceptin because of symptomatic or asymptomatic heart problems;Cardiac Safety Age and Post AC LVEF were predictors of the risk of developing CHF ;Risk of Cardiac Events (no strong evidence of an major delayed toxicity);Slamon et al 2006 Rastogi et al 2007 Suter et al 2007 Perez et al 2008 ;HER2状态判断 ;Estimation of the epidemiological effect of trastuzumab over 20 years in five European countries;ASCO 2008, abst, 6611;HER2阳性乳腺癌治疗原则 ;St.Gallen 2003;St.Gallen 2003;St.Gallen 2003;Evolution of Adjuvant Treatment of Breast Cancer;54;CHEMOTHERAPY REGIMENS- ST.GALLEN 2005IMPLICATIONS FOR PATIENT CARE;CHEMOTHERAPY REGIMENS- ST.GALLEN 2005IMPLICATIONS FOR PATIENT CARE;Choice of Adjuvant Regimens;低危患者： CMF×6周期或AC、EC×4～6周期 中危患者： FAC或FEC×6周期 高危患者： AC→T，FEC×3→T×3， TAC，A→T→C， 密集化疗 ;Changes in chemotherapy regimens for older women with breast cancer who received adjuvant chemotherapy for stage I to III breast cancer;小 结;61;;;;MA.17: Trial Design ;MA.17 Results: Disease-Free Survival by Treatment Duration (cont’