乳腺癌辅助治疗规范的解读精选.pptVIP

乳腺癌辅助治疗规范的解读 湖北省肿瘤医院内科 于 丁 Treatment Guidelines are useful Guidelines provide a benchmark and integrate new findings into clinical practice They are dynamic documents, which need periodic update They are developed to reduce under-treatment, over-treatment and wrong treatment Compliance with guidelines has been shown to improve patient outcome Adjuvant Therapy for Breast CancerTreatment Guidelines 讨论内容 辅助治疗对哪些人有益？ 如何选择哪种辅助治疗方法？ 化疗方案的选择 分子靶向治疗作用 内分泌治疗方法的选择 Breast Cancer: Adjuvant CMF(12 months) or Surgery Alone 30 year’s follow up of randomised studies of adjuvant CMF in Operable breast cancer : cohort study 30 year’s follow up of randomised studies of adjuvant CMF in Operable breast cancer : cohort study HER2 predicts benefit from adjuvant paclitaxel after AC in node-positive breast cancer: CALGB 9344 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 Estimation of the epidemiological effect of trastuzumab over 20 years in five European countries Estimation of the epidemiological effect of trastuzumab over 20 years in five European countries HER2阳性乳腺癌治疗原则 使早期乳腺癌患者复发风险降低36%~52%,死亡风险降低33% AC→T→H: ( H4 mg/kg,与首次T同时使用; 然后H 2 mg/kg维持1年。或T结束后,H6 mg/kg维持1年 ) 每3周方案, 目前推荐治疗时间为1年 在开始治疗的第3、6、9、18个月监测心脏情况 H辅助治疗的标准疗程为1年,至少应治疗6个月以保证患者最大获益 CHEMOTHERAPY REGIMENS- ST.GALLEN 2005IMPLICATIONS FOR PATIENT CARE CHEMOTHERAPY REGIMENS- ST.GALLEN 2005IMPLICATIONS FOR PATIENT CARE 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 CMF有最长的远期疗效结果，至今仍用 含蒽环类化疗是目前最基础的标准方案 含紫杉类的地位已得到不断证实及巩固 (某些亚组的疗效待进一步观察) 赫赛丁可增加化疗的效果 剂量密度已开始动摇了传统的三周疗法 MA.17 Results: Disease-Free Survival by Treatment Duration (cont’d) Trial Strategies in Adjuvant Therapy: AIs AI. Adjuvant Trials: DFS AI与TAM的随机对照临床试验 Endocrine Treatment Strategies in Early Breast Cancer(Postmenopausal women) Systemic Treatment Modalities in Early Stage