课件：乳腺癌新辅助治疗临床思路.pptx

乳腺癌新辅助治疗临床思路Neoadjuvant of treatment for breast cancerThe first generation of neoadjuvant clinical trials - NSABP 18 The second generation of neoadjuvant clinical trials-NSABP 27NSABP-B18/27Neoadjuvant vs adjuvant “AC”1, Neo-adjuvant=Adjuvant 2, pCR is a good surrogate marker for long-term outcome 3, NSABP-27 showed that the addition of preoperative taxanes to AC improve the responseRastogi et al JCO 2008In the second generation of neoadjuvant clinical,although addition of taxanes generally led to higher pCR rates, a clinically meaningful improvement in long-term outcomes was not shown consistently early improvements in pCR rates cannot yet act as surrogate endpoints most neoadjuvant trials undertaken so far have enrolled unselected populations of patients. Questionthe genomic complexity of breast cancer has started to be appreciated, with several subtypes with specific molecular profiles Gianni L EW, Semiglazov V, et al. SABC 2008 (abstract 31/Leone JP et al.J Clin Oncol 27:15s, 2009 (suppl; abstr 625) Chang HR et al. J Clin Oncol 26: 2008 (May 20 suppl; abstr 604)Part Ⅰ:Proposal for the standard characterisation of the population to treatSubtypes by IHC -ASCO/CAP guidelinesSu et al. BMC Cancer 2011, 11:292/1471-2407/11/292Shanghai Breast Cancer Survival Study datasNeoadjuvant in BC - phaseⅡ trialLuminalB4cycles Neo XTPathology,IHCHER2 positive4cycles Neo THsubtypesLuminal A subtype：ER+ or PR +，HER2-,Ki6714%Luminal B subtype：ER+ or PR +，HER2-,Ki6716%Luminal B subtype,Her2+:HER2+subtype：ER-PR-，HER2+TNBC：ER-、PR-、HER2-Tripe negative4cycles Neo TP213 patients (median follow up 24months)SubtypesLuminal BHER2+veTNBCregimesCapecitabine+DocetaxelPaclitaxel+TrastuzumabPaclitaxel+DDPnumbers90 (42%)90 (42%)33 (16%)Median age45 (26-69)47 (26-76)46 (29-66) 绝经前64 (71.1%)59 (65.6%)22 (66.7%) 绝经后26 (28.9%)31 (34.4%)11 (33.3%)Grade 117 (18.9%)0 (0%)0 (0%) 261 (67.8%)69 (76.7%)19 (57.6%) 312 (13.3%)21 (23