HER2阳性EBC的应对策略.ppt

HER2阳性EBC的应对策略 Adjuvant Chemotherapy 根据左心室射血分数(LVEF)的 赫赛汀?辅助治疗方案选择指定原则 赫赛汀?辅助治疗心脏不良事件的建议 HER2 +患者从赫赛汀?辅助治疗的获益远大于心脏不良事件的风险 赫赛汀?辅助治疗相关心脏事件是可逆性， 发生后2-4月内自行恢复的概率高不影响后续的治疗 治疗前心功能评估及方案选择可以更好的保证治疗中的心脏安全性 接受赫赛汀?辅助治疗的患者： LVEF ? 40%大多数患者可以继续接受赫赛汀?治疗，建议每3个月检测LVEF LVEF 40%建议停赫赛汀?治疗，心内科随访并每月进行一次LVEF检测 2007 St Gallen 共识： 赫赛汀?辅助方案 Neoadjuvant Chemotherapy MDACC Trial design MDACC研究：2/3的患者获病理学缓解 2009 St Gallen experts’ panel discussion result 谢谢！ 26.3%n=19 65.2%n=23 95% CI(43–84%)p=0.016 (n=42) pCR (%) P + FEC alone H + (P ? FEC) Buzdar A, et al. Proc ASCO 2007 Flow chart of observation patients:by status on 16 May 2005 1698 patients originally randomised to observation 1354 patients alive and disease-free 16 May 2005 344 patients DFS event or lost to follow-up198 alive post DFS event 469 patients remained on observation 344 patients ineligible for crossover Time to selective crossover by calendar date (n=885) 0.6 0.5 0.4 0.3 0.2 0.0 16 May 2005 22 Aug 2005 28 Nov 2005 6 Mar 2006 12 Jun 2006 18 Sep 2006 25 Dec 2006 1354 1193 596 209 116 71 30 0.1 Switched to Herceptin No. at riskObservation Proportion Randomisation to 1st dose Diagnosis to 1st dose Follow-up from 1st dose Median time (range), months 22.8 (1-52.7) 30.9 (9.1-58.3) 29.1 (0.8-34.5) Baseline characteristics of observation patients alive and disease free on 16 May 2005 Compared to patients who did not selectively cross over to Herceptin, those who did were more likely to: be younger have received anthracyclines and anthracyclines plus taxanes be diagnosed with node-positive disease have hormone receptor-positive tumours 885 of 1354 patients (65%) in the observation group who were alive and disease free on May 16 2005 crossed over and received Herceptin Questions: What was the course of disease in the subgroups of observation patients who did or did not cross over to active therapy? Is there any effect of the late introduction of Herceptin? Specific question 2 Landma