2020三阴性乳腺癌及姑息手术治疗进展(强烈推荐).pptx

三阴性乳腺癌及姑息局部治疗新进展----2020年ASCO新进展汇报提纲LBA2：晚期乳腺癌的局部治疗；507：卡培他滨节拍化疗用于术后辅助治疗；1000：KEYNOTE-355:K药联合化疗用于mTNBC治疗；1001/1002：PARPi用于mTNBC治疗；研究背景BackgroundIV期乳腺癌患者手术治疗生存获益有争议Completed randomized trials testing the value of LRT in de novo Stage IV breast cancer have provided conflicting dataECOG-ACRIN 2108: IV期乳腺癌患者手术治疗A Randomized Phase III Trial of the Value of Early Local Therapy for the Intact Primary Tumor in Patients with Metastatic Breast Cancer: ECOG-ACRIN 2108研究设计Design of E2108 br /Opened in 2011, last patient enrolled in 2015. br /研究终点Endpoints入组情况Consort diagram局部治疗情况Delivery of locoregional therapy in early local therapy armIV期乳腺癌局部治疗并不能延长OSResults: overall survivalIV期乳腺癌局部治疗并不能延长PFSResults: progression-free survival不同分子亚型对OS的影响Results: overall survival by tumor subtype局部治疗可显著降低局部进展Locoregional progression.IV期乳腺癌局部治疗并不能改善生活质量Results: health-related quality of life.小结ConclusionsNCCN指南推荐目前证据不支持IV期乳腺癌进行原发灶常规切除，但对于一些对全身治疗疗效好患者可以考虑，尤其ER阳性、HER2阴性、年龄小于55岁以及单发骨转移患者。Ann Surg Oncol. 2018 Oct;25(11):3141-3149.汇报提纲LBA2：晚期乳腺癌的局部治疗；507：卡培他滨节拍化疗用于术后辅助治疗；1000：KEYNOTE-355:K药联合化疗用于mTNBC治疗；1001/1002：PARPi用于mTNBC治疗；卡培他滨用于新/辅助治疗的临床研究汇总CREATE-X:卡培他滨用于新辅助后强化治疗74.1% vs. 67.6%89.2% vs. 83.6%CREATE-X:卡培他滨可显著延长TNBC患者的DFS/OS69.8% vs. 56.1%78.8% vs. 70.3%CBCSG-10研究设计术后加用卡培他滨可提高DFSSYSUCC-001研究：卡培他滨节拍化疗用于辅助后维持Phase III Trial of Metronomic Capecitabine Maintenance after Standard Treatment in Early Triple-Negative Breast Cancer (SYSUCC-001)SYSUCC-001研究设计SYSUCC-001 trial Design卡培他滨维持1年可以提高DFSDisease-Free Survival (primary endpoint)卡培他滨维持1年可以提高DDFSDistant Disease-Free Survival卡培他滨维持1年有延长OS趋势Overall Survival亚组分析：绝经后、I期、T1以下、淋巴结阴性TNBC获益更多Subgroup Analysis of DFS研究小结Conclusion汇报提纲LBA2：晚期乳腺癌的局部治疗；507：卡培他滨节拍化疗用于术后辅助治疗；1000：KEYNOTE-355:K药联合化疗用于mTNBC治疗；1001/1002：PARPi用于mTNBC治疗；Impassion 130奠定了TNBC免疫治疗的基础PD-L1 IC status by SP142 predicts PFS and OS benefit with atezolizumab + nab-paclitaxel1,2Median PFSMedian OSHR (95% CI)HR (95% CI)PopulationPopulationA + nP P + nPPD-L1 IC+ (41%) 7.5 mo 5.3 moA + nP P +