江澤飛2011乳腺癌指南實(shí)踐共識.ppt

1、307醫(yī)院乳腺腫瘤科 江澤飛,乳腺癌治療指南 實(shí)踐 共識,乳癌綜合治療進(jìn)展,外科手術(shù)的發(fā)展 放療地位和新思路 晚期治療 - 內(nèi)科醫(yī)生的傳統(tǒng)領(lǐng)地 輔助治療 - 分類治療策略 St.Gallen 新輔助治療 內(nèi)外合作的平臺,1950 腫瘤內(nèi)科在乳腺癌的綜合治療中開始發(fā)揮重要作用,化 療,Rayter 28:92-98,Her-2 陽性乳腺癌診療專家共識 (2009.08 上海)） 中國抗癌協(xié)會乳腺癌專業(yè)委員會,江澤飛 邵志敏 徐兵河等， 中華腫瘤雜志 2010；2 (32,Avastin in Her-2 Negative Metastatic Breast Cancer Current and

2、Future,貝伐珠單抗治療乳腺癌 痛苦地思考 如何用? 用不用,Avastin Regulatory History in US: 2010 / 07,The ODAC vote 12-1 that this indication be removed from bevacizumabs label, reasons: No overall survival advantage High cost Toxicity,FDA Recommends Removal of Bevacizumabs Breast Cancer Indication,NCCN Recommendation Stand

3、s,Avastin plus Paclitaxel still be recommended as 1st line option in US,http:/,復(fù)發(fā)轉(zhuǎn)移乳腺癌化療基本原則中國抗癌協(xié)會乳腺癌專業(yè)委員會,一、復(fù)發(fā)轉(zhuǎn)移乳腺癌的治療前評估 1、首先系統(tǒng)評估復(fù)發(fā)轉(zhuǎn)移乳腺癌患者，明確病變范圍為局限性還是全身性疾病。 2、盡可能對復(fù)發(fā)病灶活檢，重新檢測激素受體(ER和PR) 和 HER-2狀況。 3、確診骨轉(zhuǎn)移患者，治療可參考中國乳腺癌骨轉(zhuǎn)移和骨相關(guān)事件專家共識,Questions in Chemotherapy for EBC 2011,Can we avoid chemotherapy?

4、Which regimen is best? Can we avoid anthracyclines? Do we need a taxane? If yes, which one? If yes, concurrent vs sequential? What is the best HER2 regimen? How do we integrate biologics such as bevacizumab,改變臨床實(shí)踐的 AI 臨床試驗(yàn)結(jié)果,阿那曲唑 來曲唑 依西美坦,復(fù)發(fā)率/年(,0,4,8,12,16,0,2,3,5,8,10,初始,轉(zhuǎn)換,延續(xù),年,BIG 1-98,MA 17,IES

5、,ATAC ABCSG 8, ARNO95, ITA ABCSG 6a,B 33,TEAM,St. Gallen 2011Strategies for Subtypes: Dealing with the Diversity of Breast Cancer,Recommendations Consensus & Controversy,St. Gallen Consensus Overview,Surgery: sentinel node Radiation: DCIS, accelerated, partial, post mastectomy Pathology: ER, PgR, HE

6、R2, Ki-67, grade Multi-gene signatures Endocrine therapies (focusing on ovarian suppression, tamoxifen, AIs) Chemotherapy (focusing on anthracycline, taxane, platinum) Targeted therapies Neoadjuvant systemic therapy Bisphosphonates Male breast cancer,Breast Cancer Subtypes,乳癌手術(shù)治療發(fā)展,1894年 乳癌根治術(shù) 1949年

7、 乳癌擴(kuò)大根治術(shù) 乳癌改良根治術(shù) 1973-77年 乳癌保乳手術(shù) 1992年 保留腋窩的手術(shù),腋窩也可以不用清掃,前哨淋巴結(jié)活檢術(shù),NSABP B-32,隨機(jī) III期臨床研究 NSABP B-32 : 前哨淋巴結(jié)切除術(shù) 對比 腋窩淋巴結(jié)清掃術(shù) 用于臨床表現(xiàn)為淋巴結(jié)陰性的 乳腺癌患者 2010 ASCO Abstract No：LBA505,ACOSOG Z 0011,腋窩淋巴結(jié)清掃術(shù) 在 T1-2 N0 M0 期 前哨淋巴結(jié)陽性 乳腺癌的隨機(jī)研究 2010 ASCO No. CRA506,Neoadjuvant Systemic Therapy,Should neoadjuvant ther

8、apy be given only in order to alter the surgical outcome (less than mastectomy)?Yes: 37.2% No: 60.5%A: 2.3,Neoadjuvant Systemic Therapy,Is neoadjuvant endocrine therapy alone a reasonable option for postmenopausal pts. with highly endocrine-responsive disease?Yes: 97.8%No 2.2%A: 0.0% If yes, for which duration (choose one)? 3-4 months Yes: 15.2% 4-8 months Yes: 39.1% Maximal response Yes: 45.7,Primary Consideration (agreed on by majority of participants,Primary goal - treatment choice for women with early breast cancer: Integrate tumor biology and tumor extent into an estimate of responsiven