江澤飛2011乳腺癌指南實(shí)踐共識(shí)課件

307乳腺癌治療

指南實(shí)踐共識(shí)

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(tái)1950腫瘤內(nèi)科在乳腺癌的綜合治療中開(kāi)始發(fā)揮重要作用化療Rayter&Mansi.MedicalTherapyofBreastCancer2003Radiotherapy

3000BC

1500’s

1800’sSurgeryHormonalmanipulation

1937

1950赫賽汀改變了HER2陽(yáng)性轉(zhuǎn)移性乳腺癌的進(jìn)程HER2Negative(n=1782)HER2+NoHerceptin(n=118)HER2+Herceptin(n=191)DawoodS,etal.JClinOncol.2010;28:92-98.Her-2陽(yáng)性乳腺癌診療專家共識(shí)

(2009.08上海)）

中國(guó)抗癌協(xié)會(huì)乳腺癌專業(yè)委員會(huì)江澤飛邵志敏徐兵河等，《中華腫瘤雜志》2010；2(32)AvastinRegulatoryHistoryinUS:

2010/07TheODACvote12-1thatthisindicationberemovedfrombevacizumab’slabel,reasons:NooverallsurvivaladvantageHighcostToxicityFDARecommendsRemovalofBevacizumab'sBreastCancerIndication

NCCNRecommendationStandsAvastinplusPaclitaxelstillberecommendedas1stlineoptioninUS's-breast-cancer-indication/復(fù)發(fā)轉(zhuǎn)移乳腺癌化療基本原則

中國(guó)抗癌協(xié)會(huì)乳腺癌專業(yè)委員會(huì)一、復(fù)發(fā)轉(zhuǎn)移乳腺癌的治療前評(píng)估1、首先系統(tǒng)評(píng)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(duì)復(fù)發(fā)病灶活檢，重新檢測(cè)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(guó)乳腺癌骨轉(zhuǎn)移和骨相關(guān)事件專家共識(shí)》。

QuestionsinChemotherapyforEBC2011Canweavoidchemotherapy?Whichregimenisbest?Canweavoidanthracyclines?Doweneedataxane?Ifyes,whichone?Ifyes,concurrentvssequential?WhatisthebestHER2regimen?Howdoweintegratebiologicssuchasbevacizumab?

St.Gallen2011

StrategiesforSubtypes:

DealingwiththeDiversityofBreastCancerRecommendationsConsensus&ControversySt.GallenConsensusOverviewSurgery:sentinelnodeRadiation:DCIS,accelerated,partial,postmastectomyPathology:ER,PgR,HER2,Ki-67,gradeMulti-genesignaturesEndocrinetherapies(focusingonovariansuppression,tamoxifen,AIs)Chemotherapy(focusingonanthracycline,taxane,platinum)TargetedtherapiesNeoadjuvantsystemictherapyBisphosphonatesMalebreastcancer

BreastCancerSubtypes腋窩也可以不用清掃前哨淋巴結(jié)活檢術(shù)NSABPB-32

隨機(jī)III期臨床研究NSABPB-32:

前哨淋巴結(jié)切除術(shù)對(duì)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

2010ASCOAbstractNo：LBA505

ACOSOGZ0011

腋窩淋巴結(jié)清掃術(shù)在T1-2N0M0期前哨淋巴結(jié)陽(yáng)性乳腺癌的隨機(jī)研究

2010ASCONo.CRA506NeoadjuvantSystemicTherapyIsneoadjuvantendocrinetherapyaloneareasonableoptionforpostmenopausalpts.withhighlyendocrine-responsivedisease?

Yes:97.8% No2.2% A:0.0% Ifyes,forwhichduration(chooseone)?3-4months Yes:15.2%4-8months Yes:39.1%Maximalresponse Yes:45.7%PrimaryConsideration

(agreedonbymajorityofparticipants)Primarygoal-treatmentchoiceforwomenwithearlybreastcancer:Integratetumorbiologyandtumorextentintoanestimateofresponsiv