江泽飞2019乳腺癌指南实践共识.ppt

307医院乳腺肿瘤科江泽飞,乳腺癌治疗指南实践共识,乳癌综合治疗进展,外科手术的发展放疗地位和新思路晚期治疗-内科医生的传统领地辅助治疗-分类治疗策略St.Gallen新辅助治疗内外合作的平台,1950肿瘤内科在乳腺癌的综合治疗中开始发挥重要作用,化疗,Rayter28:92-98.,Her-2阳性乳腺癌诊疗专家共识(2009.08上海)）中国抗癌协会乳腺癌专业委员会,江泽飞邵志敏徐兵河等，中华肿瘤杂志2019；2(32),AvastininHer-2NegativeMetastaticBreastCancerCurrentandFuture,贝伐珠单抗治疗乳腺癌痛苦地思考如何用?用不用?,AvastinRegulatoryHistoryinUS:2019/07,TheODACvote12-1thatthisindicationberemovedfrombevacizumabslabel,reasons:NooverallsurvivaladvantageHighcostToxicity,FDARecommendsRemovalofBevacizumabsBreastCancerIndication,NCCNRecommendationStands,AvastinplusPaclitaxelstillberecommendedas1stlineoptioninUS,ascopost/articles/january-15-2019/fda-recommends-removal-of-bevacizumabs-breast-cancer-indication/,复发转移乳腺癌化疗基本原则中国抗癌协会乳腺癌专业委员会,一、复发转移乳腺癌的治疗前评估1、首先系统评估复发转移乳腺癌患者，明确病变范围为局限性还是全身性疾病。2、尽可能对复发病灶活检，重新检测激素受体(ER和PR)和HER-2状况。3、确诊骨转移患者，治疗可参考中国乳腺癌骨转移和骨相关事件专家共识。,QuestionsinChemotherapyforEBC2019,Canweavoidchemotherapy?Whichregimenisbest?Canweavoidanthracyclines?Doweneedataxane?Ifyes,whichone?Ifyes,concurrentvssequential?WhatisthebestHER2regimen?Howdoweintegratebiologicssuchasbevacizumab?,改变临床实践的AI临床试验结果,阿那曲唑来曲唑依西美坦,复发率/年(%),0,4,8,12,16,0,2,3,5,8,10,初始,转换,延续,(年),BIG1-98,MA17,IES,ATACABCSG8,ARNO95,ITAABCSG6a,B33,TEAM,St.Gallen2019StrategiesforSubtypes:DealingwiththeDiversityofBreastCancer,RecommendationsConsensus&Controversy,St.GallenConsensusOverview,Surgery:sentinelnodeRadiation:DCIS,accelerated,partial,postmastectomyPathology:ER,PgR,HER2,Ki-67,gradeMulti-genesignaturesEndocrinetherapies(focusingonovariansuppression,tamoxifen,AIs)Chemotherapy(focusingonanthracycline,taxane,platinum)TargetedtherapiesNeoadjuvantsystemictherapyBisphosphonatesMalebreastcancer,BreastCancerSubtypes,乳癌手术治疗发展,1894年乳癌根治术1949年乳癌扩大根治术乳癌改良根治术1973-77年乳癌保乳手术1992年保留腋窝的手术,腋窝也可以不用清扫,前哨淋巴结活检术,NSABPB-32,随机III期临床研究NSABPB-32:前哨淋巴结切除术对比腋窝淋巴结清扫术用于临床表现为淋巴结阴性的乳腺癌患者2019ASCOAbstractNo：LBA505,ACOSOGZ0011,腋窝淋巴结清扫术在T1-2N0M0期前哨淋巴结阳性乳腺癌的随机研究2019ASCONo.CRA506,NeoadjuvantSystemicTherapy,Shouldneoadjuvanttherapybegivenonlyinordertoalterthesurgicaloutcome(lessthanmastectomy)?Yes:37.2%No:60.5%A:2.3%,NeoadjuvantSystemicTherapy,Isneoadjuvantendocrinetherapyaloneareasonableoptionforpostmenopausalpts.withhighlyendocrine-responsivedisease?Yes:97.8%No2.2%A:0.0%Ifyes,forwhichduration(chooseone)?3-4monthsYes:15.2%4-8monthsYes:39.1%MaximalresponseYes:45.7%,PrimaryConsideration(agreedonbymajorityofparticipants),Primarygoal-treatmentchoiceforwomenwithearlybreastcancer:Integratetumorbiologyandtumorextentintoanestimateofresp