乳腺癌节拍化疗ppt课件.ppt

节拍化疗在乳腺癌中的应用,1,节拍化疗vs传统化疗,节拍化疗：小剂量化疗药、频繁、规律给药传统化疗：最大耐受剂量、每3周间隔给药,2,传统化疗,节拍化疗,3,MetronomicChemotherapy-aMulti-targetedChemotherapy,4,Numberofpublishedpapersovertheyears,5,Numberofpublishedpapersaccordingtocountry/region,6,节拍化疗在乳腺癌中的应用,晚期乳腺癌：姑息化疗，尤其是老人、多线治疗患者早期乳腺癌：辅助化疗/新辅助化疗,7,MetronomicDrug,CyclophosphamideMethotrexateFluorouracil:FT207/UFT/CapecitabineEtoposideVinorelbineTemozolomideTaxanespegylatedliposomaldoxorubicinIrinotecanCisplatin,口服便宜耐受好,8,MetronomicSchedule,PuremetronomicchemotherapyMetronomicchemotherapy+HormonaltherapyMetronomicchemotherapy+TargetedtherapyMetronomicchemotherapy+TmmunologicagentsMetronomicchemotherapy+Drugrepositioning,9,10,OngoingPuremetronomicstudies,11,MetronomicChemotherapyandHormonalTherapy,SERD:Tamoxifen/ToremifeneAromotaseinhibitorFulvestrant,12,1477postmenopausalHRpositiveBCpatients,激素受体阳性的绝经后乳腺癌患者，化疗与他莫西芬同时使用差于序贯使用,13,绝境前女性化疗可否与他莫昔芬联合使用？其他内分泌药物可否与化疗同时使用？芳香化酶抑制剂？氟维司群？,14,RandomizedPhaseIITrialofLetrozoleandLetrozolePlusLow-DoseMetronomicOralCyclophosphamideAsPrimarySystemicTreatmentinElderlyBreastCancerPatients,CR+PR=ORR,40.3%+31.6%=71.9%,43.8%+43.8%=87.6%,JClinOncol,2006,15,OtherTrials,16,OngoingTrials,17,MetronomicChemotherapyandTargetedTherapy,18,OngoingTrials,19,MetronomicChemotherapyandImmunologicAgents,20,MetronomicChemotherapyandDrugRepositioning,21,22,OtherRepositioningDrugs,Metformin（二甲双胍）propranolol（普荼洛尔）,23,节拍化疗存在的问题,传统MTD的化疗模式“根深蒂固”节拍化疗概念模糊，用药剂量、频次、间隔不清晰经验用药，缺少期随机对照研究的证据；缺少可靠的疗效预测指标,24,PK/PDDrivenMetronomics,25,BiomarkerofMetronomicChemotherapy,PlasmaVEGFandVEGFgenepolymorphismsCirculatingendothelialprogenitorcells(CEP)Thrombospondin-1(TSP-1)THBS1212(endogenousangiogenesisinhibitor)Macrocytosis(meancorpuscularvolume100fl)HIF1I