江泽飞乳腺癌指南实践共识

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,Rayter & Mansi. Medical Therapy of Breast Cancer 2003,Radiotherapy,3000 BC,1500s,1800s,Surgery,Hormonal manipulation,1937,1950,赫赛汀改变了HER2阳性转移性乳腺癌的进程,HER2 Negative ( n=1782 )HER2+ No Herceptin ( n=118 )HER2+ Herceptin ( n=191 ),Dawood S, et al. J Clin Oncol. 2010; 28:92-98.,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 2010；2 (32),Avastin in Her-2 Negative Metastatic Breast Cancer Current and Future,贝伐珠单抗治疗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 advantageHigh costToxicity,FDA Recommends Removal of Bevacizumabs Breast Cancer Indication,NCCN Recommendation Stands,Avastin plus Paclitaxel still be recommended as 1st line option in US,/articles/january-15-2011/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。,Questions in Chemotherapy for EBC 2011,Can we avoid chemotherapy? 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),BIG 1-98,MA 17,IES,ATAC ABCSG 8, ARNO95, ITA ABCSG 6a,B 33,TEAM,St. Gallen 2011Strategies for Subtypes: Dealing with the Diversity of Breast Cancer,RecommendationsConsensus & Controversy,St. Gallen Consensus Overview,Surgery: sentinel nodeRadiation: DCIS, accelerated, partial, post mastectomyPathology: ER, PgR, HER2, Ki-67, gradeMulti-gene signaturesEndocrine therapies (focusing on ovarian suppression, tamoxifen, AIs)Chemotherapy (focusing on anthracycline, taxane, platinum)Targeted therapiesNeoadjuvant systemic therapyBisphosphonatesMale breast cancer,Breast Cancer Subtypes,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,NSABP B-32,随机 III期临床研究 NSABP B-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 2010 ASCO Abstract No：LBA505,ACOSOG Z 0011,腋窝淋巴结清扫术 在 T1-2 N0 M0 期 前哨淋巴结阳性 乳腺癌的随机研究 2010 ASCO No. CRA506,Neoadjuvant Systemic Therapy,Should neoadjuvant therapy 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 estima