乳腺癌的化疗进展.ppt

乳腺癌化疗的发展，乳腺癌化疗的历史回顾，70年代：CMF80年代：anthrACyclines 90年代：taxanes 21世纪：化疗生物目标治疗例程-容量密集型，taxanes三阶段单中心随机试验。leeks，et al . breakstcancerrestreat . 2007，tx方案与AC方案比较，腋窝淋巴结阳性209例，II/III BC行4周期TXorAC。TX和AC比率，PCR增长(21%/10%，p=0.024)，RR(84%/65%，P=0.003)。TX恶心、呕吐较少，但口腔炎、腹泻、肌肉疼痛、皮肤和指甲变化比交流电明显。没有DFS差异(P=0.932)。pCR复发较少(P=0.025Hazardratio，0.189；95% ci，0.044-0.815)。(leeks，et al . breakstcancerrestreat . 2007，phase iitrialcomplearingacwithttc，Doxorubicinandcyclophosphiamide(AC化疗结束后进行放射治疗，受体阳性者为tamoxifen，Jones se，et al . jclin oncol . 2006；24 (34) :581-5387。phase iiitrialcomposingacwithtTC，结果：TC的5年DFS远远高于AC (86% v80%，p=0.015)。orr : TC/ac90%/87%，p=0.13。肌肉痛、关节痛、水肿、粒细胞减少在TC组更常见。恶心、呕吐、充血性心力衰竭在AC组更常见。JonesSE、etal。JClinOncol.200624 (34) 3336360581-5387。aphaeitrialoftdocetaxsecond-linechemotherapyinpatientswithMBC，doce taxel 100mg/m(2)every 3 weeks r 33635，baurm，et al.jcancerresancol.2007，na b-paclitaxel (ABI-007，abraxane)是将paclitaxel包裹在白蛋白中。亨德森IC，et al . expertrevanticncher . 2007；7 (7) :19-943。na B- paclitaxelforbreakcancer : anewformulationwitanimprodsafetyprofileandgreaterefficacy，Nab-paclitaxelforbrefficacyNab-paclitaxel的优点是安全性提高，剂量增加，进入肿瘤细胞的药物比例高。亨德森IC，et al . expertrevanticncher . 2007；前瞻性、多机构、随机控制研究thetrastuzumabandvnorelbineortaxansestudy。99-943。方法：HER2过表达MBC，未进行化疗的患者随机分为trastuzumab+vinorelbine，每周1次。Trastuzumab+taxane每周一次。结论：vinorelbine/trastuzumab和taxane/trastuzumab一线治疗HER2阳性MBC疗效无差异。bursteinhj、et al.cancer.2007、a phase-iitrialoffrubicinanddocetaxersusdoxorubicinandpaclitaxelinmetasreatcancer 3333MBC患者每三周随机分为AD组或AP组。Ad4 - docetaxel 4、cassierpa、et al . breakstcancerrestreat . 2007、A phase8.0米和27.3米(AP)(p=0.977 and 0.081)；AD的血液学毒性比AP重(p=0.0000) 3-4度疲劳AD重量(p=0.03)。神经病变在AP组中更常见(p=0.03)。cassierpa、et al . breakstcancerrestreat . 2007、a phase-iiitrialoffrubicinanddocetaxersusdoxorubicinandpaclitaxelinmetmetring，结论：AD和AP在生活质量和效率上没有差异，但在副作用上有差异。cassierpa、et al . breakstcancerrestreat . 2007、evidence-baseduseoftaxanestheadjuvantitus breakstcancer . areviewofrandows确认红豆杉在乳腺癌辅助治疗中的作用。提出了以蒽环为主轴的多种方案作为对照组。有充分的证据表明，定期使用taxanes治疗乳腺癌，包括激素受体阳性和Her-2阳性患者。、estvezlg、et al.cancertrev.2007、combining chemotherapyandlow-molleular-weighttheparinforthetreatment atmosadvantEnoxaparin，0，5or1.0mg/kg，每天一次。Docetaxel35-45mg/m(2)，每周一次。pr 333636%；Sd 333636，seeholzern，et al . bloodcogulfibrinolysis . 2007；18 (5) 333636015-423。vinorel bine/docetexlcombinationtreatment atmosofmetastationcbreatcancer : aph asstudy，方法： doc 333660 or 70mg/60 (3) 3336365-373。aphaseseiclinicaltrialofzd 1839(iressa trade mark)incombinationwithndocetexlasfirst-linereatmentinpatientswithithing，Gefitinib250mg，oncedaillydocetaxel 75mg/m (2)，every 3 weeks，until umorprogression，toxicityorotherreason，33例，中间治疗周期为5个周期。临床福利率为51.5%。CR:1PR:12SD:4Orr :339.4%。dennison sk、et al.investnewdrgs.2007、Aphasis linical trialofzd 1839(iressa trade mark)incombinationwithtdocetaxfires，Conclusion : thecombinationofgefittinibanddocetailintinatientswithpreviouslyuntreatedmbc，dennison sk，et al . invest nes，方法：HER-2-阳性患者。Trastuzumab 4mg/kg (day1)、followed by 2m/kg weekly、docetexcel 75mg/m2、every 3 weeks、carboplatin(25 (19) :32678-2684。multic enterphase iitrialofeoadjuvanttherapywittrastuzumab、docetaxel、andcarboplatinforhumanepidermalgrowthfactorrecepepenting，Results : sixty-seven patients，her-2-positive，completedsixcyclesoftherapy . cran DPR 3360595%(85% anansgrade 3/4 neutropeniandfebrileneutropeniawere 2%。nosymptomatic cardiacdysfunctionoccurred、coudertbp、etal . jclin oncol . 2007；25 (19) :32678-2684。multic enterphase iitrialofeoadjuvanttherapywittrastuzumab、docetaxel、andcarboplatinforhumanepidermalgrowthfactorrecepepenting，Conclusion : trastuzumabplusdocetexlandcarboplatinachievedagoodpcrrateandfavorbabletolerabilityinstageioriher-2-25 (19) :32678-2684。Pathologiccompleteresponewithsixcomparatedwithreecyclesofnceoadjuvantepirubicinplusofocetexlandgranulocytecolony-stim ululy，epirubicin 75mg/m2 doce texl 75mg/m2 onda y1 granulocytecolony-stimulatingfactorondays 3 through 10，ed ge very 21 days25 (15) :12-2018。Pathologiccompleteresponewithsixcomparatedwithreecyclesofnceoadjuvantepirubicinplusofocetexlandgranulocytecolony-stim ululy、sixcyclesofed g、compaedwithreecycles、resulted