乳腺癌节拍化疗课件

1、乳腺癌节拍化疗第1页，共28页。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周间隔给药第2页，共28页。传统化疗节拍化疗第3页，共28页。Metronomic Chemotherapy- a Multi-targeted Chemotherapy第4页，共28页。Number of published papers over the years第5页，共28页。Number of published papers according to country/region第6页，共28页。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、

2、多线治疗患者早期乳腺癌 ：辅助化疗/新辅助化疗第7页，共28页。Metronomic DrugCyclophosphamideMethotrexateFluorouracil : FT207/UFT/CapecitabineEtoposideVinorelbineTemozolomideTaxanespegylated liposomal doxorubicinIrinotecanCisplatin口服便宜耐受好第8页，共28页。Metronomic Schedule Pure metronomic chemotherapyMetronomic chemotherapy + Hormonal

3、therapyMetronomic chemotherapy + Targeted therapyMetronomic chemotherapy + Tmmunologic agentsMetronomic chemotherapy + Drug repositioning第9页，共28页。Author and yearN patientsTreatmentPhasePrevious treatment andsettingORR (%)CB (%)OS(months)Colleoni 200263Cyclophosphamide+MethotrexateIIPretreated MBC193

4、1.7%/Orlando 2006153Cyclophosphamide+MethotrexateRetrospectivePretreated MBC/15.7% withCB12 m/Orlando 200622Cyclophosphamide+Methotrexate/Pretreated MBC1846/Miscoria 201262Cyclophosphamide+MethotrexateIIPretreated MBC/7.1Perroud 201315Cyclophosphamide+MethotrexateII/6.746.7/Smith 201033Oral fluorour

5、acilIINot Pretreated MBC55Tagushi 201033CapecitabineIINot Pretreated MBC184424.8Fedele 201260CapecitabineIIPretreated MBC246217Dellapasqua 200846Cyclophosphamide+Capecitabine/Pretreated MBC4868/Wang 201268Capecitabine+CyclophosphamideIIPretreated MBC30.35316.9Yoshimoto 201251Capecitabine+Cyclophosph

6、amideIIPretreated MBC4457.8/Montagna 201224Capecitabine+CyclophosphamideIINot Pretreated MBC6275/Addeo 201034VinorelbineIINot Pretreated MBC3815.9Saridaki 201235Vinorelbine+CapecitabineIPretreated MBC46/Cazzaniga 201412 + 22Vinorelbine+CapecitabineIIIPretreated MBC/58/Otsuka 201340Irinotecan+Tegafur

7、/47/26Dellapasqua 201129Liposomal doxorubicin +cyclophosphamide/Not pretreatedLocally advanced69/第10页，共28页。Ongoing Pure metronomic studies SchedulephaseSetting Ref.Capecitabine 1000 m/m2 d1 14 + VNB 60 mg/m2 d1,8 q21d vs. VNB 50 mg/d d1,3,5/wkIIRandomizedM+, 2 cm any N TN or inflammatoryNCT01329627D

8、DP 25 mg/m2 d1 3 q3w +CTX 150 mg/d os d1 14IIM+, TNNCT01910870TXT 75 mg/m2 + CTX 50 mg/d _ 21 d, q3wIIM+NCT01526499Capecitabine 1500 mg/d + CTX 50 mg/dIIM+, HER-2 negNCT01526512Capecitabine 700 mg/m2 bid, d1 14 +Etoposide 30 mg/m2/d, d1 7 q3wIIM+NCT01589159第11页，共28页。Metronomic Chemotherapy and Hormo

9、nal TherapySERD: Tamoxifen/ ToremifeneAromotase inhibitorFulvestrant第12页，共28页。1477 post menopausal HR positive BC patients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第13页，共28页。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？第14页，共28页。Randomized Phase II Trial of Letrozole and Letrozole Plus Low-Dose Metrono

10、mic Oral Cyclophosphamide As Primary Systemic Treatment in Elderly Breast Cancer PatientsCR + PR = ORR40.3%+ 31.6%=71.9%43.8%+43.8%=87.6%J Clin Oncol,2006第15页，共28页。Other Trials Author and yearN patientsTreatmentPhasePrevious treatment andsettingORR (%)CB (%)OS(months)Aurilio 201233 (22 evaluable for

11、response)CyclophosphamideMethotrexateFulvestrantRetrospectivePretreatedMB5643.6Schwartzberg201341CapecitabineFulvestrantIIPretreatedMB24.458.128.6第16页，共28页。Ongoing Trials schedulephaseSetting Ref.AI + CM + PDN vs. CM + PDNIIM+, ER+, postmenopausalAI resistanceNCT00687648Capecitabine +AIIIER+, postme

12、nopausalNeoadjuvant Anastrozole +CapM+ Letrozole resistance: Exemestance+CapExemestane resistance: Letrozole+CapNCT01924078Anastrozole + tegafur-uracil vs. AnastrozoleIIEarly stage T2N0/1M0ER+, postmenopausalNeoadjuvantNCT01262274第17页，共28页。Metronomic Chemotherapy and Targeted TherapyAuthor and yearN

13、 patientsTreatmentPhasePrevious treatment andsettingORR (%)CB (%)OS(monthsOrlando 2006201222CyclophosphamideMethotrexateTrastuzumabIIPretreated MBC1846Dellapasqua 200846CyclophosphamideCapecitabineBevacizumabIIPretreated MBC4868Garcia-Saenz200824CyclophosphamideCapecitabineBevacizumabIIPretreated MB

14、C31.863.613.9Montagna 201224CyclophosphamideCapecitabineBevacizumabIINot Pretreated MBC6275Saloustros 201113VinorelbineBevacizumabIIPretreated MBC7.7Montagna201224Erlotinib + bevacizumab + capecitabineI/IIPretreated MBC6283第18页，共28页。Ongoing TrialsschedulephaseSetting Ref.Pertuzumab + Trastuzumab + C

15、TX 50 mg/d?T-DM1 (if PD)IIMBC, HER-2 pos, 60 yrsNCT01597414Weekly Paclitaxel+ Trastuzumab -Weekly Doxorubicin + Oral CTX Plus Weekly Trastuzumab IIHER2+ Locally Advanced BCNCT01329640Vinorelbine Metronomic +Lapatinib IIHER-2+ MBCNCT00754702Capecitabine+CTX+Lapatinib +Trastuzumab IIHER-2+ MBCNCT01873

16、833Bevacizumab + PTX vs. Bevacizumab + CTX 50 + capecitabine IIIM+, locally advanced BCNCT01131195Metronomic CTX+MTX BevacizumabIIMBCNCT00083031Vinorelbine Metronomic +Bevacizumab IIMBCNCT00694200Aflibercept + Capecitabine IMBCNCT01843725Letrozole + Metronomic CTX+ Plus/Minus Sorafenib IIMBCNCT00954

17、135第19页，共28页。Metronomic Chemotherapy and Immunologic AgentsAuthor and yearN TreatmentPhasePrevious treatment andsettingORR (%)CB (%)Colleoni 2005171CyclophosphamideMethotrexate thalidomideRandomized IIPretreatedMBC20.9 vs. 11.841.5 vs 41.5Soriano, J.201121cyclophosphamide + methotrexateVaccineRetros

18、pectivePretreatedMBC2462第20页，共28页。Metronomic Chemotherapy and Drug RepositioningAuthor and yearN patientsTreatmentPhasePrevious treatment andsettingORR (%)CB (%)Young 201269DocetaxelCapecitabineCelecoxibRetrospectivePretreated and not MBCPerroud 201315CyclophosphamideMethotrexateCelecoxibIIPretreatedMBC6.746.7第21页，共28页。SchedulephaseSetting Ref.DOX 24 mg/m2 + CTX 60 mg/m2 os/wk 12 -PTX 80 mg/m2 + CBDCA AUC 2/wk -12 Capecitabine 1000 mg/d + d