乳腺癌节拍化疗

节拍化疗在乳腺癌中的应用1精品课件节拍化疗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精品课件传统化疗节拍化疗3精品课件MetronomicChemotherapy--aMulti-targetedChemotherapy4精品课件Numberofpublishedpapersovertheyears5精品课件Numberofpublishedpapersaccordingtocountry/region6精品课件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精品课件MetronomicDrugCyclophosphamideMethotrexateFluorouracil:FT207/UFT/CapecitabineEtoposideVinorelbineTemozolomideTaxanespegylatedliposomaldoxorubicinIrinotecanCisplatin口服便宜耐受好8精品课件MetronomicSchedulePuremetronomicchemotherapyMetronomicchemotherapy+HormonaltherapyMetronomicchemotherapy+TargetedtherapyMetronomicchemotherapy+TmmunologicagentsMetronomicchemotherapy+Drugrepositioning9精品课件AuthorandyearNpatientsTreatmentPhasePrevioustreatmentandsettingORR(%)CB(%)OS(months)Colleoni200263Cyclophosphamide+MethotrexateIIPretreatedMBC1931.7%/Orlando2006153Cyclophosphamide+MethotrexateRetrospectivePretreatedMBC/15.7%withCB>12m/Orlando200622Cyclophosphamide+Methotrexate/PretreatedMBC1846/Miscoria201262Cyclophosphamide+MethotrexateIIPretreatedMBC//7.1Perroud201315Cyclophosphamide+MethotrexateII/6.746.7/Smith201033OralfluorouracilIINotPretreatedMBC55

Tagushi201033Capecitabine

IINotPretreatedMBC184424.8Fedele201260CapecitabineIIPretreatedMBC246217Dellapasqua200846Cyclophosphamide+Capecitabine/PretreatedMBC4868/Wang201268Capecitabine+CyclophosphamideIIPretreatedMBC30.35316.9Yoshimoto201251Capecitabine+CyclophosphamideIIPretreatedMBC4457.8/Montagna201224Capecitabine+CyclophosphamideIINotPretreatedMBC6275/Addeo201034VinorelbineIINotPretreatedMBC38

15.9Saridaki201235Vinorelbine+CapecitabineIPretreatedMBC46//Cazzaniga201412+22Vinorelbine+CapecitabineI–IIPretreatedMBC/58/Otsuka201340Irinotecan+Tegafur//47/26Dellapasqua201129Liposomaldoxorubicin+cyclophosphamide/NotpretreatedLocallyadvanced69//10精品课件OngoingPuremetronomicstudiesSchedulephaseSettingRef.Capecitabine1000m/m2d1–14+VNB60mg/m2d1,8q21dvs.VNB50mg/dd1,3,5/wkIIRandomizedM+,<1lineNCT01941771StandardADJCT+Capecitabine650mg/m2bidIIIADJ,TNNCT01112826SYSUCC-001PTX100mg/m2/wkx8DOX24mg/m2/wk+CTX100mg/d9wksIILocallyadvancedT>2cmanyNTNorinflammatoryNCT01329627DDP25mg/m2d1–3q3w+CTX150mg/dosd1–14IIM+,TNNCT01910870TXT75mg/m2+CTX50mg/d_21d,q3wIIM+NCT01526499Capecitabine1500mg/d+CTX50mg/dIIM+,HER-2negNCT01526512Capecitabine700mg/m2bid,d1–14+Etoposide30mg/m2/d,d1–7q3wIIM+NCT0158915911精品课件MetronomicChemotherapyandHormonalTherapySERD:Tamoxifen/ToremifeneAromotaseinhibitorFulvestrant12精品课件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精品课件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精品课件RandomizedPhaseIITrialofLetrozoleandLetrozolePlusLow-DoseMetronomicOralCyclophosphamideAsPrimarySystemicTreatmentinElderlyBreastCancerPatientsCR+PR=ORR40.3%+31.6%=71.9%43.8%+43.8%=87.6%JClinOncol,200615精品课件OtherTrialsAuthorandyearNpatientsTreatmentPhasePrevioustreatmentandsettingORR(%)CB(%)OS(months)Aurilio201233(22evaluableforresponse)CyclophosphamideMethotrexateFulvestrantRetrospectivePretreatedMB56

43.6Schwartzberg201341CapecitabineFulvestrantII

PretreatedMB24.458.128.616精品课件OngoingTrialsschedulephaseSettingRef.AI+CM+PDNvs.CM+PDNIIM+,ER+,postmenopausalAIresistanceNCT00687648Capecitabine+AIIIER+,postmenopausalNeoadjuvantAnastrozole+CapM+Letrozoleresistance:Exemestance+CapExemestaneresistance:Letrozole+CapNCT01924078Anastrozole+tegafur-uracilvs.AnastrozoleIIEarlystageT2N0/1M0ER+,postmenopausalNeoadjuvantNCT0126227417精品课件MetronomicChemotherapyandTargetedTherapyAuthorandyearNpatientsTreatmentPhasePrevioustreatmentandsettingORR(%)CB(%)OS(monthsOrlando2006201222CyclophosphamideMethotrexateTrastuzumabIIPretreatedMBC1846

Dellapasqua200846CyclophosphamideCapecitabineBevacizumabIIPretreatedMBC4868

Garcia-Saenz200824CyclophosphamideCapecitabineBevacizumabIIPretreatedMBC31.863.613.9Montagna201224CyclophosphamideCapecitabineBevacizumabIINotPretreatedMBC6275

Saloustros201113VinorelbineBevacizumabIIPretreatedMBC7.7

Montagna201224Erlotinib+bevacizumab+capecitabine

I/II

PretreatedMBC6283

18精品课件OngoingTrialsschedulephaseSettingRef.Pertuzumab+Trastuzumab+CTX50mg/d?T-DM1(ifPD)IIMBC,HER-2pos,>60yrsNCT01597414WeeklyPaclitaxel+Trastuzumab--WeeklyDoxorubicin+OralCTXPlusWeeklyTrastuzumabIIHER2+LocallyAdvancedBCNCT01329640VinorelbineMetronomic+LapatinibIIHER-2+MBCNCT00754702Capecitabine+CTX+Lapatinib+TrastuzumabIIHER-2+MBCNCT01873833Bevacizumab+PTXvs.Bevacizumab+CTX50+capecitabineIIIM+,locallyadvancedBCNCT01131195MetronomicCTX+MTX±BevacizumabIIMBCNCT00083031VinorelbineMetronomic+BevacizumabIIMBCNCT00694200Aflibercept+CapecitabineIMBCNCT01843725Letrozole+MetronomicCTX+Plus/MinusSorafenibIIMBCNCT0095413519精品课件MetronomicChemotherapyandImmunologicAgentsAuthorandyearNTreatmentPhasePrevioustreatmentandsettingORR(%)CB(%)Colleoni2005171CyclophosphamideMethotrexate±thalidomideRandomizedIIPretreatedMBC20.9vs.11.841.5vs41.5Soriano,J.201121cyclophosphamide+methotrexateVaccineRetrospectivePretreatedMBC246220精品课件MetronomicChemotherapyandDrugRepositioningAuthorandyearNpatientsTreatmentPhasePrevioustreatmentandsettingORR(%)CB(%)Young201269DocetaxelCapecitabineCelecoxibRetrospectivePretreatedandnotMBC

Perroud201315CyclophosphamideMethotrexateCelecoxibIIPretreatedMBC6.746.721精品课件SchedulephaseSettingRef.DOX24mg/m2+CTX60mg/m2os/wk×12--PTX80mg/m2+CBDCA