江澤飛 2011乳腺癌指南實踐共識課件

307乳腺癌治療

指南實踐共識

乳癌綜合治療進(jìn)展外科手術(shù)的發(fā)展放療地位和新思路晚期治療--內(nèi)科醫(yī)生的傳統(tǒng)領(lǐng)地輔助治療--分類治療策略St.Gallen新輔助治療–內(nèi)外合作的平臺1950腫瘤內(nèi)科在乳腺癌的綜合治療中開始發(fā)揮重要作用化療Rayter&Mansi.MedicalTherapyofBreastCancer2003Radiotherapy

3000BC

1500’s

1800’sSurgeryHormonalmanipulation

1937

1950赫賽汀改變了HER2陽性轉(zhuǎn)移性乳腺癌的進(jìn)程HER2Negative(n=1782)HER2+NoHerceptin(n=118)HER2+Herceptin(n=191)DawoodS,etal.JClinOncol.2010;28:92-98.Her-2陽性乳腺癌診療專家共識

(2009.08上海)）

中國抗癌協(xié)會乳腺癌專業(yè)委員會江澤飛邵志敏徐兵河等，《中華腫瘤雜志》2010；2(32)AvastininHer-2Negative

MetastaticBreastCancer

CurrentandFuture貝伐珠單抗治療乳腺癌痛苦地思考如何用?用不用??

NCCNRecommendationStandsAvastinplusPaclitaxelstillberecommendedas1stlineoptioninUS's-breast-cancer-indication/

QuestionsinChemotherapyforEBC2011Canweavoidchemotherapy?Whichregimenisbest?Canweavoidanthracyclines?Doweneedataxane?Ifyes,whichone?Ifyes,concurrentvssequential?WhatisthebestHER2regimen?Howdoweintegratebiologicssuchasbevacizumab?

改變臨床實踐的AI臨床試驗結(jié)果阿那曲唑來曲唑依西美坦復(fù)發(fā)率/年(%)04812160235810初始轉(zhuǎn)換延續(xù)(年)BIG1-98MA17IESATACABCSG8,ARNO95,ITAABCSG6aB33TEAMSt.Gallen2011

StrategiesforSubtypes:

DealingwiththeDiversityofBreastCancerRecommendationsConsensus&ControversySt.GallenConsensusOverviewSurgery:sentinelnodeRadiation:DCIS,accelerated,partial,postmastectomyPathology:ER,PgR,HER2,Ki-67,gradeMulti-genesignaturesEndocrinetherapies(focusingonovariansuppression,tamoxifen,AIs)Chemotherapy(focusingonanthracycline,taxane,platinum)TargetedtherapiesNeoadjuvantsystemictherapyBisphosphonatesMalebreastcancer

乳癌手術(shù)治療發(fā)展1894年乳癌根治術(shù)1949年乳癌擴(kuò)大根治術(shù)乳癌改良根治術(shù)1973-77年乳癌保乳手術(shù)1992年保留腋窩的手術(shù)腋窩也可以不用清掃前哨淋巴結(jié)活檢術(shù)

ACOSOGZ0011

腋窩淋巴結(jié)清掃術(shù)在T1-2N0M0期前哨淋巴結(jié)陽性乳腺癌的隨機(jī)研究

2010ASCONo.CRA506NeoadjuvantSystemicTherapyShouldneoadjuvanttherapybegivenonlyinordertoalterthesurgicaloutcome(lessthanmastectomy)?

Yes:37.2%

No:60.5% A:2.3%

PrimaryConsideration

(agreedonbymajorityofparticipants)Primarygoal-treatmentchoiceforwomenwithearlybreastcancer:Integratetumorbiologyandtumorextentintoanestimateofresponsivenesstotreatme