江澤飛-乳腺癌指南實(shí)踐共識(shí)說課材料

江澤飛-2011乳腺癌指南實(shí)踐共識(shí)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(shí)

(2009.08上海)）

中國(guó)抗癌協(xié)會(huì)乳腺癌專業(yè)委員會(huì)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??AvastinRegulatoryHistoryinUS:

2010/07TheODACvote12-1thatthisindicationberemovedfrombevacizumab’slabel,reasons:NooverallsurvivaladvantageHighcostToxicityFDARecommendsRemovalofBevacizumab'sBreastCancerIndication

NCCNRecommendationStandsAvastinplusPaclitaxelstillberecommendedas1stlineoptioninUS/articles/january-15-2011/fda-recommends-removal-of-bevacizumab's-breast-cancer-indication/復(fù)發(fā)轉(zhuǎn)移乳腺癌化療基本原則

中國(guó)抗癌協(xié)會(huì)乳腺癌專業(yè)委員會(huì)一、復(fù)發(fā)轉(zhuǎn)移乳腺癌的治療前評(píng)估1、首先系統(tǒng)評(píng)估復(fù)發(fā)轉(zhuǎn)移乳腺癌患者，明確病變范圍為局限性還是全身性疾病。2、盡可能對(duì)復(fù)發(fā)病灶活檢，重新檢測(cè)激素受體(ER和PR)和HER-2狀況。

3、確診骨轉(zhuǎn)移患者，治療可參考《中國(guó)乳腺癌骨轉(zhuǎn)移和骨相關(guān)事件專家共識(shí)》。

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

改變臨床實(shí)踐的AI臨床試驗(yàn)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

BreastCancerSubtypes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)NSABPB-32

隨機(jī)III期臨床研究NSABPB-32:

前哨淋巴結(jié)切除術(shù)對(duì)比腋窩淋巴結(jié)清掃術(shù)用于臨床表現(xiàn)為淋巴結(jié)陰性的乳腺癌患者

2010ASCOAbstractNo：LBA505

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