江泽飞2011乳腺癌指南实践共识课件

307乳腺癌治疗

指南实践共识

乳癌综合治疗进展外科手术的发展放疗地位和新思路晚期治疗--内科医生的传统领地辅助治疗--分类治疗策略St.Gallen新辅助治疗–

内外合作的平台1950肿瘤内科在乳腺癌的综合治疗中开始发挥重要作用化疗Rayter&Mansi.MedicalTherapyofBreastCancer2003Radiotherapy

3000BC

1500’s

1800’sSurgeryHormonalmanipulation

1937

1950赫赛汀改变了HER2阳性转移性乳腺癌的进程HER2Negative(n=1782)HER2+NoHerceptin(n=118)HER2+Herceptin(n=191)DawoodS,etal.JClinOncol.2010;28:92-98.Her-2阳性乳腺癌诊疗专家共识

(2009.08上海)）

中国抗癌协会乳腺癌专业委员会江泽飞邵志敏徐兵河等，《中华肿瘤杂志》2010；2(32)AvastinRegulatoryHistoryinUS:

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

NCCNRecommendationStandsAvastinplusPaclitaxelstillberecommendedas1stlineoptioninUS's-breast-cancer-indication/复发转移乳腺癌化疗基本原则

中国抗癌协会乳腺癌专业委员会一、复发转移乳腺癌的治疗前评估1、首先系统评估复发转移乳腺癌患者，明确病变范围为局限性还是全身性疾病。2、尽可能对复发病灶活检，重新检测激素受体(ER和PR)和HER-2状况。

3、确诊骨转移患者，治疗可参考《中国乳腺癌骨转移和骨相关事件专家共识》。

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

St.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腋窝也可以不用清扫前哨淋巴结活检术NSABPB-32

随机III期临床研究NSABPB-32:

前哨淋巴结切除术对比腋窝淋巴结清扫术用于临床表现为淋巴结阴性的乳腺癌患者

2010ASCOAbstractNo：LBA505

ACOSOGZ0011

腋窝淋巴结清扫术在T1-2N0M0期前哨淋巴结阳性乳腺癌的随机研究

2010ASCONo.CRA506NeoadjuvantSystemicTherapyIsneoadjuvantendocrinetherapyaloneareasonableoptionforpostmenopausalpts.withhighlyendocrine-responsivedisease?

Yes:97.8% No2.2% A:0.0% Ifyes,forwhichduration(chooseone)?3-4months Yes:15.2%4-8months Yes:39.1%Maximalresponse Yes:45.7%PrimaryConsideration

(agreedonbymajorityofparticipants)Primarygoal-treatmentchoiceforwomenwithearlybreastcancer:Integratetumorbiologyandtumorextentintoanestimateofresponsiv