乳腺癌内分泌治疗的临床思考ppt.ppt

绝经前早期乳腺癌卵巢功能抑制用药指征 新辅助内分泌治疗(NAE): 指对非转移性乳腺癌患者，在应用局部治疗前进行系统的内分泌治疗，达到原发病灶和区域淋巴结降期的目的 提高乳腺癌的局部控制率，提高局部晚期乳腺癌手术切除率 为可能需行乳房切除的患者提供保乳机会 可以抑制体内已经存在的微小转移灶 氟维司群显著降低雌激素受体和孕激素受体的表达 NS = 无统计学差异 ER PgR Robertson JFR, et al. Cancer Res 2001; 61:6739–6746. 0020/0021研究氟维司群中位TTP时间为5.5个月 Robertson JFR, et al. Cancer 2003; 98:229–238. HR=0.95 95%CI=0.82–1.10 P=0.48 中位TTP (中位随访15.1个月) 氟维司群 (n=428) 5.5个月 阿那曲唑 (n=423) 4.1个月 0.0 0.2 0.4 0.6 0.8 0 200 400 时间 (天) 无进展比例 1.0 600 800 1000 1200 氟维司群是NCCN指南推荐转移性乳腺癌内分泌治疗有效选择 NCCN Clinical Practice Guidelines in OncologyTM. Breast Cancer v2. 2011. NCCN Clinical Practice Guidelines in OncologyTM. 乳腺癌临床实践指南 (中国版) v1. 2011. Cardoso F, et al. Ann Oncol 2011; 22(S6):vi25-vi30. 氟维司群在乳腺癌内分泌治疗中尚待解决的问题 最佳的给药剂量？ 最佳的给药时机？ 最合适的治疗人群？ 联合其他内分泌治疗药物的可行性？ IBCSG = International Breast Cancer Study Group * Previous neoadjuvant AI studies treated patients for 3 to 4 months, and for tumors that initially would have required mastectomy, 40% responded sufficiently to permit BCS.1 However, after that period of treatment, some patients remain inoperable or still require mastectomy. This prospective study, in 142 postmenopausal women with ER-positive large operable or locally advanced breast cancer, was conducted to determine whether preoperative letrozole continued beyond 3 months improved surgical outcome.2 After 3 months of letrozole, 84 patients had responded sufficiently for BCS to be performed. However, another 42 patients had some response, but it was insufficient to permit BCS. Treatment was continued in those 42 patients (22 completed 12 months of total treatment). Response was determined by clinical palpation, and calculation of tumor volume reduction—separately for the first 3 months (0 to 3 months), the second 3 months (between 3 and 6 months), and from 6 to 12 months—enabled assessment of tumor shrinkage relative to duration of treatment. 1. Smith. Semin Oncol. 2004;31(suppl 12):9. 2. Update of Renshaw et al. Breast Cancer Res Treat. 2004;88(su