潘跃银-乳腺癌辅助治疗-从临床指南走向临床实践讨论.ppt

乳腺癌的辅助治疗——从临床指南走向临床实践讨论 安徽医科大学第一附属医院 潘跃银 ADJUVANT BREAST CANCER DECISION= PUZZLE ! TREATMENT GUIDELINES FOR ADJUVANT THERAPY OF BREAST CANCER Aim : to enhance individual clinical decision-making Evidence : from clinical trials / metaanalysis(= Average treatment effects) Opinion of breast cancer experts is important Pulling It All Together: Desirable Attributes of Guidelines 正确与可靠性 简明、可操作性 灵活性 多学科合作 CASE 1 40 year old, premenopausal woman Infiltrating ductal carcinoma Tumor 0.5 cm 0/10 positive lymph nodes Grade 1 ER+，PR+. HER+ 辅助治疗方案? NCCN 2010 ESMO ST.GALLEN 适应症 雌激素或孕激素受体阳性的浸润性乳腺癌患者，不论年龄、淋巴结状态或是否应用了辅助化疗，都应考虑辅助内分泌治疗。 CASE 1 40 year old, premenopausal woman Infiltrating ductal carcinoma Tumor 0.5 cm 0/10 positive lymph nodes Grade 1 ER+，PR+. HER+ 辅助治疗方案? TAM 风险评价与治疗选择 CASE 2.: Adjuvant! Online Results ESMO 46 y.o., pT2 (3cm), pN0, Grade 2, R0, ER/PR+, HER2- ST GALLEN St gallen ESMO ST GALLEN NCCN ST GALLEN ESMO NCCN ASCO CASE 5 40岁 3CM,G1,N- 5%浸润性导管癌，95%DCIS ER+，PR+. HER+++ 辅助治疗方案? 辅助治疗方案? TAM? CT? HECEPTIN? ADJUVANT CHEMOTHERAPY REGIMENSIN 2010 SELECTION OF ADJUVANT CHEMOTHERAPY REGIMENS : ACCORDING TO THE ENDOCRINE-RESPONSIVENESS AND THE RISK OF THE TUMOR * * * * * * * * * * * 46 y.o., pT2 (3cm), pN0, Grade 2, R0, ER/PR+, HER2- ST GALLEN NCCN ESMO 化疗方案 Patient M.F.: Guideline Recommendations 46 y.o., pT2 (3cm), pN0, Grade 2, R0, ER/PR+, HER2- Risk Category Treatment Preferred Chemotherapy ESMO Intermediate ET alone or CT ? ET A?CMF, CEF, AC?T, TAC, FEC?T, FEC100, A?T?CMF St. Gallen Intermediate ET (consider + CT) Specific regimens not listed NCCN -- Consider 21-gene assay or ET ± CT TAC, TC, AC?P, AC CT = chemotherapy; ET = endocrine therapy CASE 2 Therapy recommendation: Recommendation: NNBC-3 trial ESMO: 3x FEC – 3x Docetaxel; US: TAC; CHINA ? A-BASED Radiotherapy right breast Endocrine therapy (TAM) CASE 3 40 year old, premenopausal woman Infiltrating ductal carcinoma Tumor 2.1 cm 0/10 posit