乳腺癌新辅助化疗共识与进展课件.ppt

HER2阳性乳腺癌新辅助化疗策略 对于 HER2-阳性 肿瘤， 何为首选方案? 尚无答案! Taxane + trastuzumab only 7.7% Taxane, trastuzumab and pertuzumab 23.1% Platin, taxane, trastuzumab ± pertuzumab12.8% Non-taxane regimen containing platin, trastuzumab ± pertuzumab 0 Anthracycline - taxane and anti-HER2 56.4% 2015年St Gallen投票 HER2阳性乳腺癌新辅助化疗策略 Gianni L, et al. Lancet. 2010 Jan 30;375(9712):377-84. Lancet Oncol. 2014 May;15(6):640-7. NOAH研究 化疗+Herceptin 化疗 如何进一步提高疗效呢？ 增加化疗药物的配伍？ 增加靶向药物的配伍？ Untch M, et al. J Clin Oncol. 2010 Apr 20;28(12):2024-31 Gepar Quattro: 化疗方案加卡培他滨 All 445例 EC-T+H 146例 EC-TX+H 144例 EC-T-X+H 136例 pCR : ypT0 ypN0/+ 含紫杉类和蒽环类的方案再加卡培他滨并未改善HER2+BC的pCR HER2阳性乳腺癌新辅助化疗策略 GBG 66: 化疗方案再加卡铂 手术 373例 HER2+ II-III期 R P=0.581 P=0.585 von Minckwitz G, et al. Lancet Oncol. 2014 Jun;15(7):747-56 HER2+人群 新辅助两药化疗再加卡铂，未改善pCR 卡铂组：血液学毒性和非血液学毒性比例更高 HER2阳性乳腺癌新辅助化疗策略 HER2阳性乳腺癌新辅助化疗策略 蒽环、紫衫基础上联合双靶（曲妥珠单抗+拉帕替尼）提高pCR 共1155例患者，483例(41.8%)HR-，672例(58.2%)HR+ 拉帕替尼联合曲妥珠单抗双阻断对比曲妥珠单抗单药，pCR率显著提高了13%，HR-患者提高18% Clavarezza M, et al. Clin Cancer Res. 2016 May 2. pii: clincanres.1881.2015. HR+ HR- Gianni L, et al. Lancet Oncol. 2012 Jan;13(1):25-32. Lancet Oncol. 2016 May 11. 双靶提高了16.8%的bpCR HR-亚组人群获益更高 NeoSphere研究：联合帕妥珠单抗 HER2阳性乳腺癌新辅助化疗策略 蒽环、紫衫基础上联合双靶（曲妥珠单抗+帕妥珠单抗）提高pCR . . . . . . . * Patients with histologically confirmed invasive, unilateral or bilateral breast cancer were included in the Gepartrio study. Locally advanced tumors were eligible but were randomized to a different stratum. All patients needed to have a measurable tumor of at least 2 cm. We excluded from participation patients with favorable prognosis according to their tumor size, receptor and nodal status, grade, and age, as in our previous trials these patients achieved a pCR in only around 2%. All patients received 2 cycles of Docetaxel 75 mg/m2, Doxorubicin 50 mg, and Cyclophosphamide 500 mg on day one every 3 weeks. Growth factors together with ciprofloaxicin were given as primary prophylaxis for febrile neutropeni