对早期EGFR-2阳性乳腺癌患者选择最佳辅助化疗方案.ppt

赫赛汀显著提高早期乳腺癌的DFS和OSSelectionofChemotherapyRegimensinPatientsReceivingTrastuzumab(CCOrecommendation29)曲妥珠单抗可联用所有可用的化疗方案*没有临床研究评估单纯赫赛汀辅助治疗是否获益；SASBC07(RESPECT)研究评估赫赛汀单药VS赫赛汀联合化疗用于老年乳腺癌患者辅助化疗。UseofTrastuzumabandanAnthracycline-ContainingRegimen(CCOrecommendation30)由于可能增加心脏毒性，不推荐曲妥珠单抗同步含有蒽环类的化疗方案。在晚期乳腺癌患者，赫赛汀同步蒽环类药物发生充血性心力衰竭的发生率高达25%.*RecommendationtakenverbatimfromtheCCOguideline.共识/adaptations/breastsystemictherapy?AmericanSocietyofClinicalOncology2016.Allrightsreserved.共识ConcurrentadministrationofAdjuvantTrastuzumabandNon-AnthracyclineChemotherapyRegimens(CCOrecommendation31)无蒽环类的化疗方案应与曲妥珠单抗同步而非序贯使用。Trastuzumab-BasedChemotherapy/TrastuzumabRegimensforPatientsatHigherRiskofCardiotoxicity(CCOrecommendation32)6TCbH方案的心脏毒性低于4AC-4TH，推荐高心脏毒性风险的患者接受多西他赛-曲妥珠单抗或TCbH方案。*AdditionofTrastuzumabtoChemotherapyRegimensNotEvaluatedinaPhaseIIITrial(CCOrecommendation33)一些化疗方案中加入曲妥珠单抗的做法并未得到Ⅲ期试验的证据，例如TC方案。这类方案可能已经在临床中使用，并来自于合理的考虑，特别是为降低心脏毒性。*DurationofTrastuzumabTherapyandCardiacFunctionAssessment(CCOrecommendation34)患者接受曲妥珠单抗辅助治疗应至少1年，期间应定期评估心脏功能。**RecommendationtakenverbatimfromtheCCOguideline.共识/adaptations/breastsystemictherapy?AmericanSocietyofClinicalOncology2016.Allrightsreserved.SlamonSABCS2006BCIRG006:SecondInterimAnalysis

Disease-FreeSurvivalTreatmentArmsAC→TAC→THTCHNumberofevents192128142Riskreduction39%33%Hazardratio0.610.6795%confidenceinterval0.48-0.760.54-0.83Pvalue0.00010.0003OverallSurvivalNumberofevents804956Riskreduction41%34%Hazardratio0.590.6695%confidenceinterval0.42-0.850.47-0.93Pvalue0.00410.017SlamonDetal.PresentedatSABC2006;Abstract52.帕妥珠辅助治疗/adaptations/breastsystemictherapy?AmericanSocietyofClinicalOncology2016.Allrightsreserved.铂类辅助治疗新辅助使用铂类可以提高pCR率，达到pCR的TNBC患者，生存也得到了改善。但是在TNBC或BRCA1orBRCA2突变的患者中，没有观察到铂类辅助或新辅助治疗能够改善