早期乳腺癌輔助化療進(jìn)展中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院徐兵河-全文預(yù)覽
【正文】 0 Women /Yr 隨機(jī)分組后年 AC?TH AC?T N9831/B31遠(yuǎn)處轉(zhuǎn)移風(fēng)險 赫賽汀輔助治療北美臨床 N9831/B31 總生存時間 AC?TH 94% 91% 87% 92% AC?T N Deaths AC?T 1679 92 AC?TH 1672 62 HR=, 2P= Years From Randomization Patients (%) Years 100 90 80 70 0 1 2 3 4 5 93% 86% 84% 80% 80% 91% 86% 77% 73% n 1074 1075 1073 Events 77 98 147 AC?DH DCarboH AC?D 60 50 HR= HR= BCIRG 006研究 DFS Slamon et al 2022 SABCS (abstract 1) 無病生存率 總生存率 HR (95% CI) P值 HR (95% CI) P值 N9831/B31 (~) (~) HERA (~) (~) FinHER (~) (~) BCIRG ACTH TCH (~) (~) (~) (~) 曲妥珠單抗輔助治療 Trastuzumab: Adjuvant Breast Cancer ? All trials demonstrated an important benefit in disease free survival in the trastuzumabtreated group ? Some trials also demonstrated a striking benefit in overall survival ? However some concerns exist for cardiac safety 激素受體陽性、 HER2陽性乳腺癌的全身輔助治療 組織學(xué)類型： ?導(dǎo)管癌 ?小葉癌 ?混合型癌 ?化生性癌 pT pT2或 pT3； 和 pN0或 pN1mi（腋窩淋巴結(jié)轉(zhuǎn)移灶 ≤2 mm） ?腫瘤 ≤ cm或 ?微浸潤或 ?腫瘤 ~ cm，且高分化 pN0 不進(jìn)行輔助治療 pN1mi 考慮輔助內(nèi)分泌治療 腫瘤 ~ cm，且中 /低分化或伴預(yù)后不良因素 輔助內(nèi)分泌治療 177。 : 作用機(jī)制 Trastuzumab in adjuvant , phase III studies Tria l N Se lec tion c r iter ia D e s ign Pr ima r y e ndpo int N SA B P B 3 1 2 ,70 0 N ode+, IHC 3+ or FISH + 4 A C 4T+/ H OS Inter group N9831 3 ,00 0 N ode+, IHC 3+ or FISH + 4 A C 4T+/ H D FS H ER A Tria l 3 ,19 2 N ode+ and – IHC 3+ or FISH + C himio+/ H 1 ou 2 ans D FS B C IRG 0 0 6 3 ,00 0 N ode+ and – FISH + 4 A C 4T+/ H ou T C H D FS 赫賽汀 174。 HER2陽性對生存期的影響 ?HER2陽性的乳腺癌患者的生存率降低！ 中位生存期 HER2 陽性 3 年 HER2 陰性 6–7 年 Slamon DJ et al. Science 1987。 Winer E On behalf of CALGB/ECOG/SWOG/NCCTG investigators HER2+ Breast Cancer and Adjuvant Therapy Her2 ? Her2是一種原癌基因，該基因與乳腺癌細(xì)胞增殖有關(guān)。 365: 16871717 Chemotherapy versus endocrine therapy in the treatment of breast cancer ? In patients with ER+ disease, tamoxifen improves 15year recurrence by % and survival by % ? Gains made with tamoxifen treatment appear to be irrespective of adjuvant chemotherapy EBCTCG. Lancet 2022。 365: 16871717 Recurrence (%) 7056 women: 19% nodepositive 0 10 20 30 40 50 60 0 1 3 5 4 2 5year gain % (SE ) Logrank 2p Chemotherapy alone % Chemotherapy + about 5 years39。 tamoxifen Time (years) 10,386 women: 20% ERunknown, 30% nodepositive EBCTCG. Lancet 2022。 tamoxifen % Time (years) 0 5 15 10 ER=oestrogen receptor。 older women, 70% nodepositive Placebo % 0 10 20 30 40 50 60 15year gain % (SE ) Logrank 2p Polychemotherapy % 0 5 15 10 15year probabilities of breast cancer mortality in women aged 5069 years, with / without polychemotherapy Time (years) Younger women, 35% nodepositive。 365: 16871717 Placebo % 0 10 20 30 40 50 60 Breast cancer mortality (%) 15year gain % (SE ) Logrank 2p Polychemo
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