早期乳癌术后辅助化疗 .ppt
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1、内 容乳癌个体化治疗研究临床实践-方案选择乳腺癌系统辅助治疗取得的进展 疾病相关复发风险降低百分比疾病相关复发风险降低百分比01020304017%42%46%31%CEF vs CMFCEF vs CMFLevine 2005AC AC T vs AC T vs ACHenderson 2003Piccart 2005三苯氧胺三苯氧胺 vs vs 安慰剂安慰剂Fisher 2004DAC vs FACDAC vs FACMartin 200528%HER2+&HER2-Romond 20055052%HER2+化疗化疗+赫赛汀赫赛汀 vs vs 化疗化疗化疗化疗 赫赛汀赫赛汀 vs vs 化
2、疗化疗辅助治疗方案选择应有循证医学依据 整体治疗计划 方案组成 剂量 疗程 选择与临床试验的入组条件最相近的方案NCCN指南(英文版、中文版)St Gallen专家共识INT C9741 剂量密度 与 标准剂量中位随访5年 C9741DFS:ER 状状态与与剂量密集量密集随访69个月Disease-Free Survival0.00.10.20.30.40.50.60.70.80.91.001234567YearER+q3wkER-q3wkER-q2wkER+q2wkER+q2 n=636 Events=126 ER-q2 n=336 Events=99ER+q3 n=639 Events=1
3、33 ER-q3 n=327 Events=127P=.014P=NSER=estrogen receptorsWith permission from Hudis C,et al.2005 San Antonio Breast Cancer Symposium.Abstract 41.分子分型与病理免疫组化分型的大致关系 ER+Her-2 -、分化好、Ki-67低 ER+Her-2 -、分化差、Ki-67高Luminal AHer-2+HR+Her-2+HR-Luminal BHer-2 ER PR(80%)Her-2+ERHer-2 positiveHer-2-Basal-likeNorm
4、al-likeWWW.Pnas.org/cgi/doi/10.1073/pnas.191367098基因分型预后基因分型预后PAM 50 预测不同亚型生存率Supervised Risk Predictor of Breast Cancer Based on Intrinsic SubtypesJoel S.Parker,Michael Mullins,Maggie J Clin Oncol 27:1160-1167个体化治疗时代 乳腺癌不是一种单一的疾病,而是一组生物学行为不同的疾病。术后辅助化疗不再有“通用”的方案RANDOMIZERANDOMIZEtamoxifen x 5 yrs ta
5、moxifen x 5 yrs Albain,et al.Breast Cancer Res Treat 2005Albain,et al.Breast Cancer Res Treat 2005n=1477n=1477 CAF x 6,then CAF x 6,then tamoxifen tamoxifen CAF x 6,with CAF x 6,with concurrent tam concurrent tam (n=361)(n=361)(n=550)(n=550)(n=566)(n=566)SWOG 8814SWOG 8814Postmenopausal N+ER+SWOG 88
6、14/TBCI 0100 Sample Size for This AnalysisPatients with samples-666Patients with samples-666 (45%of parent trial)45%of parent trial)RT-PCR obtained-601(90%)RT-PCR obtained-601(90%)Tamoxifen aloneTamoxifen alone 148 148CAFT(concurrent)CAFT(concurrent)234234CAF-T(sequential)CAF-T(sequential)219219Fina
7、l sample for primary analysisFinal sample for primary analysis148+219=367 148+219=367(40%of parent trial)(40%of parent trial)0.000.250.500.751.00Disease-free survival0246810Years since registrationTamoxifen(n=55,15 events)CAF-T (n=91,26 events)Stratified log-rank p=0.97 at 10 yearsLow risk(RS 18)Dis
8、ease-Free Survival by Treatment低低RS者化疗无受益者化疗无受益0.000.250.500.751.00Disease-free survival0246810Years since registrationTamoxifen (n=47,26 events)CAF-T (n=71,28 events)Stratified log-rank p=0.033 at 10 yearsHigh risk(RS 31)Disease-Free Survival by Treatment0.000.250.500.751.00Disease-free survival024
9、6810Years since registrationTamoxifen (n=46,22 events)CAF-T (n=57,20 events)Stratified log-rank p=0.48 at 10 yearsIntermediate risk(RS 18-30)Disease-Free Survival by Treatment高高RS者化疗明显受益者化疗明显受益RS与化疗获益的关系与化疗获益的关系0.000.250.500.751.00Disease-free survival0246810Years since registrationTamoxifen(n=57,20
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