表柔比星法瑪新乳腺癌治療

1、目錄,含法瑪新®FEC/CEF方案是NCCN指南和St Gallen共識(shí)推薦的早期乳腺癌輔助治療的基礎(chǔ)方案1，2FEC100相比FEC50顯著提高10年無(wú)病生存率和總生存率3FEC100的遲發(fā)性心臟毒性和繼發(fā)性惡性腫瘤發(fā)生率與FEC50無(wú)顯著差異3,1. NCCN Clinical Practice Guidelines in Oncology?；Breast Cancer ；V.2.2007,3. Jacques B

2、onneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant S

3、tudy Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,2. A. Goldhirsch et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007.

4、 Annals of Oncology 2007；18: 1133–44,,,2007 St.Gallen 早期乳腺癌治療專(zhuān)家共識(shí),A. Goldhirsch et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Annals of

5、Oncology 2007；18: 1133–44,2007St. Gallen共識(shí)重點(diǎn)：重申對(duì)早期乳腺癌患者根據(jù)內(nèi)分泌治療敏感性的評(píng)價(jià)來(lái)確定合適的系統(tǒng)治療方案的重要性。,A. Goldhirsch et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast can

6、cer 2007. Annals of Oncology 2007；18: 1133–44,內(nèi)分泌治療高度敏感內(nèi)分泌治療敏感性不確定內(nèi)分泌治療不敏感,2007St. Gallen共識(shí)對(duì)內(nèi)分泌治療的敏感性分類(lèi),A. Goldhirsch et al. Progress and promise: highlights of the international expert consensus on the primary therap

7、y of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,低度危險(xiǎn)：淋巴結(jié)陰性并具備所有以下特征pT≤2cm病理分級(jí)為1級(jí)ER和/或PgR表達(dá)未侵犯腫瘤周邊血管無(wú)HER2/neu基因過(guò)表達(dá)或擴(kuò)增年齡≥35歲,2007 St. Gallen共識(shí)：早期乳腺癌危險(xiǎn)度分級(jí),A. Goldhirsch et al. Progress and promise

8、: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,高度危險(xiǎn):淋巴結(jié)陽(yáng)性(1－3個(gè)淋巴結(jié)受累)，ER和PgR缺失，或HER2/neu基因過(guò)表達(dá)或擴(kuò)增淋巴結(jié)陽(yáng)性（4個(gè)或4個(gè)以上淋巴結(jié)受累）,2007 St. Ga

9、llen共識(shí):乳腺癌危險(xiǎn)度分級(jí),A. Goldhirsch et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,中度危險(xiǎn):淋巴結(jié)陰性并至少具備以下特征中的一

10、項(xiàng)pT＞2cm病理分級(jí)為2－3級(jí)ER和PgR缺失有腫瘤周邊血管侵犯HER2/neu基因過(guò)表達(dá)或擴(kuò)增年齡＜35歲淋巴結(jié)陽(yáng)性(1-3個(gè)淋巴結(jié)受累)， ER和PgR表達(dá)，且無(wú)HER2/neu基因過(guò)表達(dá)或擴(kuò)增,2007 St. Gallen共識(shí)：早期乳腺癌危險(xiǎn)度分級(jí),A. Goldhirsch et al. Progress and promise: highlights of the international expert

11、consensus on the primary therapy of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,ET: 內(nèi)分泌治療,2007 St. Gallen共識(shí)早期乳腺癌治療推薦: 化療仍然是基礎(chǔ)治療,A. Goldhirsch et al. Progress and promise: highlights of the internationa

12、l expert consensus on the primary therapy of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,2007 St Gallen早期乳腺癌治療：化療,大部分專(zhuān)家支持對(duì)于所有的患者（除禁忌癥）都可以使用含蒽環(huán)類(lèi)的化療方案聯(lián)合環(huán)磷酰胺、5－氟尿嘧啶和蒽環(huán)類(lèi)抗生素治療方案，如FEC/CEF等得到廣泛的認(rèn)同和支持,“……Most

13、 Panelists supported the use of anthracyclines for allpatients and an even greater majority supported anthracyclineuse for patients with HER2-positive disease……Combinations of cyclophosphamide, 5-fluorouracil and an an

14、thracycline(variously abbreviated as CAF, CEF, FEC, FAC [93–96]),commanded relatively wide support, as did the sequence ofanthracycline and cyclophosphamide followed by paclitaxel ordocetaxel……”,A. Goldhirsch et al.

15、Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Annals of Oncology 2007；18: 1133–44,法瑪新®用于輔助治療提高淋巴結(jié)陽(yáng)性，預(yù)后差的早期乳腺癌患者的長(zhǎng)期生存,,（FASG-05 III 期、多中心隨

16、機(jī)研究10年隨訪(fǎng)結(jié)果）,,,Bonneterre J, Roché H, Kerbrat P, et al. J Clin oncol. 2005 Apr 20;23(12): 2686-93.,F500 mg/m2 IVE 50 mg/m2 IV每3周 x 6療程*C 500 mg/m2 IV,F 500 mg/m2 IV E 100 mg/m2 IV每3周 x 6療程*C 500 mg/m2 I

17、V,試驗(yàn)設(shè)計(jì),*禁止預(yù)防性使用集落刺激因子和抗生素,,,研究人群 (n = 565)絕經(jīng)前/后的婦女患者早期乳腺癌術(shù)后腋窩淋巴結(jié)陽(yáng)性,,,隨機(jī)化,,,,,3.Jacques Bonneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Pro

18、gnosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,F:5-FU E:EPI C:CTX,3.Jacques Bonneterre, Henri Roc

19、hé, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Random

20、ized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,兩組患者特征無(wú)統(tǒng)計(jì)學(xué)差異,兩組治療情況相似,FEC100FEC50(n = 268)(n = 278)完成6個(gè)療程治療患者的百分比 94% 　　　95.7%,,,,3.Jacques Bonneterre, Henri Roché, et al. Epirubicin Increas

21、es Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr

22、 20;23(12):2686-93.,結(jié)果：FEC100相比FEC50顯著提高10年無(wú)病生存率,3.Jacques Bonneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Brea

23、st Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,結(jié)果：FEC100相比FEC50顯著提高10年總生存率,3.Jacques Bonneterre, Henri Roché, et al. Epirubici

24、n Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol.

25、 2005 Apr 20;23(12):2686-93.,FEC100 的遲發(fā)性心臟毒性和繼發(fā)性惡性腫瘤的發(fā)生與FEC50無(wú)顯著差異,,,3.Jacques Bonneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-P

26、ositive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,結(jié)論,FEC100相比FEC50顯著提高10年無(wú)病生存率和總生存率FEC100的遲發(fā)性心臟毒性和繼發(fā)性惡性腫瘤的發(fā)生與FEC50無(wú)

27、顯著差異,3.Jacques Bonneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the F

28、rench Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,總結(jié),含法瑪新®FEC/CEF方案是NCCN指南和St Gallen共識(shí)推薦的早期乳腺癌輔助治療的基礎(chǔ)方案1，2FEC100相比FEC50顯著提高10年無(wú)病生存率和總生存率3FEC100的遲發(fā)性心臟毒性和繼發(fā)性惡性腫瘤發(fā)生率與FEC50無(wú)顯著

29、差異3,1. NCCN Clinical Practice Guidelines in Oncology?；Breast Cancer ；V.2.2007,3. Jacques Bonneterre, Henri Roché, et al. Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognos

30、is, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial. J Clin Oncol. 2005 Apr 20;23(12):2686-93.,2. A. Goldhirsch et al. Progress and promise: highlights