絕經(jīng)后受體陽性乳腺癌患者高危人群的內(nèi)分泌治療

1、絕經(jīng)后激素受體陽性乳腺癌患者高危人群的內(nèi)分泌治療,北京大學人民醫(yī)院王 殊,ER陽性患者預后,EBCTCG，Lancet. 2005,Long-Term Risk of Breast Cancer,Presented By Ian Smith at 2014 ASCO Annual Meeting,Clinical trials,MA17,Anastrozoleletrozoleexemetane,BIG 1-98,ATAC,AB

2、CSG 6a,IES,B 33,ABCSG-8 ARNO95/ITA,TEAM,Upfront switch/sequential extended,MA27,ANA 5Y,EXE 5Y,FACE,ANA 5Y,LET 5Y,Head to head,ATTOM,ATLAS,Tamoxifen,高危人群,腫瘤大小淋巴結(jié)轉(zhuǎn)移組織學分級ER/PRHER2Ki67,分子分型 RS

3、 ROR,淋巴結(jié)轉(zhuǎn)移與生存,,Annals of Oncology, 2007,受體陽性乳腺癌患者的生存(SEER Data),,,,0.95,,1.00,0.90,0.85,0.80,0.75,0,10,20,30,40,50,60,70,80,,,Survival (mo),Cumulative proportion surviving,Joint ER/PR Phenotype,ER+PR+ (n=12,811),ER+PR-

4、 (n=2,436),ER-PR+ (n=663),,,,,,,,,,,,,Node-negative patientswith T1-T3 tumors,HER2陽性患者預后較差,Tamoxifen,Anastrozole,RFS,RFS,Dowsett,JCO,2008,Ki-67,Pathol Oncol Res. 2014,10,21-Gene Recurrence Score Assay forPostmenop

5、ausal, ER(+) Breast Cancer,Lancet Oncol. 2010,,,,,,,,,,,,,高危人群 風險控制,AI還是TAM?初始還是序貫？5年還是更長？,高危人群 風險控制,AI還是TAM?初始還是序貫？5年還是更長？,ATAC,BIG1-98,,Relationship of ER level and response to ET,,,,,,,,,高危人群 風險控制,AI還是TAM?初始還是序貫

6、？5年還是更長？,BIG1-98 序貫,,,,高危人群 風險控制,AI還是TAM?初始還是序貫？5年還是更長？,Pooled analysis ATLAS + aTTom:Breast Cancer Mortality,Presented By Ian Smith at 2014 ASCO Annual Meeting,Extended Adjuvant Therapy with AIs,Presented By Ian Smit

7、h at 2014 ASCO Annual Meeting,Slide 13,Presented By Ian Smith at 2014 ASCO Annual Meeting,Slide 14,Presented By Ian Smith at 2014 ASCO Annual Meeting,Longer-Term Outcomes of Letrozole v. Placebo After 5Years of Tamoxifen

8、 in the MA.17 Trial: Analyses Adjusting for Treatment Crossover,Presented By Ian Smith at 2014 ASCO Annual Meeting,MA17,HR = 0.61，P = .04,Slide 17,Presented By Ian Smith at 2014 ASCO Annual Meeting,,,Slide 19,Presented B

9、y Ian Smith at 2014 ASCO Annual Meeting,Slide 20,Presented By Ian Smith at 2014 ASCO Annual Meeting,Slide 21,Presented By Ian Smith at 2014 ASCO Annual Meeting,How Long Is Long Enough? Defining Optimal Duration and Selec

10、tion of Adjuvant Endocrine Therapy,Presented By Ian Smith at 2014 ASCO Annual Meeting,ConclusionSo What do We Do As Clinicians?,Presented By Ian Smith at 2014 ASCO Annual Meeting,,,,,,,,,,,,,,,,,副作用-ATAC,副作用 BIG1-98,副作用-

11、IES,Value-Based Approach to Systemic Therapy in Patients with Breast Cancer: What is the Evidence?,Presented By Michael Hassett at 2014 ASCO Annual Meeting,What do we get for what we spend?,Presented By Michael Hassett a

12、t 2014 ASCO Annual Meeting,Value?,Presented By Michael Hassett at 2014 ASCO Annual Meeting,Valuable treatments should produce outcomes that reflect meaningful clinical benefit to patients,Presented By Michael Hassett at