晚期hr her2-乳腺癌内分泌治疗的几点思考ppt课件.ppt

晚期HR+ HER2-乳腺癌内分泌 治疗的几点思考,,,,化疗or内分泌治疗？,1,,,用哪种药物？,2,,,持续多长时间？,3,一线治疗方案的选择,复发,化疗or内分泌治疗？,远处,局部,区域,内脏,其他,,,,,,危及生命,,CT,,,ET,,,,,有or无？TAM or AI?,＞12个月 or ＜12个月？,Pre or Peri or Post？,辅助内分泌药物,无病间期,月经状态,用哪种药物？,绝经后乳腺癌,一线内分泌药物使用哪个是合理的,持续多久,一直用到有进展的明确证据,,用哪种药物？,Al (nonsteroidal) Fulvestrant Al + palbociclib Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Al (nonsteroidal) Al + fulvestrant Al + palbociclib Tamoxifen,Al (nonsteroidal) Fulvestrant Al + palbociclib,Al, nonsteroidal preferred Al + fulvestrant Al + palbociclib,Late relapse (> 12 months since adjuvant therapy),Early relapse (≤ 12 months since adjuvant therapy),Late relapse (> 12 months since adjuvant therapy),Early relapse (≤ 12 months since adjuvant therapy),Prior treatment with an Al,Prior treatment with tamoxifen,Prior adjuvant endocrine therapy,No prior adjuvant endocrine therapy,,,,,,,,,,,,,Premenopausal,所有的病人都需要 OFS?,哪种药物与OFS搭档最好？,什么时候开始用OFS用哪种OFS？,,,,绝经前乳腺癌,对于绝经前HR+ MBC目前缺少大宗的数据指导。

对于绝经前HR+ MBC，ET+OFS应作为优选未接受辅助内分泌治疗的绝经前HR+ MBC应接受 OFS+TAM/AI对于辅助ET方案为TAM的绝经前HR+ MBC,若在辅助治疗期间或者辅助治疗结束后12个月内复发，应接受OFS+AI4,1,2,3,GnRH？,手术切除？,现有的证据表明，手 术切除和GnRH对 卵巢功能的抑制效果 相当但是ASCO晚期乳腺 癌内分泌指南和ESMO 晚期乳腺癌专家共识 都强调要重视GnRH 对卵巢功能抑制不完全 的风险1,21.J Clin Oncol. 2016 Sep 1;34(25):3069-103. 2.Ann Oncol. 2017 Jan 1;28(1):16-33.,用哪种药物？,Al (nonsteroidal) Fulvestrant Al + palbociclib Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Al (nonsteroidal) Al + fulvestrant Al + palbociclib Tamoxifen,Al (nonsteroidal) Fulvestrant Al + palbociclib,Al, nonsteroidal preferred Al + fulvestrant Al + palbociclib,Late relapse (> 12 months since adjuvant therapy),Early relapse (≤ 12 months since adjuvant therapy),Late relapse (> 12 months since adjuvant therapy),Early relapse (≤ 12 months since adjuvant therapy),Prior treatment with an Al and OFS,Prior treatment with tamoxifen with or without OFS,Prior adjuvant endocrine therapy,No prior adjuvant endocrine therapy,,,,,,,,,,,,OFS,,,二线治疗方案的选择,,,,一线方案和 DFI 会影响二线药物选择,,,,目前，对辅助治疗耐药缺乏明确、可靠的定义。

也没有证据以辅助治疗为基础指导一线，二线的选择若病人分期较早而DFI短，或者在辅助内分泌治疗时就发生进展，后续的内分泌治疗效果可能较差一线方案和DFI对二线方案的影响,,,500 mg/IM on Days 0, 14, and 18, followed by 500 mg every 28 days,,500 mg/IM on day 0, 250 mg on days 14 and 28, then 250 mg every 28 days,Fulvestrant的使用方式,J Natl Cancer Inst 106:djt337, 2014,绝经后乳腺癌二线用哪种药物？,Al (nonsteroidal) Fulvestrant Al + palbociclib Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Al (nonsteroidal) Al + fulvestrant Al + palbociclib Tamoxifen,Al (nonsteroidal) Fulvestrant Al + palbociclib,Al, nonsteroidal preferred Al + fulvestrant Al + palbociclib,First line,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen (late relapse),Depending on prior therapy: Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,,,,,,Sequential therapy based on prior exposure and response to hormone therapy,,,,Al (nonsteroidal) Fulvestrant Al + palbociclib Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Al (nonsteroidal) Al + fulvestrant Al + palbociclib Tamoxifen,Al (nonsteroidal) Fulvestrant Al + palbociclib,Al, nonsteroidal preferred Al + fulvestrant Al + palbociclib,OFS,绝经前乳腺癌二线用哪种药物？,,,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen (late relapse),Depending on prior therapy: Fulvestrant ± palbociclib Al + everolimus Al (steroidal) Tamoxifen,,,,,,First line,Second line(with Continued OFS),,,Sequential therapy based on prior exposure and response to hormone therapy,,化疗＋抗HER2治疗应作为一线 选择,内分泌治疗＋抗HER2治疗应 作为一线治疗缓解后的维持 治疗手段,CT+anti-HER2,,,晚期HR+ HER2+乳腺癌一线方案如何选择?,ET+anti-HER2,晚期乳腺癌治疗，有据可依，但不可拘于定法。

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