乳腺癌内分泌治疗的新思路和临床实践

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1、乳癌内分泌治疗新思路和临床实践乳癌的治疗手段Surgery手术Radiationtherapy放疗Chemotherapy化疗Hormonetherapy内分泌治疗Biotherapy生物治疗Newtherapies新的治疗乳癌内分泌治疗的发展1970198019902000TamoxifenTamoxifenMAAG新的芳香化酶抑制剂Exemestane/MA新的芳香化酶抑制剂TamoxifenpureA.E.?MAIIIIIIIIIIIIIIIHormoneTherapyResponseRate(%)inDifferentReceptorSta

2、tusSurvivalbyResponseArimidex1mg02040608010001234CRorPRStable24wksProgressionYearsfromRandomisation%SurvivalMAAGPreventionDCIS/Neoadj5yearsMetastaticDisease1st2nd3rdAdjuvantTAMTAMTAMTAMOVABL三苯氧胺（TAM)最重要的乳癌内分泌治疗药物Tamoxifenfor5YearsvsNoTreatmentPercentYearsER+85.276.168.273.762.

3、754.911.5(SE0.9)13.4(SE1.1)13.4(SE1.4)68.2%54.9%020406080100051015vsRecurrencesBreastDeaths020406080100051015ER+73.0%64.0%91.480.973.087.873.264.03.6(SE0.7)7.8(SE1.0)9.0(SE1.4)vsYearsPercentTamoxifenAdjuvantTherapyforEBC辅助内分泌治疗的决定因素是激素受体状况ER阳性效果最好8TamoxifenAdjuvantTherapyforEBC

4、合适的TAM服药时间为5年9TamoxifenAdjuvantTherapyforEBCER阳性无论年龄大小都可用TAM10TamoxifenAdjuvantTherapyforEBC降低对侧乳癌发生增加子宫内膜癌的风险11TamoxifenAdjuvantTherapyforEBCER阳性TAM和化疗合用比单用TAM更有效CAF与TAM序贯合用比同时效果更好MAAGPreventionDCIS/Neoadj5yearsMetastaticDisease1st2nd3rdAdjuvant1TAMTAMTAMTAMOVABLTamoxifenInd

5、icationsinBreastCancer三苯氧胺乳癌内分泌治疗不可动摇的地位！？SurvivalDataAnastrozole/MAMediantimetodeath(months)2yearsurvivalrate(%)P<0.05MeanChangeinWeight(kg)+SEMMonthsfromStartofTherapy01234569-2-1012345megestrolacetate4x40mg(n=85)Arimidex10mg(n=92)瑞宁得1mg(n=98)瑞宁得用药9个月没有明显的体重变化瑞宁得(Arimidex)比MA

6、更有效、更安全瑞宁得(Arimidex)1mg在复发转移乳癌治疗中缓解率/临床获益率相当生存期更长耐受性更好PreventionDCIS/Neoadj5yearsMetastaticDisease1st2nd3rdAIAIAdjuvantTAMTAMTAMTAM1ArimidexinBreastCancerMAAnastrozoleisSuperiortoTamoxifeninFirstLineTherapy（0030）JCO2000;18:3748*Hazardratio(tam:‘Arimidex’)1.44,lowerCL1.16.Study‘

7、powered’forequivalence.Medianfollow-upof18months.71%progressedTrial0030:Kaplan-MeierCurveofProbabilityofTimetoProgression‘Arimidex’(n=171)Tamoxifen(n=182)MedianTTP*:‘Arimidex’11.1monthstamoxifen5.6monthsp=0.005(2-sided)010203040506070809010006121824303642Timetoprogression(mont

8、hs)PercentagenotprogressedAIsisSuperiortoTamoxifenasFi