ASCO 乳腺癌内分泌治疗进展 刘冬耕PPT课件
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• 54% node-negative • 8 yrs follow-up: compliance, recurrence, death
SABCS 2012
Results：
• Recurrence: 617 vs 711 women (2p=0.002) • Breast cancer mortality: 331 vs 397 (2p=0.01) • Overall mortality: 639 vs 722 (2p=0.01) • Recurrence and breast cancer mortality
ASCO 2013
复发率分别为：28%和32%， p=0.003
10 vs 5 years of tamoxifen: Recurrence by year of follow-up
10 vs 5 years of tamoxifen: Breast Cancer Death by Treatment Allocation
ATLAS:10 years of tamoxifen vs 5:
(Adjuvant Tamoxifen - Longer Against Shorter)
• 6846 women with ER+ disease completed 5years of tamoxifen, then were randomised to: – CONTINUE to year 10, or – STOP at year 5
Main risk: endometrial cancers: absolute hazard 0.5%,
Endometrial cancers
Endometrial Cancer death
10 years
102 (2.9%)
37 (1.1%)
5 years
45 (1.3%)
20 (0.6%)
Rate ratio (95%CI)
2013 ASCO 乳腺癌内分泌治疗进 展
2013-07-6
内容
• 辅助内分泌治疗（延长治疗改善疗效） – aTTom – ATLAS – MA-17
• 晚期乳腺癌治疗进展（乳腺癌耐药研究进展） – BOLERO 2 – TANDEM – EGF – 其他新药
• 其他研究（包括基础和临床）
超过半数乳腺癌的复发和死亡出现在 他莫昔芬结束后
2.20 (1.31-2.34)
1.83 (1.09-3.09)
P-value P<0.0001 P=0.02
Conclusions
• aTTom and ATLAS together provide proof beyond reasonable doubt that continuing tamoxifen beyond 5 years reduces recurrence over the following years: no effect in years 5-6, benefit mainly after year 7
early breast cancer
Richard Gray,Daniel Rea,Kelly Handley& 17 others on behalf of the aTTom Collaborators
5 years of tamoxifen versus no tamoxifen*
10 vs 5 years of tamoxifen: effect on breast cancer recurrence
73.2
60
64%
64.0
40
Tamoxifen
20
Control
0
0
5
10
15
Years
0
0
5
10
15
Years
Adapted with permission. Early Breast Cancer Trialists’ Collaborative Group Meeting, 2000.
20,187 women with ER-positive or ER-unknown disease randomised in 5 trials of 10 vs 5 years of tamoxifen:
10 vs 5 years of tamoxifen: Death after recurrence by year of follow-up
10 vs 5 years of tamoxifen: Overall survival by treatment and year of follow-up
% of patients % of patients
Recurrences
15%
17%
100 85.2
76.1
80
68.2
73.7
68%
60
62.7
55%
54.9
40
20
Tamoxifen Control
Breast Cancer Deaths
Leabharlann Baidu
9%
18%
100
91.4
80.9
80
87.8
73.0
73%
– Little effect during years 5-9 – benefit mainly after year 10
• Continuing tamoxifen beyond 5 years also reduces breast cancer mortality: no effect in years 5-6 ，25% reduction after year 10.
• 10 years tamoxifen vs no tamoxifen reduces breast cancer mortality by a third in the first decade and a half in the second decade
ECOG, Scottish&
NSABP B-14
1,588
ATLAS*
11,646
aTTom
6,953
ALL TRIALS
20,187
* ATLAS, Lancet 2013; 381: 805-16
aTTom: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years in 6,953 women with
SABCS 2012
Results：
• Recurrence: 617 vs 711 women (2p=0.002) • Breast cancer mortality: 331 vs 397 (2p=0.01) • Overall mortality: 639 vs 722 (2p=0.01) • Recurrence and breast cancer mortality
ASCO 2013
复发率分别为：28%和32%， p=0.003
10 vs 5 years of tamoxifen: Recurrence by year of follow-up
10 vs 5 years of tamoxifen: Breast Cancer Death by Treatment Allocation
ATLAS:10 years of tamoxifen vs 5:
(Adjuvant Tamoxifen - Longer Against Shorter)
• 6846 women with ER+ disease completed 5years of tamoxifen, then were randomised to: – CONTINUE to year 10, or – STOP at year 5
Main risk: endometrial cancers: absolute hazard 0.5%,
Endometrial cancers
Endometrial Cancer death
10 years
102 (2.9%)
37 (1.1%)
5 years
45 (1.3%)
20 (0.6%)
Rate ratio (95%CI)
2013 ASCO 乳腺癌内分泌治疗进 展
2013-07-6
内容
• 辅助内分泌治疗（延长治疗改善疗效） – aTTom – ATLAS – MA-17
• 晚期乳腺癌治疗进展（乳腺癌耐药研究进展） – BOLERO 2 – TANDEM – EGF – 其他新药
• 其他研究（包括基础和临床）
超过半数乳腺癌的复发和死亡出现在 他莫昔芬结束后
2.20 (1.31-2.34)
1.83 (1.09-3.09)
P-value P<0.0001 P=0.02
Conclusions
• aTTom and ATLAS together provide proof beyond reasonable doubt that continuing tamoxifen beyond 5 years reduces recurrence over the following years: no effect in years 5-6, benefit mainly after year 7
early breast cancer
Richard Gray,Daniel Rea,Kelly Handley& 17 others on behalf of the aTTom Collaborators
5 years of tamoxifen versus no tamoxifen*
10 vs 5 years of tamoxifen: effect on breast cancer recurrence
73.2
60
64%
64.0
40
Tamoxifen
20
Control
0
0
5
10
15
Years
0
0
5
10
15
Years
Adapted with permission. Early Breast Cancer Trialists’ Collaborative Group Meeting, 2000.
20,187 women with ER-positive or ER-unknown disease randomised in 5 trials of 10 vs 5 years of tamoxifen:
10 vs 5 years of tamoxifen: Death after recurrence by year of follow-up
10 vs 5 years of tamoxifen: Overall survival by treatment and year of follow-up
% of patients % of patients
Recurrences
15%
17%
100 85.2
76.1
80
68.2
73.7
68%
60
62.7
55%
54.9
40
20
Tamoxifen Control
Breast Cancer Deaths
Leabharlann Baidu
9%
18%
100
91.4
80.9
80
87.8
73.0
73%
– Little effect during years 5-9 – benefit mainly after year 10
• Continuing tamoxifen beyond 5 years also reduces breast cancer mortality: no effect in years 5-6 ，25% reduction after year 10.
• 10 years tamoxifen vs no tamoxifen reduces breast cancer mortality by a third in the first decade and a half in the second decade
ECOG, Scottish&
NSABP B-14
1,588
ATLAS*
11,646
aTTom
6,953
ALL TRIALS
20,187
* ATLAS, Lancet 2013; 381: 805-16
aTTom: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years in 6,953 women with