乳腺癌的辅助治疗-从临床指南走向临床实践讨论

CASE 2.: Adjuvant! Online Results
46 y.o., pT2 (3cm), pN0, Grade 2, R0, ER/PR+, HER2-
2nd generation regimen + tamoxifen
DFS
OS
Risk of relapse at 10 yrs with no additional therapy = 37%
(= Average treatment effects) • Opinion of breast cancer experts is important
Inter-Guideline Comparison
As expected, significant agreement in scientific content
Pentheroudakis et al. Ann Oncol. 2008;19:2067-2078.
Patient Examples: Key Points
Local / national guidelines:
Faster adaptation of clinical trial data Similar recommendations of evidencebased regimens More practical
Invasive ductal breast cancer:
pT2 (3 cm), pN0 (sn) Grade 2 ，R0 ER +, PR+, HER2 0 Premenopausal
风险评价与治疗选择
CASE 2.ຫໍສະໝຸດ Baidu Adjuvant! Online Results https://www.adjuvantonline.com
Adjuvant online
Personal experience and local policy
Industry advertising
Literature (individual studies, review)
Reimbursement conditions，
insurance policy
TREATMENT GUIDELINES FOR ADJUVANT THERAPY OF BREAST CANCER
• Aim : to enhance individual clinical decision-making • Evidence : from clinical trials / metaanalysis
• 辅助治疗方案? TAM
CASE 2
Presentation for second opinion: 46 years Large regional breast center:
tumor excision + sentinel node biopsy right side + breast reduction both sides
With so many parameters to consider, how do we approach treatment?
Develop Clinical Practice Guidelines
Defined as… “systematically developed statements to assist practitioner and patient decisions
• 辅助治疗方案?
NCCN 2010
ESMO
ST.GALLEN
适应症
• 雌激素或孕激素受体阳性的浸润性乳腺癌患者，不论年龄 、淋巴结状态或是否应用了辅助化疗，都应考虑辅助内分 泌治疗。
CASE 1
40 year old, premenopausal woman Infiltrating ductal carcinoma Tumor 0.5 cm 0/10 positive lymph nodes Grade 1 ER+，PR+. HER+
about appropriate health care for specific clinical circumstances”
Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990.
乳腺癌的辅助治疗 ——从临床指南走向临床实践讨论
安徽医科大学第一附属医院 潘跃银
Treatment of Early-Stage Breast Cancer: Considerations
Enough?
ADJUVANT BREAST CANCER DECISION = PUZZLE !
Guidelines (NIH, NCCN, St-Gallen )
International guidelines:
More general Slower/longer process of integrating newer regimens
CASE 1
40 year old, premenopausal woman Infiltrating ductal carcinoma Tumor 0.5 cm 0/10 positive lymph nodes Grade 1 ER+，PR+. HER+
Eg, in 9 guidelines on NSCLC included in the analysis, the concordance was > 80% (80-98%)
Heterogeneity reflects
Different development groups and intended focus Differences in diagnostic and treatment approach by country Different resources available Different uptake of the new approaches Different level of patient involvement in the decision making process