乳腺癌的新辅助治疗ppt课件
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NSABP B-18
1523 pts with clinical T1-3, N0-N1 breast cancer
Stratification • Age • Clinical Tumor Size • Clinical Nodal Status
Operation
AC x 4
AC x 4
Operation
pCR vs residual disease, Overall Survival
.
.
Intrinsic sub-types have different prognosis and different response to primary CT
.
Response Rates with Neoadjuvant Trastuzumab
Kelly et al 2006, n=37 Burstein et al 2003, n=40
Bines et al 2003, n=32 Baselga et al 2007, n=31 Christofanilli et al 2006, n=30
T → FEC + H
T → FEC + H
D+H
pCR to Neoadjuvant Chemotherapy is correlated with improved DFS & OS
(NSABP B-27)
Disease free-survival
Overall Survival
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
40
32
Mast Lump
60
68
P < 0.01
Postop-Chemo Preop- Chemo
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
.
.
NSABP B-27: Overall Survival Nodal Status
Pts without pCR
.
Pts with pCR
NSABP B-27: OS, DFS, RFS
.
Preoperative vs postoperative, Overall Survival
.
The Cochrane Library, Issue 3, 2008
36% 43%
9% 4%
23%
pCR (63 pts)
pNon-Inv (26 pts)
pInv (160 pts)
20%
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
100 80 60
% 40 20 0
NSABP B-18:
Surgery Performed
Study Pernas et al 2006, n=16 Buzdar et al 2007, n=64 Coudert et al 2005, n=33 Lybaert et al 2006, n=89 Gianni et al 2007, n=115 Limentani et al 2007, n=31 Griggs et al 2005, n=18 Hurley et al 2002, n=48 Harris et al 2003, n=40
.
2411 pts
NSABP B-27
Pts with T1c-3 N0 or T1-3N1 breast cancer
Randomization
AC x 4 Tam X 5 Yrs
Surgห้องสมุดไป่ตู้ry
AC x 4 Tam X 5 Yrs
Taxotere x 4
Surgery
AC x 4 Tam X 5 Yrs
X+D+H
AT → T → CMF + H
D + V + T (including IBC) D+H D + cisplatin + H (including IBC) V + H (including IBC)
Surgery
Taxotere x 4
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
NSABP B-27 Pathologic Complete Response in
Breast
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
.
Goals of Neoadjuvant Theapy in Breast Cancer
• To improve surgical outcomes and options
- For operable breast cancer, the aim is to increase the chance of breast conserving surgery in patients who would otherwise require mastectomy
OPEN ISSUES IN MULTIDISCIPLINARY BREAST CANCER MANAGEMENT Mediterranean School of Oncology Rome, March 30, 2012
NEOADJUVANT THERAPY
Lucia Mentuccia Oncologia Medica, Sora
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
NSABP B-18:
Clinical and Pathologic Breast Tumor Response
cCR (249 pts)
cPR (296 pts) cSD + cPD (140 pts)
- For inoperable locally advanced breast cancers, the aim is to achieve operability
• To gain information on tumor response
• To define short-term surrogate markers of response
NSABP B-18
1523 pts with clinical T1-3, N0-N1 breast cancer
Stratification • Age • Clinical Tumor Size • Clinical Nodal Status
Operation
AC x 4
AC x 4
Operation
pCR vs residual disease, Overall Survival
.
.
Intrinsic sub-types have different prognosis and different response to primary CT
.
Response Rates with Neoadjuvant Trastuzumab
Kelly et al 2006, n=37 Burstein et al 2003, n=40
Bines et al 2003, n=32 Baselga et al 2007, n=31 Christofanilli et al 2006, n=30
T → FEC + H
T → FEC + H
D+H
pCR to Neoadjuvant Chemotherapy is correlated with improved DFS & OS
(NSABP B-27)
Disease free-survival
Overall Survival
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
40
32
Mast Lump
60
68
P < 0.01
Postop-Chemo Preop- Chemo
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
.
.
NSABP B-27: Overall Survival Nodal Status
Pts without pCR
.
Pts with pCR
NSABP B-27: OS, DFS, RFS
.
Preoperative vs postoperative, Overall Survival
.
The Cochrane Library, Issue 3, 2008
36% 43%
9% 4%
23%
pCR (63 pts)
pNon-Inv (26 pts)
pInv (160 pts)
20%
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
100 80 60
% 40 20 0
NSABP B-18:
Surgery Performed
Study Pernas et al 2006, n=16 Buzdar et al 2007, n=64 Coudert et al 2005, n=33 Lybaert et al 2006, n=89 Gianni et al 2007, n=115 Limentani et al 2007, n=31 Griggs et al 2005, n=18 Hurley et al 2002, n=48 Harris et al 2003, n=40
.
2411 pts
NSABP B-27
Pts with T1c-3 N0 or T1-3N1 breast cancer
Randomization
AC x 4 Tam X 5 Yrs
Surgห้องสมุดไป่ตู้ry
AC x 4 Tam X 5 Yrs
Taxotere x 4
Surgery
AC x 4 Tam X 5 Yrs
X+D+H
AT → T → CMF + H
D + V + T (including IBC) D+H D + cisplatin + H (including IBC) V + H (including IBC)
Surgery
Taxotere x 4
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
NSABP B-27 Pathologic Complete Response in
Breast
.
Bear HD, et al. J ClinOncol. 2006;24(13):2019-2027.
.
Goals of Neoadjuvant Theapy in Breast Cancer
• To improve surgical outcomes and options
- For operable breast cancer, the aim is to increase the chance of breast conserving surgery in patients who would otherwise require mastectomy
OPEN ISSUES IN MULTIDISCIPLINARY BREAST CANCER MANAGEMENT Mediterranean School of Oncology Rome, March 30, 2012
NEOADJUVANT THERAPY
Lucia Mentuccia Oncologia Medica, Sora
.
Wolmark N t al; J Natl Cancer Inst Monogr. 2001
NSABP B-18:
Clinical and Pathologic Breast Tumor Response
cCR (249 pts)
cPR (296 pts) cSD + cPD (140 pts)
- For inoperable locally advanced breast cancers, the aim is to achieve operability
• To gain information on tumor response
• To define short-term surrogate markers of response