最新乳腺癌分子靶向药物治疗进展

无论年龄大小，赫赛汀均显示DFS获益
HERA
<35 years 35-49 years 50-59 years ≥60 years
N9831 / B-31 <40 years
40-49 years
50-59 years
≥60 years
0.0
0.5
1.0
1.5
2.0
2.5
Favours Herceptin
HER2-positive LABC (IHC 3+ and/or FISH+)
n=115 H + AP q3w x 3
n=113 AP q3w x 3
HER2-negative LABC (IHC 0/1+)
n=99 AP q3w x 3
H+P q3w x 4
P q3w x 4
P q3w x 4
H q3w x 4 + CMF q4w x 3
Favours no Herceptin
HR
Perez et al 2007; Smith et al 2007
赫赛汀的新辅助治疗研究进展
EBC
Adjuvant
Neo
HERA NSABP B-31 NCCTG N9831 BCIRG 006
NOAH
MDACC
GeparQuattro
Numerous Phase II studies
CMF q4w x 3
CMF q4w x 3
Surgery followed by radiotherapya
Surgery followed by radiotherapya
Surgery followed by radiotherapya
H continued q3w to Week 52
aHormone receptor-positive patients receive adjuvant tamoxifen AP, doxorubicin 60 mg/m2, paclitaxel 150 mg/m2; H, Herceptin 8 mg/kg loading then 6 mg/kg P, paclitaxel 175 mg/m2; CMF, cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2, 5-fluorouracil 600 mg/m2 LABC, locally advanced breast cancer; q3w, every 3 weeks; q4w, every 4 weeks
H, Herceptin; AC, doxorubicin, cyclophosphamide P, paclitaxel; D, docetaxel; Carbo, carboplatin HR, hazard ratio
Slamon et al 2006 Perez et al 2007; Smith et al 2007
NOAH研究中赫赛汀新辅助显著提高了pCR率
pCR 90 (%) 80
70 60 50 40 30 20 10
0
Without Herceptin With Herceptin
p=0.002
23
43
HER2 positive (n=228)
17
HER2 negative
(n=99)
Total population
乳腺癌分子靶向药物治疗进展
HIGHLIGHTS IN BREAST CANCER
Endocrine therapy
Targeted therapies
Treatment of BC
Chemotherapy
DISEASE BIOLOGY
赫赛汀可减少三分之一的死亡风险
HERA CTxH 1 year B-31 / N9831 ACPH
无论肿瘤大小，赫赛汀均显示DFS获益
HERA
0-2 cm >2-5 cm >5 cm
N9831 / B-31
0-2 cm >2-5 cm >5 cm
BCIRG 006 ACDH
DCarboH
<2 cm ≥2 cm <2 cm ≥2 cm
0.0
0.5
1.0
Favours Herceptin HR
DFS, disease-free survival
1.5
2.0
2.5
Favours no Herceptin
Slamon et al 2006 Perez et al 2007; Smith et al 2007
无论淋巴结情况，赫赛汀均显示DFS获益
HERA
N9831 / B-31
BCIRG 006 ACDH DCarboH
N, node
N1-3+ nodes ≥4+ nodes Not assessed
pCR, pathological complete response in the breast IBC, inflammatory breast cancer
p=0.004
19
55
29
HER2 positive (n=62)
HER2 negative
(n=14)
百度文库
Relapse Progression
MBC
1st
2nd+
line
lines
HO648g M77001 US Oncology BCIRG 007 CHAT TAnDEM RHEA
GBG-26 BO17929 EGF104900 Numerous Phase II studies
NOAH study: neoadjuvant Herceptin for LABC
Overall survival benefit
Median follow-up, years 2 3
BCIRG 006 ACDH
3
BCIRG 006 DCarboH
3
0
Favours
1 Favours no 2
Herceptin
Herceptin
HR
Size of square represents sample size; horizontal bars indicate 95% confidence intervals
N1-3+ nodes 4-9+ nodes >10+ nodes
NN+ NN+
0.0
0.5
1.0
Favours Herceptin HR
1.5
2.0
2.5
Favours no Herceptin
Slamon et al 2006 Perez et al 2007; Smith et al 2007