课件：HER2阳性乳腺癌的治疗.ppt

* References Rastogi P, Jeong J, Geyer CE, et al. Five year update of cardiac dysfunction on NSABP B-31, a randomized trial of sequential doxorubicin/ cyclophosphamide (AC)→paclitaxel (T) vs. AC→T with trastuzumab(H). Oral presentation at the 43rd American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, Illinois, USA, 1?5 June, 2007 (Abstract LBA513) Perez EA, Suman VJ, Davidson NE, et al. Cardiac safety analysis of doxorubicin and cyclophosphamide followed by paclitaxel with or without trastuzumab in the North Central Cancer Treatment Group N9831 Adjuvant Breast Cancer Trial. J Clin Oncol 2008; 26:1231?1238. Slamon D, Eiermann W, Robert N, et al. BCIRG 006 phase III trial comparing AC→T with AC→TH and with TCH in the adjuvant treatment of HER2-amplified early breast cancer patients: Third planned efficacy analysis. Oral presentation at the 32nd San Antonio Breast Cancer Symposium, San Antonio, Texas, USA, 10?13 December 2009 (Abstract 62). Procter M, Suter TM, de Azambuja E, et al. Longer-term assessment of trastuzumab-related cardiac adverse events in the Herceptin Adjuvant (HERA) Trial. J Clin Oncol 2010; 28:3422?3428. * 心脏毒性与累积剂量有关，一旦超过累积剂量心脏毒性反应发生的机会就会明显地增加，阿霉素引起心脏毒性的平均剂量为468mg/m2，而表阿霉素为935mg/m2。当阿霉素的累积剂量达到550mg/m2，表阿霉素达到1000mg/m2时，充血性心力衰竭发生率为5%左右 * * * * References Marty M et al. J Clin Oncol 2005; 23: 4265-4274. Pegram M et al. J Clin Oncol (Meeting Abstracts) 2007; 25: 34s, abs LBA1008. Robert N et al. J Clin Oncol 2006; 24: 2786-2792. Smith I et al. Anticancer Drugs 2001; 12 (Suppl 4): S3-S10. * * 30个月中位随访期后，赫赛汀?加紫杉醇亚组中位生存期延长达7个月. * * 在最后一例患者入组后随访12个月，赫赛汀?联合多西紫杉醇组显示显著改善所有临床结果。尤其值得注意的是赫赛汀?联合多西紫杉醇使中位生存期从22.7个月提高到31.2个月（p=0.0062）超过对照组8.5个月,2004年被欧盟批准作为HER2阳性转移性乳腺癌一线治疗的又一标准方案 * * * * 蒽环类、紫杉类治疗失败的MBC患者，研究显示卡培他滨单药治疗仍可获得15%~26%的有效率，可耐受三药治疗的HER2阳性MBC患者，HTX是可考虑的一线治疗方案选择。 * * * * * * 阿那曲唑单药组怎么会31例 * * * * * * * 赫赛汀在临床具体应用的用法用量为： 转移性乳腺癌 建议曲妥珠单抗初次负荷剂量为第1天4mg/kg，静脉输注90分钟以上，随后2 mg/kg IV 30分钟，每周1次，维持治疗直至疾病进展。 或曲妥珠单抗第1天8 mg/kg IV 90分钟，随后6 mg/kg IV 9