HER-2阴性晚期乳腺癌最新ASCO推荐(转载)

发表者：江丰收人已读

According to ASCO, about 75% of advanced breast cancers areHER2-negative. Although targeted therapies are beginning to emerge, the development of drugs forHER2-negative disease has lagged behind that forHER2-positive disease, which has already produced targeted agents such astrastuzumab(Herceptin).

Recommendation Highlights

1. Endocrine therapy, rather than chemotherapy, should be offered as the standard first-line treatment for patients with hormone-receptor-positive disease. Exceptions are for immediately life-threatening disease and when there are concerns about resistance to hormone therapy. The main benefit of this regimen is that it is less toxic than chemotherapy and offers patients a better quality of life.
2. Sequential single-agent chemotherapy should be used as opposed to combination therapy. However, combination regimens can be used for life-threatening disease when time allows for only 1 therapeutic option. Single-agent therapy is less toxic than combination therapy, but if a single drug fails to achieve a response, rapidly progressing, life-threatening disease could advance.
3. The role of bevacizumab (Avastin) is controversial, the panel acknowledges, and it should be considered with single-agent chemotherapy only when disease is immediately life-threatening or symptoms are severe. Bevacizumab is not currently approved for this indication in the United States, so its use would be off-label.
4. Several active drugs are available for first-line therapy, and no single agent has demonstrated superiority in this population. The evidence for efficacy, however, is strongest for taxanes and anthracyclines. Other options include capecitabine, gemcitabine, platinum-based compounds, vinorelbine, and ixabepilone. The choice of treatment depends on a number of factors, including patient preference.
5. Chemotherapy should be continued until disease progression, if tolerated, because it can modestly improve overall survival and substantially improve progression-free survival. However, the balance between toxicity and quality of life must be taken into account.
6. Chemotherapy regimens should not be tailored to different breast cancer subtypes (such as triple-negative or lobular disease) because there is currently no evidence of differential efficacies. In addition, invitro chemoresistance assays should not be used to select treatment.
7. Second-line therapy (or greater) might be of clinical benefit and should be offered on the basis of factors such as previous treatments, toxicity, coexisting medical conditions, and patient choice. As with first-line treatment, there is no clear evidence showing the superiority of one drug or regimen over another.
8. Palliative care should be offered to patients throughout the continuum of care.
9. Because curative therapy is not yet available for advanced breast cancer, clinicians should encourage eligible patients to participate in clinical trials. In the absence of immediately life-threatening disease, this should include the option of phase2 and even targeted phase1 trials before all standard lines of therapy have been used.

1. Endocrine therapy, rather than chemotherapy, should be offered as the standard first-line treatment for patients with hormone-receptor-positive disease. Exceptions are for immediately life-threatening disease and when there are concerns about resistance to hormone therapy. The main benefit of this regimen is that it is less toxic than chemotherapy and offers patients a better quality of life.

2. Sequential single-agent chemotherapy should be used as opposed to combination therapy. However, combination regimens can be used for life-threatening disease when time allows for only 1 therapeutic option. Single-agent therapy is less toxic than combination therapy, but if a single drug fails to achieve a response, rapidly progressing, life-threatening disease could advance.

3. The role of bevacizumab (Avastin) is controversial, the panel acknowledges, and it should be considered with single-agent chemotherapy only when disease is immediately life-threatening or symptoms are severe. Bevacizumab is not currently approved for this indication in the United States, so its use would be off-label.

4. Several active drugs are available for first-line therapy, and no single agent has demonstrated superiority in this population. The evidence for efficacy, however, is strongest for taxanes and anthracyclines. Other options include capecitabine, gemcitabine, platinum-based compounds, vinorelbine, and ixabepilone. The choice of treatment depends on a number of factors, including patient preference.

5. Chemotherapy should be continued until disease progression, if tolerated, because it can modestly improve overall survival and substantially improve progression-free survival. However, the balance between toxicity and quality of life must be taken into account.

6. Chemotherapy regimens should not be tailored to different breast cancer subtypes (such as triple-negative or lobular disease) because there is currently no evidence of differential efficacies. In addition, invitro chemoresistance assays should not be used to select treatment.

7. Second-line therapy (or greater) might be of clinical benefit and should be offered on the basis of factors such as previous treatments, toxicity, coexisting medical conditions, and patient choice. As with first-line treatment, there is no clear evidence showing the superiority of one drug or regimen over another.

8. Palliative care should be offered to patients throughout the continuum of care.

9. Because curative therapy is not yet available for advanced breast cancer, clinicians should encourage eligible patients to participate in clinical trials. In the absence of immediately life-threatening disease, this should include the option of phase2 and even targeted phase1 trials before all standard lines of therapy have been used.

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