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JCO：激素受体阳性转移性乳腺癌内分泌治疗2016新指南

2016年06月21日

编译：南南和北北

来源：桓兴医讯

目的

对激素受体阳性转移性乳腺癌女性的内分泌治疗提出建议。

To develop recommendations about endocrine therapy for women with hormone receptor (HR) –positive metastatic breast cancer (MBC).

方法

美国临床肿瘤学会召集了一个专家小组，对2008年至2015年的临床证据进行了系统回顾分析，建立了证据基础上的推荐建议。感兴趣的结果包括对激素药物的使用排序、激素药物与化疗的比较、生物靶向治疗、绝经前女性的治疗。本指南提出了激素受体阳性转移性乳腺癌女性内分泌治疗的治疗建议。

The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women. This guideline puts forth recommendations for endocrine therapy as treatment for women with HR-positive MBC.

推荐建议

对大多数激素受体阳性的转移性乳腺癌女性，优选激素序贯治疗。除转移性乳腺癌即刻威胁生命以外，初始治疗应使用单药或联合药物。患者的肿瘤只要有激素受体表达，就应进行激素治疗。应当在辅助治疗类型、无病间期、器官功能基础上制定治疗建议。肿瘤标志物不应当是确定肿瘤进展的唯一标准，其它肿瘤标志物还处在实验阶段。评价绝经状态非常重要，卵巢抑制或卵巢切除应当纳入绝经前女性的治疗中。对于绝经女性，芳香化酶抑制剂加或不加细胞周期蛋白依赖性激酶抑制剂Palbociclib是首选的一线内分泌治疗。作为二线治疗，应当给予500mg负荷剂量的氟维司群，再给予Palbociclib。绝经后转移性乳腺癌女性，若接受非甾体类芳香化酶抑制剂时疾病进展，可给予依西美坦联合哺乳类雷帕霉素靶蛋白（mTOR）抑制剂依维莫司。在激素受体阳性且HER2阳性的转移性乳腺癌患者中，HER2靶向治疗联合芳香化酶抑制剂对不适合化疗的患者有效。

Sequential hormone therapy is the preferential treatment for most women with HR-positive MBC. Except in cases of immediately life-threatening disease, hormone therapy, alone or in combination, should be used as initial treatment. Patients whose tumors express any level of hormone receptors should be offered hormone therapy. Treatment recommendations should be based on type of adjuvant treatment, disease-free interval, and organ function. Tumor markers should not be the sole criteria for determining tumor progression; use of additional biomarkers remains experimental. Assessment of menopausal status is critical; ovarian suppression or ablation should be included in premenopausal women. For postmenopausal women, aromatase inhibitors (AIs) are the preferred first-line endocrine therapy, with or without the cyclin-dependent kinase inhibitor palbociclib. As second-line therapy, fulvestrant should be administered at 500 mg with a loading schedule and may be administered with palbociclib. The mammalian target of rapamycin inhibitor everolimus may be administered with exemestane to postmenopausal women with MBC whose disease progresses while receiving nonsteroidal AIs. Among patients with HR-positive, human epidermal growth factor receptor 2–positive MBC, human epidermal growth factor receptor 2–targeted therapy plus an AI can be effective for those who are not chemotherapy candidates.

责任编辑：Dr.q

2016年06月25日

郭大夫

厦门市妇幼保健院 | 医学影像科

学习了

2016年06月25日

郭大夫

厦门市妇幼保健院 | 医学影像科

内分泌治疗

2016年06月23日

王强

武汉市黄陂区人民医院 | 病理科

这个要好好学习一下