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刘健教授：五年生存数据最接近发达国家水平，乳腺癌诊治进入慢病管理新时代

2018-07-12 佚名 肿瘤资讯

五年生存数据乳腺癌
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对于ER阳性/HER2阴性的晚期乳腺癌治疗，内分泌治疗是至关重要的治疗手段。最新研究发现，内分泌治疗联合靶向治疗、联合卵巢功能抑制治疗都能进一步为乳腺癌患者带来获益。随着学科的发展与综合诊治意识的提高，ER阳性/HER2阴性的晚期乳腺癌已迈入慢病管理新时代。

对于ER阳性/HER2阴性的晚期乳腺癌治疗，内分泌治疗是至关重要的治疗手段。最新研究发现，内分泌治疗联合靶向治疗、联合卵巢功能抑制治疗都能进一步为乳腺癌患者带来获益。随着学科的发展与综合诊治意识的提高，ER阳性/HER2阴性的晚期乳腺癌已迈入慢病管理新时代。

BOLERO-6研究：内分泌治疗联合靶向治疗能带来显着获益

ER阳性/HER2阴性的晚期乳腺癌的内分泌治疗与靶向治疗是近年来主要的研究热点，众多的研究主要围绕内分泌治疗联合靶向治疗，例如与mTOR抑制剂依维莫司、CDK4/6抑制剂以及PI3K抑制剂的联合。

BOLERO-6研究是其中值得回味且意义深刻的一项研究。这是一项随机、开放的Ⅱ期临床研究，比较了依维莫司联合依西美坦相比单药依维莫司治疗或卡培他滨单药化疗对ER+/HER2-晚期乳腺癌的疗效。其中依维莫司联合依西美坦组的研究结果与过去的BOLERO-2研究基本一致，但是依维莫司单药治疗组的结果则与既往研究不大相同。在过去的研究中，依维莫司单药治疗的PFS大概在3个月左右，而在本次研究中达到了将近7个月。因此，如何判定患者应单药治疗还是需要联合治疗，将是未来探索的热点之一。

另外，在该研究中卡培他滨单药治疗组的PFS达到了9个多月，其结果也比既往研究（<7个月）要好。由于该研究是开放的Ⅱ期研究，样本例数不多，而且单药治疗组的结果与既往研究所有区别，因此我们要审慎地评估该研究结果。

但无论如何，我们还是能观察到依维莫司联合依西美坦的稳定疗效，与既往研究结果一致，所以该试验的研究者仍然推荐依维莫司联合依西美坦作为标准治疗。而依维莫司或卡培他滨的单药治疗在一些特定人群中也具有一定的优势，这是未来值得进一步探索的研究方向，有待更多的专家共同研究与讨论。

TEXT&SOFT研究：进一步佐证辅助内分泌治疗联合卵巢功能抑制的指南推荐

自从2014年TEXT&SOFT研究的联合分析结果问世以来，乳腺癌内分泌治疗策略发生了巨大的变化，其研究结果的更新不断推动乳腺癌内分泌治疗的进步。在既往的研究数据中，绝经前联合卵巢功能抑制的研究基本上都是阴性结果，而TEXT&SOFT研究的联合分析得出了阳性结果。今年ASCO会议上，该研究公布了最新的安全性数据分析，综合风险因素和亚组分析，让我们更充分辨别OFS及OFS联合依西美坦的获益人群。这一研究结果再一次证明了卵巢功能抑制联合内分泌治疗对于绝经前患者的重要价值，同时也证实了指南所推荐的内分泌治疗的基本原则。CSCO 2018版专家共识中，低风险患者推荐应用单药三苯氧胺，中度风险患者可以考虑使用卵巢功能抑制联合三苯氧胺的方法，而对于高风险患者则极力推荐依西美坦联合卵巢功能抑制的策略。因此，今年ASCO会议上的最新数据进一步佐证了这一指南推荐的正确性。

“全方位全周期”管理理念：推动乳腺癌诊治进入慢病管理新时代

“全方位全周期”的慢病管理模式是很好的理念，这是“2030年健康中国”上提出的目标。实际上，世界卫生组织在2006年就已经把肿瘤定义为慢性病，我国在2011年也出台了慢病管理的条例，极大地推动了肿瘤慢病管理的模式。4月1日，全球癌症患者生存状态的最新数据出炉，在所有的癌种中，我国乳腺癌的五年生存数据最接近发达国家水平，这得益于中国专家在乳腺癌防控与治疗方面所做出的努力。因此，我们专委会联合国家卫计委有关部门及相关院士专家共同发起了以乳腺癌为试点的全方位全周期的管理模式，从去年开始在全国各地进行巡讲与推广。

随着早晚期乳腺癌生存期的不断延长，其伴随疾病及治疗相关并发症的处理显得非常重要，关系到患者的生存时间与生存质量。例如，ER阳性的晚期乳腺癌患者需要长期接受内分泌治疗，特别是绝经后患者要使用芳香化酶抑制剂，会带来一系列的不良反应，包括骨质疏松、心血管并发症以及脂代谢方面的不良反应。因此，单靠肿瘤科的力量是不够的，需要联合更多学科的专家，包括内分泌科、骨科、心脏科等专家来共同管理。我们率先在乳腺癌进行试点，取得了可喜的成绩，未来也希望能不断完善这一模式并推广到其他肿瘤的治疗上。

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    2019-04-30 ms3117646317107274

    #发达国家#

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    2018-11-03 thinkibmz_44722603

    #生存数据#

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    2018-07-14 一叶知秋

    #新时代#

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    2018-07-12 phoebeyan520

    学习了.谢谢分享

    0

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    2018-07-12 131****1460

    学习了受益匪浅

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