直击ABC5:Eric P. Winer教授专访:新的研究成果改变进展期乳腺癌临床实践

2019-12-02 佚名 肿瘤资讯

ESO-ESMO 晚期乳腺癌第 5 届国际共识大会 (ABC5)在葡萄牙里斯本举行,该会议专注晚期乳腺癌诊疗进展并每2年更新一次指南。本次会议期间,肿瘤资讯非常荣幸邀请到乳腺癌治疗领域的世界级专家、丹娜法伯癌症研究所的Eric Paul Winer教授,Winer教授简要阐述了《ESO-ESMO晚期乳腺癌国际共识》与其他指南的不同之处,着力介绍了CDK4/6抑制剂、免疫治疗与TDM1三种治疗方法将

ESO-ESMO 晚期乳腺癌第 5 届国际共识大会 (ABC5)在葡萄牙里斯本举行,该会议专注晚期乳腺癌诊疗进展并每2年更新一次指南。本次会议期间,肿瘤资讯非常荣幸邀请到乳腺癌治疗领域的世界级专家、丹娜法伯癌症研究所的Eric Paul Winer教授,Winer教授简要阐述了《ESO-ESMO晚期乳腺癌国际共识》与其他指南的不同之处,着力介绍了CDK4/6抑制剂、免疫治疗与TDM1三种治疗方法将在进展期乳腺癌治疗中占据非常重要的地位。

Eric P. Winer,Professor,美国丹娜法伯癌症研究所乳腺肿瘤学中心,首席临床策略官,妇女癌症科科长,医疗事务高级副总裁,苏珊·史密斯妇女癌症中心乳腺癌肿瘤学中心主任,汤普森乳腺癌研究主席,研究所医师,哈佛医学院医学教授。

《ESO-ESMO晚期乳腺癌国际共识》不同于其他指南的特点

《ESO-ESMO晚期乳腺癌国际共识》的最大特点是它面对的是全世界的乳腺癌患者,虽然指南中着重讨论了各种药物均可及国家中乳腺癌患者的治疗,但同时也明确意识到世界范围内仍有许多地区存在药物不可及的问题,因此指南制定时尽最大努力为这样的患者提供更多的治疗选择。此外《ESO-ESMO晚期乳腺癌国际共识》更倾向于实用性,因为共识制定委员会的所有成员均为临床医生。

CDK4/6抑制剂治疗ER阳性HER2阴性乳腺癌非常有效

就CDK4/6抑制剂这类药物的整体状况谈一些看法,而不是只专注于某个药物和某项研究。现在已经非常清楚,CDK4/6抑制剂是一类非常有效的药物,不仅是现在,未来同样也是。现在共有三种CDK4/6抑制剂,均可显着延长ER阳性乳腺癌患者的无进展生存,这里主要是指HER2阴性患者,对于HER2阳性患者可能也具有一定治疗作用,但目前尚未对此进行更多的探索。对于ER阳性HER2阴性的患者,一线或二线CDK4/6抑制剂治疗均可明显延长无进展生存,现有的所有CDK4/6抑制剂的研究数据均显示有明确的生存获益,这样的结果令人欣喜。在美国多数患者接受CDK4/6抑制剂作为一线治疗的一部分,当然作为二线治疗我认为也是合理的,CDK4/6抑制剂治疗不但可以控制症状,还可延长无进展生存与总生存。但遗憾的是只有在药物可及的国家里,患者才可能使用CDK4/6抑制剂进行治疗。

免疫治疗给三阴性乳腺癌带来突破

目前至少在美国免疫治疗已被批准治疗三阴性乳腺癌,即阿替利珠单抗联合白蛋白紫杉醇治疗PD-L1阳性的三阴性乳腺癌,这一治疗的获批主要源于IMpassion130研究,该研究显示免疫治疗联合化疗能显着改善三阴性乳腺癌患者的无进展生存和总生存。我个人认为,近1-2年内将会有更多免疫治疗的证据公布,扩展三阴性乳腺癌中免疫治疗的应用,现在只能耐心等待更多的结果出现。目前已有帕博利珠单抗用于乳腺癌新辅助治疗的研究,现有结果显示可以提高病理完全缓解率,倾向于改善无病生存,但将之用于临床还为时过早。

T-DM1不仅仅可以用于HER2阳性晚期乳腺癌二线治疗

至少在美国,KATHERINE研究结果甫一问世就立即改变了临床实践,对于多数Ⅱ/Ⅲ期或HER2阳性乳腺癌,新辅助治疗是标准治疗,对于新辅助治疗后仍有残留疾病的患者应优先考虑T-DM1治疗,或许会有一些患者不适合,但这类患者数目非常有限,所以对于多数有残留疾病的患者,TDM1应作为优选治疗。KATHERINE研究和KRISTINE研究均强烈提示,T-DM1在早期乳腺癌治疗中占有很重要的作用,未来几年内一定会证实这一点。而且T-DM1的最大优势还在于,较常用的化疗方案毒性更少。

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    2020-07-28 licz0423
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