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ASCO指南：乳腺癌的新辅助化疗，内分泌治疗和靶向治疗

2021-01-28 美国临床肿瘤学会 J Clin Oncol . 2021 Jan 28;JCO2003399. doi: 10.1200/JCO.20.03399

乳腺癌

目的：制定有关乳腺癌最佳新辅助治疗的指南建议。

中文标题：

ASCO指南：乳腺癌的新辅助化疗，内分泌治疗和靶向治疗

英文标题：

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

发布机构：

美国临床肿瘤学会

发布日期：

2021-01-28

简要介绍：

目的：制定有关乳腺癌最佳新辅助治疗的指南建议。

方法：ASCO召集了一个专家小组，对有关乳腺癌新辅助疗法的文献进行系统的回顾，并提供推荐的护理选择。 结果：共有41篇符合资格标准的文章，构成了指南建议的证据基础。

建议：接受新辅助治疗的患者应由多学科护理团队管理。新辅助治疗的合适候选人包括患有炎症性乳腺癌的患者以及残留疾病可能促使治疗改变的患者。新辅助疗法也可用于减少局部疗法的程度或减少启动疗法的延迟。尽管应常规使用肿瘤组织学，等级，分期和雌激素，孕激素和人类表皮生长因子受体2（HER2）的表达来指导临床决策，但尚无足够的证据支持使用其他标志物或基因组图谱。临床淋巴结阳性和/或至少为T1c疾病的三阴性乳腺癌（TNBC）患者应接受含蒽环类和紫杉烷类治疗；那些患有cT1a或cT1bN0 TNBC的患者不应常规接受新辅助治疗。可能向TNBC患者提供卡铂以增加病理完全反应。当前没有足够的证据支持在标准化学疗法中添加免疫检查点抑制剂。对于激素受体（HR）阳性（HR阳性），HER2阴性肿瘤的患者，如果可以在没有手术信息的情况下做出治疗决定，则可以使用新辅助化疗。在HR阳性，HER2阴性的绝经后患者中，激素疗法可用于降低疾病的发病率。淋巴结阳性或高危淋巴结阴性，HER2阳性的患者应接受新辅助治疗并联合抗HER2阳性治疗。患有T1aN0和T1bN0，HER2阳性疾病的患者不应该常规接受新辅助治疗。

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