乳癌的治疗PPT多媒体教学.ppt
http://www.100md.com
参见附件(185KB)。
乳癌的治疗
中山医科大学肿瘤医院
管忠震
转移性乳癌(IV期)
? 治疗目标为姑息。全身治疗+局部治疗
? 5-15%化疗后有可能长期CR
? 局部肿瘤控制，可用手术或放疗
? 系统治疗的原则：
- 年老，绝经期后，ER/PR(-)，病变进展快，重要脏器受犯者：先用内分泌治疗(一线 二线三线)如无效，改用化疗
-年青，绝经期前，ER/PR(一)，病变进展快，无重要脏器侵犯者：化疗(一线二线 三线)支持治疗。
转移性乳癌(IV期)
? 一线化疗：ADR based，如CAF
二线化疗：TAXANE based，单药或联合
三线化疗：Xeloda
? HER2/neu过度表达(+)者，Herceptin+ Taxol优于TAXOL alone。
? 骨转移者，可并用双磷酸盐类，减轻疼痛 /骨质破坏。
常用化疗药
Docetaxel
ADR, Epirubiein, THP- ADR
Paclitaxel
NVB
Capecitabine(Xeloda)
常用化疗药
CDDP
CTX, IFOSFAMIDE
5FU
MTX
MMC
mitoxantrone
TSPA
VLB, VCR
常用内分泌治疗药
TAMOXIFEN 20mg/日 P.O.
TOremifene(Fareston) 60mg/日P.O.
Letrazol(Femara)2.5mg/ 日 P.O.
Arimidex( Anastrozole)1mg/日 P.O.
Progestin(Megace) 40mg，每日3 - 4次 P.O.
LHRH agonist：Leuprolide 7.5mg im每月一次
GnRH agonist ：Zoladex
Letrozole (Femara) vs. Tamoxifen (Nolvadex) as First-line Treatment of Advanced Breast Cancer
R Smith et al, San Antonio 2000
? 907 postmenopausal breast cancer patients with locally advanced or metastatic breast cancer
- 65% ER/PR positive
- 20% prior anti-estrogen treatment
? Treatment: Randomized to letrozole 2.5 mg/day vs. tamoxifen 20 mg qd
? Results: TTPORClinical Benefit
Letrozole41 wks30%49%
Tamoxifen26 wks20%38%
(p=0.0001)(p=0.001) (p=0.001)
常用联合化疗方案
? CMFCTX100mg/m2 poqdd1-14
辅助化疗用MTX40mg/m2 iv d1,d8
淘汰趋势 5-FU600mg/m2 iv d1,d8
? CAFCTX 100mg/m2poqdd1-14
一线标准ADR30mg/m2 ivd1,d8
方案5-FU 500mg/m2ivd1,d8
常用联合化疗方案
二线：Taxol
Paclitaxel135-175 mg/m2 3hrivinf d1
每3周，或 80 mg/m2 q.wk
预处理：Dexamethasone20mgpo-12h，-6h
Benadryl 50mg iv-30-60min
Cimetidine 300mg iv -30-60min或Ranitidine50mgiv -30-60min
常用联合化疗方案
二线：Taxotere
Docetaxel80-100 mg/m2iv，1hr iv drip每3周 或40 mg/m2iv, 1hr inf, 每周. 可连续用
6周,停2周,为一周期。总量可达3-4周期
预处理：用药前1晚，用药日晨，用药后晚各口服Dexamethasone 8mg ，共3次。注苯海拉明
50mg， iv ，-30min
每周方案：MyelotoxicityFatique，结膜炎
常用联合化疗方案
一线：TA
Doxorubicin50mg/m2 iv d1
Docetaxel75 mg/m2 iv d1
or Doxorubicin60mg/m2 iv d1 Docetaxel 60 mg/m2iv d1
every 4 weeks(Dieras 1997)
常用联合化疗方案
一线：TAC
Doxorubicin50mg/m2 iv d1，then
Docetaxel75 mg/m2 iv d1
CTX 500mg/m2ivd1
every 4 weeks(Bozec， 1997)
常用联合化疗方案
一线：Taxol + Carbo ( Perez，2000)
Paclitaxel 200 mg/m2 3hriv inf d1
CarboplatinAUC 6
every 3 weeks
OR 62%
G3/4neutropenia82%
G3neuropathy16%
A Multicenter Phase II Trial of Capecitabine
(Xeloda) in Paclitaxel (Taxol)-Refractory
Metastatic Breast Cancer
Blum, ASCO 1998
? Patients: 163 paclitaxel-resistant breast cancer patients, 2-3 prior regimens
? Treatment: Capecitabine 2510 mg/m2/day divided bid given for 2 out of 3 weeks
? Toxicity: Grade 3/4 diarrhea (14%), hand-foot syndrome (10%)
? Response: 20% response rate (3 CRs), median duration of response 8.1 months, TTP 93 days
A Randomized Phase II Trial of Capecitabine (Xeloda) vs. CMF as First Line Chemotherapy of Breast Cancer in Women Aged > 55 Years
O'Shaughnessy, ASCO 1998
? Patients: 95 untreated stage IV breast cancer patients > 55
? Treatment: Capecitabine 2510 mg/m2/day divided bid 2 out of 3 weeks vs. CMF
A Randomized Phase II Trial of Capecitabine (Xeloda) vs. CMF as First Line Chemotherapy of Breast Cancer in Women Aged > 55 Years
O'Shaughnessy, ASCO 1998
? Grade 3/4 toxicity:
-Hand-foot syndrome: Capecitabine 16%, CMF 0%
- Diarrhea: Capecitabine 8%, CMF 3%
- Myelosuppression: Capecitabine 20%, CMF 47%
? Results:
- Response rate: Capecitabine 25%, CMF 16%
- Median TTP: Capecitabine 132 days, CMF 94 days
名称 发生率(%)
I--IV度III--IV度
手足综合征 62.8% 10%
皮肤色素沉着 44.3% /
腹泻 12.9% 4.3%
贫血 30.0%/
胆红素升高 14.3%/
HER-2 in Breast Cancer
Trastuzumab (Herceptin)
? Derived from murine 4D5 antibody
? 95% humanized recombinant molecule
? Targets ECD of HER2 growth factor receptor
? Anti-proliferative to HER2+ cell lines
? Enhances antibody dependent cellular toxicity
? Not immunogenic
Trastuzumab (Herceptin) Plus Chemotherapy in Metastatic Breast Cancer
Slamon et al, NEJM 2001
? 31 month follow-up
AC+HAC T+HT
CR8%4%8%2%
PR48% 38%34%15%
OR56% 42%41%17%
Duration 9.1 mo 6.710.54.5 p<0.001
TTP7.8 mo6.1 6.93.0 p<0.001
Survival 26.8 mo21.4 22.118.4p=0.16
Trastuzumab (Herceptin) Cardiotoxicity
HAC+HAC T+HT
Any Dysfunction 7% 28% 7%11%1%
Class III-IV 5% 19% 3% 4% 1%
Class III-IV 6% 0%
after rx
94% of pts in H-only trial had received an anthracycline......（后略) ......
乳癌的治疗
中山医科大学肿瘤医院
管忠震
转移性乳癌(IV期)
? 治疗目标为姑息。全身治疗+局部治疗
? 5-15%化疗后有可能长期CR
? 局部肿瘤控制，可用手术或放疗
? 系统治疗的原则：
- 年老，绝经期后，ER/PR(-)，病变进展快，重要脏器受犯者：先用内分泌治疗(一线 二线三线)如无效，改用化疗
-年青，绝经期前，ER/PR(一)，病变进展快，无重要脏器侵犯者：化疗(一线二线 三线)支持治疗。
转移性乳癌(IV期)
? 一线化疗：ADR based，如CAF
二线化疗：TAXANE based，单药或联合
三线化疗：Xeloda
? HER2/neu过度表达(+)者，Herceptin+ Taxol优于TAXOL alone。
? 骨转移者，可并用双磷酸盐类，减轻疼痛 /骨质破坏。
常用化疗药
Docetaxel
ADR, Epirubiein, THP- ADR
Paclitaxel
NVB
Capecitabine(Xeloda)
常用化疗药
CDDP
CTX, IFOSFAMIDE
5FU
MTX
MMC
mitoxantrone
TSPA
VLB, VCR
常用内分泌治疗药
TAMOXIFEN 20mg/日 P.O.
TOremifene(Fareston) 60mg/日P.O.
Letrazol(Femara)2.5mg/ 日 P.O.
Arimidex( Anastrozole)1mg/日 P.O.
Progestin(Megace) 40mg，每日3 - 4次 P.O.
LHRH agonist：Leuprolide 7.5mg im每月一次
GnRH agonist ：Zoladex
Letrozole (Femara) vs. Tamoxifen (Nolvadex) as First-line Treatment of Advanced Breast Cancer
R Smith et al, San Antonio 2000
? 907 postmenopausal breast cancer patients with locally advanced or metastatic breast cancer
- 65% ER/PR positive
- 20% prior anti-estrogen treatment
? Treatment: Randomized to letrozole 2.5 mg/day vs. tamoxifen 20 mg qd
? Results: TTPORClinical Benefit
Letrozole41 wks30%49%
Tamoxifen26 wks20%38%
(p=0.0001)(p=0.001) (p=0.001)
常用联合化疗方案
? CMFCTX100mg/m2 poqdd1-14
辅助化疗用MTX40mg/m2 iv d1,d8
淘汰趋势 5-FU600mg/m2 iv d1,d8
? CAFCTX 100mg/m2poqdd1-14
一线标准ADR30mg/m2 ivd1,d8
方案5-FU 500mg/m2ivd1,d8
常用联合化疗方案
二线：Taxol
Paclitaxel135-175 mg/m2 3hrivinf d1
每3周，或 80 mg/m2 q.wk
预处理：Dexamethasone20mgpo-12h，-6h
Benadryl 50mg iv-30-60min
Cimetidine 300mg iv -30-60min或Ranitidine50mgiv -30-60min
常用联合化疗方案
二线：Taxotere
Docetaxel80-100 mg/m2iv，1hr iv drip每3周 或40 mg/m2iv, 1hr inf, 每周. 可连续用
6周,停2周,为一周期。总量可达3-4周期
预处理：用药前1晚，用药日晨，用药后晚各口服Dexamethasone 8mg ，共3次。注苯海拉明
50mg， iv ，-30min
每周方案：MyelotoxicityFatique，结膜炎
常用联合化疗方案
一线：TA
Doxorubicin50mg/m2 iv d1
Docetaxel75 mg/m2 iv d1
or Doxorubicin60mg/m2 iv d1 Docetaxel 60 mg/m2iv d1
every 4 weeks(Dieras 1997)
常用联合化疗方案
一线：TAC
Doxorubicin50mg/m2 iv d1，then
Docetaxel75 mg/m2 iv d1
CTX 500mg/m2ivd1
every 4 weeks(Bozec， 1997)
常用联合化疗方案
一线：Taxol + Carbo ( Perez，2000)
Paclitaxel 200 mg/m2 3hriv inf d1
CarboplatinAUC 6
every 3 weeks
OR 62%
G3/4neutropenia82%
G3neuropathy16%
A Multicenter Phase II Trial of Capecitabine
(Xeloda) in Paclitaxel (Taxol)-Refractory
Metastatic Breast Cancer
Blum, ASCO 1998
? Patients: 163 paclitaxel-resistant breast cancer patients, 2-3 prior regimens
? Treatment: Capecitabine 2510 mg/m2/day divided bid given for 2 out of 3 weeks
? Toxicity: Grade 3/4 diarrhea (14%), hand-foot syndrome (10%)
? Response: 20% response rate (3 CRs), median duration of response 8.1 months, TTP 93 days
A Randomized Phase II Trial of Capecitabine (Xeloda) vs. CMF as First Line Chemotherapy of Breast Cancer in Women Aged > 55 Years
O'Shaughnessy, ASCO 1998
? Patients: 95 untreated stage IV breast cancer patients > 55
? Treatment: Capecitabine 2510 mg/m2/day divided bid 2 out of 3 weeks vs. CMF
A Randomized Phase II Trial of Capecitabine (Xeloda) vs. CMF as First Line Chemotherapy of Breast Cancer in Women Aged > 55 Years
O'Shaughnessy, ASCO 1998
? Grade 3/4 toxicity:
-Hand-foot syndrome: Capecitabine 16%, CMF 0%
- Diarrhea: Capecitabine 8%, CMF 3%
- Myelosuppression: Capecitabine 20%, CMF 47%
? Results:
- Response rate: Capecitabine 25%, CMF 16%
- Median TTP: Capecitabine 132 days, CMF 94 days
名称 发生率(%)
I--IV度III--IV度
手足综合征 62.8% 10%
皮肤色素沉着 44.3% /
腹泻 12.9% 4.3%
贫血 30.0%/
胆红素升高 14.3%/
HER-2 in Breast Cancer
Trastuzumab (Herceptin)
? Derived from murine 4D5 antibody
? 95% humanized recombinant molecule
? Targets ECD of HER2 growth factor receptor
? Anti-proliferative to HER2+ cell lines
? Enhances antibody dependent cellular toxicity
? Not immunogenic
Trastuzumab (Herceptin) Plus Chemotherapy in Metastatic Breast Cancer
Slamon et al, NEJM 2001
? 31 month follow-up
AC+HAC T+HT
CR8%4%8%2%
PR48% 38%34%15%
OR56% 42%41%17%
Duration 9.1 mo 6.710.54.5 p<0.001
TTP7.8 mo6.1 6.93.0 p<0.001
Survival 26.8 mo21.4 22.118.4p=0.16
Trastuzumab (Herceptin) Cardiotoxicity
HAC+HAC T+HT
Any Dysfunction 7% 28% 7%11%1%
Class III-IV 5% 19% 3% 4% 1%
Class III-IV 6% 0%
after rx
94% of pts in H-only trial had received an anthracycline......（后略) ......
附件资料：
相关资料1：
- 《21世纪临床心电图教学图谱》.卢喜烈.李中健.石亚君.扫描版.pdf
- 《田立莉甜式小学数学教学指导及评析》扫描版.pdf
- 《HTML与CSS网页设计教学做一体化教程》.pdf
- 小学语文教学板书的设计与运用.pdf
- [伯里曼人体结构绘画教学].(美)乔治.伯里曼.中文.清晰扫描版.pdf
- 韩语学习零起点30天入门-昂秀外语教学研究组.pdf
- 神经生理学教学彩图.rar
- 走遍天下书为侣教学设计 完美版
- ICU专科护士临床教学基地认证的实施与管理.pdf
- 护理临床教学.pdf
- 《精通HTML+CSS网页布局与样式》（视频教学版）.pdf
- 艾滋病的教学知识PPT.ppt
- 中医四大经典教学医案选编.pdf .epub
- 《淘宝大曝光：开店、装修、推广与运营实战》（全程视频教学版）.pdf
- 《钱歌川英语学习大全：教育泰斗毕生英语教学总结》.epub