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CSCO2018大家访谈录│王晓稼教授:内分泌+CDK4/6抑制剂还是化疗

2018-09-26 佚名 ioncology

9月21日下午,2018CSCO举行了“CSCO 乳腺癌专家委员会-乳腺癌内分泌治疗专场”,诸位大咖针对乳腺癌内分泌治疗进行了不同方面的探讨。浙江省肿瘤医院王晓稼教授作专题报告“晚期乳腺癌治疗策略:内分泌联合CDK4/6抑制剂还是化疗”。

9月21日下午,2018CSCO举行了“CSCO 乳腺癌专家委员会-乳腺癌内分泌治疗专场”,诸位大咖针对乳腺癌内分泌治疗进行了不同方面的探讨。浙江省肿瘤医院王晓稼教授作专题报告“晚期乳腺癌治疗策略:内分泌联合CDK4/6抑制剂还是化疗”。

如何为HR+/HER2-晚期乳腺癌患者选择一线治疗方案

HR+/HER2-晚期乳腺癌的临床治疗主要基于内分泌治疗优先的原则。我们在临床上会首先对晚期乳腺癌患者的内分泌治疗敏感性和肿瘤负荷进行评估,包括评估肿瘤的特征、患者以往的DFS、肿瘤转移部位、肿瘤负荷和内脏转移有无症状等。我们要对初始转移灶进行活检,检测转移灶是否也是ER阳性,预测患者内分泌治疗的敏感性以及肿瘤进展速度。

HR+/HER2-晚期乳腺癌一般发展相对缓慢,对内分泌治疗敏感,临床中可参考患者既往用药选择内分泌治疗方案。内分泌治疗耐药、肿瘤快速进展、内脏转移广泛或症状明显、存在内脏危象、年纪较轻的患者可以先给予化疗。

之前临床上会根据肿瘤进展风险的高低区别性选择内分泌治疗或化疗,当CDK4/6抑制剂加入一线治疗方案,低进展风险和中高风险的患者都能从中获益。CDK4/6抑制剂+芳香化酶抑制剂(AI)用于一线治疗的客观缓解率达到40%~50%,临床获益率超过80%,延长了10个多月的无进展生存期(PFS),使HR+/HER2-晚期乳腺癌患者一线PFS突破2年。

中度风险患者的治疗方案更加个体化,这些患者的年纪可能在50岁左右,患者有内脏转移,但是没有出现内脏危象。这些患者可能无法耐受化疗,接受单纯内分泌治疗又可能疗效不佳,因为内分泌治疗起效较慢。CDK4/6抑制剂的问世帮助我们解决了这个难题,中度风险患者接受CDK4/6抑制剂联合内分泌治疗,既避免了常规内分泌治疗有效率低的问题,也避免了化疗的严重副作用。

HR+/HER2-晚期乳腺癌继发内分泌耐药后的后续治疗方案

CDK4/6抑制剂用于HR+/HER2-晚期乳腺癌二线治疗依然能很好地控制肿瘤,明显延长PFS。在PALOMA-3研究中,二线哌柏西利联合氟维司群治疗的PFS为11.2个月,显着优于氟维司群单药组的4.6个月。

目前我们已有多种可逆转内分泌耐药的策略,BOLERO-2研究证实,内分泌治疗进展后进行内分泌治疗联合mTOR通路的双重封锁能够带来PFS获益;临床试验也探索了依维莫司联合氟维司群以及Buparlisib联合氟维司群(500 mg)的方案;内分泌治疗联合HDAC抑制剂的III期临床研究正在开展。HR+/HER2-晚期乳腺癌一线内分泌治疗耐药后有多种治疗方案,其中CDK4/6抑制剂联合内分泌是副反应相对比较轻的策略。

CDK4/6抑制剂哌柏西利已于8月在中国获批,我们已经等待太久了。哌柏西利在中国上市主要基于多项国际多中心II期、III期研究结果(PALOMA-1,2),以及在中国HR+/HER2-晚期乳腺癌患者中开展的药代动力学研究。CDK4/6抑制剂+内分泌带来的一线PFS获益已经超过化疗,但没有化疗导致的严重副反应。

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    2019-02-08 gwc392
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    2018-10-08 jklm09
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    2018-11-06 soongzhihua
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    2018-09-28 zhouqu_8
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    2018-09-28 zhangj7111
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    2018-09-26 tw007007

    目前没有用过帕布,希望后续有机会

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1682465, encodeId=3a3616824656e, content=<a href='/topic/show?id=d4d031e8074' target=_blank style='color:#2F92EE;'>#分泌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31780, encryptionId=d4d031e8074, topicName=分泌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0da227938338, createdName=gwc392, createdTime=Fri Feb 08 13:42:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851796, encodeId=dba11851e963e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Oct 08 09:42:00 CST 2018, time=2018-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1703082, encodeId=dbad1e0308204, content=<a href='/topic/show?id=98b24402bb' target=_blank style='color:#2F92EE;'>#CDK4#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4402, encryptionId=98b24402bb, topicName=CDK4)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=166330479856, createdName=soongzhihua, createdTime=Tue Nov 06 22:42:00 CST 2018, time=2018-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435507, encodeId=8bc6143550e86, content=<a href='/topic/show?id=09dc439915' target=_blank style='color:#2F92EE;'>#CDK#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4399, encryptionId=09dc439915, topicName=CDK)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Sep 28 01:42:00 CST 2018, time=2018-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490685, encodeId=3b6d1490685ee, content=<a href='/topic/show?id=2765440372' target=_blank style='color:#2F92EE;'>#CDK4/6#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4403, encryptionId=2765440372, topicName=CDK4/6)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c7068807080, createdName=zhangj7111, createdTime=Fri Sep 28 01:42:00 CST 2018, time=2018-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346760, encodeId=c7bf346e6067, content=目前没有用过帕布,希望后续有机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8e425737, createdName=tw007007, createdTime=Wed Sep 26 16:07:46 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346741, encodeId=89a0346e41a8, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Wed Sep 26 12:48:43 CST 2018, time=2018-09-26, status=1, ipAttribution=)]
    2018-09-26 kafei

    学习了谢谢

    0

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