乳腺癌内分泌治疗的新思路和临床实践专家讲座.pptx

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,乳癌内分泌治疗新思绪和临床实践,乳腺癌内分泌治疗的新思路和临床实践,第1页,乳癌治疗伎俩,Surgery,手术,Radiation therapy,放疗,Chemotherapy,化疗,Hormone therapy,内分泌治疗,Biotherapy,生物治疗,New therapies,新治疗,乳腺癌内分泌治疗的新思路和临床实践,第2页,乳癌内分泌治疗发展,1970,1980,1990,Tamoxifen,Tamoxifen,MA,AG,新芳香化酶抑制剂,Exemestane/,MA,新芳香化酶抑制剂,Tamoxifen,pure A.E.?,MA,I,II,I,II,III,I,II,III,乳腺癌内分泌治疗的新思路和临床实践,第3页,Hormone Therapy Response Rate(%)in Different Receptor Status,乳腺癌内分泌治疗的新思路和临床实践,第4页,Survival by Response,Arimidex 1 mg,0,20,40,60,80,100,0,1,2,3,4,CR or PR,Stable,24,wks,Progression,Years from Randomisation,%,Survival,乳腺癌内分泌治疗的新思路和临床实践,第5页,MA,AG,Prevention DCIS/,Neoadj,5,years,Metastatic,Disease,1,st,2,nd,3,rd,Adjuvant,TAM,TAM,TAM,TAM,OVABL,三苯氧胺（,TAM),最主要乳癌内分泌治疗药品,乳腺癌内分泌治疗的新思路和临床实践,第6页,Tamoxifen for 5 Years vs No Treatment,Percent,Years,ER+,85.2,76.1,68.2,73.7,62.7,54.9,11.5(,SE 0.9),13.4(,SE 1.1),13.4(,SE 1.4),68.2%,54.9%,0,20,40,60,80,100,0,5,10,15,vs,Recurrences,Breast Deaths,0,20,40,60,80,100,0,5,10,15,ER+,73.0%,64.0%,91.4,80.9,73.0,87.8,73.2,64.0,3.6(,SE 0.7),7.8(,SE 1.0),9.0(,SE 1.4),vs,Years,Percent,乳腺癌内分泌治疗的新思路和临床实践,第7页,Tamoxifen Adjuvant Therapy for EBC,辅助内分泌治疗,决定原因,是激素受体情况,ER,阳性,效果最好,8,乳腺癌内分泌治疗的新思路和临床实践,第8页,Tamoxifen Adjuvant Therapy for EBC,适当,TAM,服药时间,为5年,9,乳腺癌内分泌治疗的新思路和临床实践,第9页,Tamoxifen Adjuvant Therapy for EBC,ER,阳性,不论年纪大小都可用,TAM,10,乳腺癌内分泌治疗的新思路和临床实践,第10页,Tamoxifen Adjuvant Therapy for EBC,降低对侧乳癌发生增加子宫内膜癌风险,11,乳腺癌内分泌治疗的新思路和临床实践,第11页,Tamoxifen Adjuvant Therapy for EBC,ER,阳性,TAM,和化疗适用,比单用,TAM,更有效,CAF,与,TAM,序贯适用,比,同时效果,更加好,乳腺癌内分泌治疗的新思路和临床实践,第12页,MA,AG,Prevention DCIS/,Neoadj,5,years,Metastatic,Disease,1,st,2,nd,3,rd,Adjuvant,1,TAM,TAM,TAM,TAM,OVABL,Tamoxifen,Indications in Breast Cancer,三苯氧胺 乳癌内分泌治疗不可动摇地位！？,乳腺癌内分泌治疗的新思路和临床实践,第13页,Survival Data,Anastrozole/MA,Median time,to death(months),2,year,survival rate(%),P,Anastrozole is=,Exemestane is?,Neoadjuvant,Letrozole is,Adjuvant,？,Anastrozole,乳腺癌内分泌治疗的新思路和临床实践,第23页,Milestones,Activated1996,Planned accrual9366,Accrual to dateClosed 1999,Ongoing AI Adjuvant Trials:ATAC(Anastrozole),Trialists Group TA.,Br J Cancer,.;85:317.,RANDOM IZE,Surgery,Tamoxifen 20 mg od,Anastrozole 1 mg od,Tamoxifen 20 mg od,Anastrozole 1 mg od,5,years,DFS/OS,乳腺癌内分泌治疗的新思路和临床实践,第24页,KaplanMeier Curves of Disease-free Survival in ITT Population,Curves truncated at 42 months,HR95.2%CI,p,-value,AN vs TAM0.830.710.960.0129,Comb vs TAM1.020.881.180.7718,Tamoxifen,Anastrozole,Combination,Time to event(months),Proportion event free(%),Time to event(months),Proportion event free(%),0,80,85,90,95,100,0,6,12,18,24,30,36,42,乳腺癌内分泌治疗的新思路和临床实践,第25页,KaplanMeier Curves of Disease-free Survivalin,Receptor-positive Population,Curves truncated at 42 months,HR95.2%CI,p,-value,AN vs TAM0.780.650.930.0054,Comb vs TAM1.020.871.210.7786,Time to event(months),Proportion event free(%),Tamoxifen,Anastrozole,Combination,0,80,85,90,95,100,0,6,12,18,24,30,36,42,乳腺癌内分泌治疗的新思路和临床实践,第26页,Predefined adverse events*,Hot flushes,A Arimidex,T Tamoxifen,C Combination,1060,T,C,1229,1243,A,%,patients,A vs T,C vs T,A vs C,0.79,1.02,0.78,OR,0.0001,0.75,0.0001,p value,乳腺癌内分泌治疗的新思路和临床实践,第27页,A vs T,C vs T,A vs C,0.52,0.94,0.56,0.0001,0.5,10,0,10,20,30,40,50,60,n,Endometrial thickness(mm),乳腺癌内分泌治疗的新思路和临床实践,第31页,Median endometrial thickness,0,2,4,6,8,10,0,12,24,Endometrial thickness(mm),Arimidex,Tamoxifen,Combination,Time(months),乳腺癌内分泌治疗的新思路和临床实践,第32页,A vs T,C vs T,A vs C,0.23,0.46,0.50,0.02,0.11,0.51,OR,p value,A,T,C,A,Arimidex;C,combination;T,tamoxifen,3,13,6,%,patients,Predefined adverse events,Endometrial cancer,乳腺癌内分泌治疗的新思路和临床实践,第33页,ATAC Summary,Anastrozole is superior to tamoxifen in terms of:,Disease-free survival in:,Overall population(HR=0.83)Receptor-positive patients(HR=0.78),Incidence of contralateral breast cancer in,:Overall population(OR=0.42),乳腺癌内分泌治疗的新思路和临床实践,第34页,Conclusions,Anastrozole is the first and only AI to show superior efficacy and improved tolerability compared with tamoxifen in the treatment of EBC,Overall risk-benefit assessment supports anastrozole becoming the future adjuvant treatment of choice in postmenopausal women,Anastrozole also shows promise for the chemoprevention of breast cancer,乳腺癌内分泌治疗的新思路和临床实践,第35页,Analysis of the Incidence of New(Contralateral)Breast Primaries,Time to first contralateral new primary(months),0,6,12,18,24,30,36,42,0,98,99,100,Proportion without CL BCa(%),Anastrozole,Tamoxifen,Combination,OR95%CI,p,-value,AN vs TAM0.420.220.790.0068,Comb vs TAM0.840.511.40 0.5132,乳腺癌内分泌治疗的新思路和临床实践,第36页,Arimidex(Anastrozole)in Breast cancer prevention:Design of IBIS II and data from ATAC,乳腺癌内分泌治疗的新思路和临床实践,第37页,Why use an Aromatase Inhibitor?,At least as effective as tamoxifen in ABC,ATAC trial provides early warning on side effects,ATAC trial provides efficacy data in early breast cancer at all endpoints;striking reduction in contralateral breast cancer events,Very low side-effect profile,乳腺癌内分泌治疗的新思路和临床实践,第38页,ATAC:incidence of new(contralateral)breast primaries in ITT population,9,invasive,0,5,10,15,20,25,30,35,Tamoxifen,(n=3116),Arimidex,(n=3125),Combination,(n=3125),5,DCIS,3,DCIS,23,invasive,5,DCIS,30,invasive,No.cases,Arimidex vs tamoxifen OR 0.42;95%CI 0.22,0.79;p=0.007,Combination vs tamoxifen OR 0.84;95%CI 0.51,1.40;p=0.51,乳腺癌内分泌治疗的新思路和临床实践,第39页,Women-years of follow-up per arm 3100 x 2.8=8600,Rate of contralateral tumours in womennot treated with tamoxifen(women-years),Expected contralateral tumours,Observed on tamoxifen,46%reduction,Observed on Arimidex,77%REDUCTION,ATAC:projected contralateral tumour reduction rate for Arimidex,7/1000,61,33,14,乳腺癌内分泌治疗的新思路和临床实践,第40页,IBIS I,Tamoxifen in prevention,Breast cancer incidence is reduced by 32%,101(,placebo)vs 69(TAM)OR 0.68 p=0.01,乳腺癌内分泌治疗的新思路和临床实践,第41页,IBIS II:Prevention,High-risk postmenopausal women,aged 40-70 years,2-arm trial for high-risk patients,5-year treatment,placebo controlled,N=6000 high-risk patients,Randomization,Arimidex,1 mg,Placebo,乳腺癌内分泌治疗的新思路和临床实践,第42页,IBIS II:DCIS,Women,aged 40-70 years,who have had DCIS diagnosed within the previous 6 months,2-arm trial(no placebo arm),5-year treatment,2 tablets/day,N=4000,Randomization,Arimidex,1 mg,Tamoxifen20 mg,乳腺癌内分泌治疗的新思路和临床实践,第43页,NSABP,NSABP centres:USA and Canada,Double-blind randomized study,Postmenopausal,(n=3000),Start date:Q4,Randomize,1:1,5,years anastrozole,1 mg od,5,years tamoxifen,20 mg od,乳腺癌内分泌治疗的新思路和临床实践,第44页,Prevention DCIS/,Neoadj,5,years,Metastatic,Disease,AI,1,st,2,nd,3,rd,AI,AI,Adjuvant,TAM,TAM,TAM,TAM,1,Arimidex in Breast Cancer,MA,AI,绝经后,绝经前？,AI,AI,乳腺癌内分泌治疗的新思路和临床实践,第45页,绝经前乳癌内分泌治疗,卵巢去势,绝经前,抗芳香化酶,瑞宁得（阿那曲唑）,氟隆,依西美坦,绝经后,乳腺癌内分泌治疗的新思路和临床实践,第46页,卵巢切除加口服依西美坦,治疗绝经前乳腺癌骨转移长久缓解,霍秀兰，女，41岁，住院号50982,.2 多发骨转移，左锁上淋巴结转移，,穿刺活检,ER(+)PR(+)Her-2(+),.4.6,因患者未停经，给予双侧卵巢切除术，1月后骨痛症状改进，骨质修复；,.5.11口服依西美坦，.6.6 骨痛深入减轻，疗效评价：,PR,乳腺癌内分泌治疗的新思路和临床实践,第47页,Zoladex,诺雷得,用于绝经前乳腺癌患者治疗,乳腺癌内分泌治疗的新思路和临床实践,第48页,Zoladex与卵巢切除术治疗复发转移乳癌效果比较,乳腺癌内分泌治疗的新思路和临床实践,第49页,Zoladex 3.6mg,用于绝经前进展期乳腺癌,II,期临床试验,资料起源于 29 个,II,期临床试验(,n,=228),CR+PR=36.4%,中位缓解间期 =22 周,耐受性好，未出现因不良反应退出,抑制雌激素药理作用是常见,面部潮红(75.9%),性欲减退(,47.4%,),乳腺癌内分泌治疗的新思路和临床实践,第50页,Klijn JGM,et al.J Clin Oncol;19:34353.,变量,LHRH,类似物,LHRH,类似物,+,Tamoxifen,相对,危险度,p,值,OR(CR+PR),30%,39%,0.67,0.03,PFS(,中位),5.4月,8.7 月,0.70,Zoladex Arimidex TAM,Zoladex+Arimidex,诺雷得+瑞宁得,绝经前乳癌内分泌治疗,乳腺癌内分泌治疗的新思路和临床实践,第53页,诺雷德+瑞宁得治疗绝经前患者,田,XX，,女，39岁，住院号53056,.10 多发骨转移、肝转移,ER(+)PR(+)Her-2(+),.11.1 Herceptin,治疗,PD,.01.3.TA,化疗2周期,SD 2 mo,.3.28,诺雷德+瑞宁得,PR,症状显著改进，生活自理，,KPS 90,分,B,超示肝脏病灶显著缩小,X,光片示骨病灶好转,至11月疾病依然处于缓解期,乳腺癌内分泌治疗的新思路和临床实践,第54页,A Randomized Trial of,Zoladex+TAM,vs,Zoladex+Arimidex,in per/perimenopausal patients with hormone dependent ABC,乳腺癌内分泌治疗的新思路和临床实践,第55页,Zoladex+TAM,vs,Zoladex+Arimidex,in per/perimenopausal ABC patients,1999.1-.12,119,cases ABC,First line,ER(+),Zoladex 3.6mg/28d +TAM 20mg/d,Zoladex 3.6mg/28d +Arimidex 1mg/d,乳腺癌内分泌治疗的新思路和临床实践,第56页,Zoladex+Arimidex,vs,Zoladex+TAM,in pre/perimenopausal ABC patients,Zoladex+Arimidex,Zoladex+TAM,CR+PR,80%53%,Median duration,of CB,12.1 months 8.3 months,Median time to,Death,18.9 months 14.3 months,乳腺癌内分泌治疗的新思路和临床实践,第57页,Zoladex+Arimidex,is effcient and well tolerated,should be considered for,first line therapy,in per/perimenopausal women with hormone dependent ABC,Milla-Santos,SAB,Dec,乳腺癌内分泌治疗的新思路和临床实践,第58页,Overview of LHRHa in Breast Cancer Adjuvant Therapy,Benefits of Reversible Ovarian Ablation,乳腺癌内分泌治疗的新思路和临床实践,第59页,1.,EBCTCG.Lancet 1996;348:118996.,2.Brincker H,et al.J Clin Oncol 1987;5:17718.,Zoladex,用于辅助治疗,Zoladex 3.6mg,单用或与,tamoxifen,适用在晚期乳腺癌治疗中显示其良好疗效和耐受性,EBCTCG 1996,年资料明确了绝经前早期乳腺癌治疗中卵巢去势延长生存作用,乳腺癌内分泌治疗的新思路和临床实践,第60页,Estimation of the hazard ratio for relapse between women with drug-induced amenorrhea(group A)and those without(group B),10,published studies(1995),Results:,1.,In 9/10 studies RFS longer in group A than in group B,NB Bonadonnas CMF study:20-year RFS=39%vs 30%(=22%reduction;p=NS),2.Mean hazard ratio:0.56 (0.39-0.86),*,del Mastro et al.N Engl J Med 1995;333:596-597,Conclusion:,Drug-induced amenorrhea is associated with a 44%reduction in the rate of relapse,乳腺癌内分泌治疗的新思路和临床实践,第61页,*,Aebi et al.Lancet;355:1869-1874,Impact of chemotherapy-induced amenorrhea(AM+)in the adjuvant setting by age*,IBCSG studies I,II,V,VII:treatment with chemotherapy only,ER+AM-,ER+AM+,ER-AM-,ER-AM+,8000 patients,Design,Conferring additional benefit when added to standard treatment,Potential replacement for chemotherapy,乳腺癌内分泌治疗的新思路和临床实践,第63页,ZEBRA,试验,(,Zoladex Early Breast Cancer Research Association),“诺雷德”（戈舍瑞林）,与,CMF,辅助治疗,绝经期前和更年期妇女乳腺癌疗效比较,乳腺癌内分泌治疗的新思路和临床实践,第64页,ZEBRA,试验设计,手术 放疗,Zoladex 3.6mg 1/28,天 2年,绝经前/围绝经期,LNM(),早期乳腺癌 年纪,50 岁,随访,CMF,1/28,天,x 6,程,随机化1:1 (开放 多中心,),肿瘤复发,死亡,死亡,乳腺癌内分泌治疗的新思路和临床实践,第65页,ZEBRA,临床试验结论,Zoladex,在受体阳性病例与,CMF,疗效相等,ER,水平检测对治疗起关键作用,Zoladex,较之,CMF,有更小不良反应,Zoladex,单药治疗,是对,ER+、,淋巴结阳性、绝经前/围绝经期早期乳腺癌,CMF,化疗之外又一治疗选择,乳腺癌内分泌治疗的新思路和临床实践,第66页,CMF x 6,Zoladex 3.6mg/28,天,x 3,年,+,TAM 20mg/,天,x 5,年,随机分组 1:1,绝经前,ER+,和/或,PgR+ve,乳腺癌,Jakesz R,et al.Breast Cancer Res Treat 1999;57:25,Abstr 2.,Jakesz R,et al.Eur J Surg Oncol;26:281,Abstr 110.,1,045 可评定病例,淋巴结+/,ABCSG AC05,临床试验奥地利乳腺癌辅助治疗试验,乳腺癌内分泌治疗的新思路和临床实践,第67页,ABCSG AC05,临床试验结果,Zoladex 3.6mg,加用,TAM,组,DFS,显著提升,总生存率亦有提升趋势,Zoladex 3.6mg,加用,TAM,较,CMF,对绝经前受体阳性乳腺癌辅助治疗更为有效,Jakesz R,et al.Breast Cancer Res Treat 1999;57:25,Abstr 2.,Jakesz R,et al.Eur J Surg Oncol;26:281,Abstr 110.,乳腺癌内分泌治疗的新思路和临床实践,第68页,2,648,例,随机化试验,淋巴结+/-,不论,ER,状态,标准治疗=放疗 化疗,tamoxifen,标准治疗,手术,.,Zoladex 3.6mg/28,天,2,年,Tamoxifen 20mg/,天,2,年,Zoladex 3.6mg/28,天+,TAM,2,年,无深入治疗,Houghton J,et al.ASCO;19:93a,Abstr 359.,Zoladex,用于绝经前患者(,ZIPP),乳腺癌内分泌治疗的新思路和临床实践,第69页,ZIPP,结果,乳癌术后在标准治疗中加用,Zoladex,DFS,显著改进(,HR=0.77,p,0.001),提升生存趋势(,HR=0.78,p,=0.08),对侧乳腺癌发生率降低(,HR=0.60,p,=0.05),ER+ve,患者较,ERve,或不详患者更有益,Houghton J,et al.ASCO;19:93a,Abstr 359.,Baum M.Breast Cancer Res Treat 1999;57:30,Abstr 24.,乳腺癌内分泌治疗的新思路和临床实践,第70页,INT-0101 ECOG/SWOG,临床试验,手术,CAF x 6,随机化 1:1:1,CAF x 6,Zoladex,x 5,年,CAF x 6,Zoladex,+TAM x 5,年,Davidson NE,et al.Breast 1999;8:2323,Abstr 069.,多中心试验,1,504,例合格病例,绝经前淋巴结,+、,受体,+,比较局部复发率/,DFS/,生存率,乳腺癌内分泌治疗的新思路和临床实践,第71页,INT-0101:5-Year,结果,*,CAF+Zoladex vs CAF alone,#,CAF+Zoladex+TAM vs CAF+Zoladex 3.6mg,+,当前尚无统计分析发表,NS=,无意义,CAF CAF+Zoladex CAF+Zoladex+TAM,(,n,=494)(,n,=502)(,n,=507),DFS(%)67 70(,p,=0.06)*77(,p,0.01),#,40,岁患者,DFS,(%)54 65,+,72,+,总体生存率 85 86(,NS)86(NS),Kuter I.Oncologist 1999;4:299308.,Davidson NE,et al.Breast 1999;8:2323,Abstr 069.,乳腺癌内分泌治疗的新思路和临床实践,第72页,Zoladex,辅助治疗试验结果总结,研究治疗疾病基本情况,DFS,结果,ZEBRAZOL vs.CMFLNM+ZOL,对,ER+,患者与,CMF,等效,(,n,=1,640)74%ER+,AC05ZOL+TAMER/PR+,ZOL+TAM,较,CMF,更有效,(,n,=1,045)vs.CMF,GROCTATAM+Ov.Supp.ER+NS,(,n,=244)vs.CMF,INT-0101CAF vs.LNM+,CAFZT vs.CAFZ,更有效,(,n,=1,504)CAF+ZOL vs.ER/PR+,CAF+ZOL+TAM,CAFZ,vs.CAF,更有效趋势,但无统计学差异(,p,=0.06),ZIPP ZOL+,标准治疗,70%,ER+,标准治疗,ZOL,(,n,=2,648)vs.,较单用标准治疗更有效 标准治疗*,*,标准治疗=+/-放疗,+/-,化疗+/-,tamoxifen,乳腺癌内分泌治疗的新思路和临床实践,第73页,结 论,Zoladex,对绝经前受体阳性早期乳癌辅助治疗有效,Zoladex,单药或联合,TAM,疗效不比化疗效果差,在标准化疗基础上加,Zoladex,TAM,效果更加好,Zoladex,可作为,绝经前、受体阳性早期乳癌辅助治疗,乳腺癌内分泌治疗的新思路和临床实践,第74页,N-low risk,N-average/high risk,N+,TAM or none,1.Ov abl+TAM,CT2.CT+TAM Ov abl3.TAM4.Ov abl,1.CT+TAM,Ov abl2.,Ov abl,+TAM,CT,TAM or none,1.TAM,2.CT+,TAM,1.CT+TAM 2.TAM,ER+ve,Ov abl,oophorectomy or GnRH analogue;CT,chemotherapy,Guidelines for adjuvant therapyof breast cancer,St Gallen,Risk group,ER-ve,Premenopausal,Postmenopausal,NA,CT,CT,乳腺癌内分泌治疗的新思路和临床实践,第75页,Questions,Does endocrine therapy add to chemotherapy?Answer:yes,Does chemotherapy add to optimal endocrine therapy?Answer:,In premenopausal ER-positive breast cancer:,unknown,probably no or only minor extra benefit,replacement of tamoxifen by an aromataseinhibitor might improve optimal endocrine therapy,乳腺癌内分泌治疗的新思路和临床实践,第76页,Study design BOOG1,Multicentre,open,randomized trial in high-risk ER-positive primary breast cancer,Main question:,does chemotherapy(CT)add to,optimal,endocrine therapy in steroid receptor-positive patients?,Randomization,optimal endocrine therapy RToptimal endocrine therapy+standard CT RT,Stratification:,nodal status(N0,N1-4,N,4),age categories(40 vs 40 years),cDNA microarray profile,BCT vs mastectomy,乳腺癌内分泌治疗的新思路和临床实践,第77页,Study design BOOG1(2),Zoladex+Arimidex(5 yrs),Zoladex+Arimidex(5 yrs)+CT (5 x FEC),R,乳腺癌内分泌治疗的新思路和临床实践,第78页,Ongoing International Clinical Trial,Arimidex,vs,Arimidex+Herceptin,for ER/PR positive,and Her-2 overexpression,Advanced Breast Cancer,乳腺癌内分泌治疗的新思路和临床实践,第79页,瑞宁得用于,绝经后,复发转移乳癌,79 岁 女性,1996,年左乳癌,T2N1M0,术后,CMF,化疗,1998,年右乳癌,T2N0M0 ER(+)PR(+)TAM 10mg/d,年11月肺部结节影（,M?）,ECT,示,第六肋浓聚,但,X片未见骨质破坏,Next:,瑞宁得 1mg 1/d .10-,乳腺癌内分泌治疗的新思路和临床实践,第80页,瑞宁得用于复发转移乳癌,+诺雷得,用于,绝经前患者,34,yrs,女性,CAF,辅助治疗后肝转移、骨转移,ER(+)PR(+)Her-2(+),Herceptin PD,Taxotere+Carboplatin 2 周期 SD,ER(+)PR(+),.1-Zoladex+Arimidex,疗效：PR 治疗中（.12）,乳腺癌内分泌治疗的新思路和临床实践,第81页,瑞宁得用于高危乳癌术后辅助治疗,65 岁 女性,年 左乳改良根治术,T3N2M0 LNM 10/10,ER(+)PR(+)Her-2(+),因冠心病、糖尿病等术后3个月未化疗,辅助治疗:,芳香化酶抑制剂,乳腺癌内分泌治疗的新思路和临床实践,第82页,瑞宁得+诺雷得,绝经前乳癌辅助治疗,绝经前,T2N1M0 LNM 2/5,ER(+)PR(+)Her-2(+),CAF,辅助化疗 2 个周期,化疗期间肺结核加重,下步治疗：,停化疗,抗结核治疗,诺雷得+瑞宁得,辅助内分泌治疗,乳腺癌内分泌治疗的新思路和临床实践,第83页,Prevention DCIS/,Neoadj,5,years,Metastatic,Disease,AI,1,st,2,nd,3,rd,AI,AI,Adjuvant,AI,AI,TAM,TAM,TAM,TAM,?,1,AI,芳香化酶抑制剂现实状况和未来,绝经前,诺雷得 诺雷得+瑞宁得,乳腺癌内分泌治疗的新思路和临床实践,第84页,乳癌内分泌治疗方向,新药品,新指征,（解救-新辅助-辅助-预防）,新联合,内分泌药品联合（,LHRHa+Ais,）,辅助治疗与化疗(,CAF-T),序贯联合,与生物治疗（,Herceptin,）,联合,乳腺癌内分泌治疗的新思路和临床实践,第85页,乳癌全身治疗科学合理应用,内分泌治疗,化 疗,生物治疗,乳腺癌内分泌治疗的新思路和临床实践,第86页,