Coates A S, Winer E P, Goldhirsch A, Gelber R D, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn H-J
International Breast Cancer Study Group, University of Sydney, Sydney, Australia.
Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
Ann Oncol. 2015 Aug;26(8):1533-46. doi: 10.1093/annonc/mdv221. Epub 2015 May 4.
The 14th St Gallen International Breast Cancer Conference (2015) reviewed substantial new evidence on locoregional and systemic therapies for early breast cancer. Further experience has supported the adequacy of tumor margins defined as 'no ink on invasive tumor or DCIS' and the safety of omitting axillary dissection in specific cohorts. Radiotherapy trials support irradiation of regional nodes in node-positive disease. Considering subdivisions within luminal disease, the Panel was more concerned with indications for the use of specific therapies, rather than surrogate identification of intrinsic subtypes as measured by multiparameter molecular tests. For the treatment of HER2-positive disease in patients with node-negative cancers up to 1 cm, the Panel endorsed a simplified regimen comprising paclitaxel and trastuzumab without anthracycline as adjuvant therapy. For premenopausal patients with endocrine responsive disease, the Panel endorsed the role of ovarian function suppression with either tamoxifen or exemestane for patients at higher risk. The Panel noted the value of an LHRH agonist given during chemotherapy for premenopausal women with ER-negative disease in protecting against premature ovarian failure and preserving fertility. The Panel noted increasing evidence for the prognostic value of commonly used multiparameter molecular markers, some of which also carried prognostic information for late relapse. The Panel noted that the results of such tests, where available, were frequently used to assist decisions about the inclusion of cytotoxic chemotherapy in the treatment of patients with luminal disease, but noted that threshold values had not been established for this purpose for any of these tests. Multiparameter molecular assays are expensive and therefore unavailable in much of the world. The majority of new breast cancer cases and breast cancer deaths now occur in less developed regions of the world. In these areas, less expensive pathology tests may provide valuable information. The Panel recommendations on treatment are not intended to apply to all patients, but rather to establish norms appropriate for the majority. Again, economic considerations may require that less expensive and only marginally less effective therapies may be necessary in less resourced areas. Panel recommendations do not imply unanimous agreement among Panel members. Indeed, very few of the 200 questions received 100% agreement from the Panel. In the text below, wording is intended to convey the strength of Panel support for each recommendation, while details of Panel voting on each question are available in supplementary Appendix S2, available at Annals of Oncology online.
第14届圣加仑国际乳腺癌大会（2015年）回顾了早期乳腺癌局部区域和全身治疗方面的大量新证据。更多的经验支持将肿瘤切缘定义为“浸润性肿瘤或导管原位癌无墨染”的充分性，以及在特定队列中省略腋窝淋巴结清扫的安全性。放疗试验支持对淋巴结阳性疾病的区域淋巴结进行照射。考虑到管腔型疾病的细分，专家小组更关注特定治疗方法的使用指征，而不是通过多参数分子检测来替代识别内在亚型。对于肿瘤大小达1厘米的淋巴结阴性癌症患者的HER2阳性疾病治疗，专家小组认可一种简化方案，即使用紫杉醇和曲妥珠单抗作为辅助治疗，不使用蒽环类药物。对于绝经前内分泌反应性疾病患者，专家小组认可对于高危患者使用他莫昔芬或依西美坦抑制卵巢功能的作用。专家小组指出，对于绝经前ER阴性疾病患者，在化疗期间给予促性腺激素释放激素（LHRH）激动剂在预防过早卵巢功能衰竭和保留生育能力方面的价值。专家小组指出，越来越多的证据表明常用多参数分子标志物具有预后价值，其中一些标志物还携带晚期复发的预后信息。专家小组指出，在可行的情况下，此类检测结果经常用于辅助决定管腔型疾病患者是否纳入细胞毒性化疗，但指出尚未为此目的为任何此类检测确定阈值。多参数分子检测费用昂贵，因此在世界上许多地区无法获得。现在大多数新发乳腺癌病例和乳腺癌死亡发生在世界欠发达地区。在这些地区，费用较低的病理检测可能提供有价值的信息。专家小组的治疗建议并非适用于所有患者，而是旨在确立适用于大多数患者的规范。同样，经济因素可能要求在资源较少的地区使用费用较低且疗效仅略低的治疗方法。专家小组的建议并不意味着专家小组成员之间达成一致意见。事实上，在收到的200个问题中，很少有问题获得专家小组100%的同意。在下文，措辞旨在传达专家小组对每项建议的支持力度，而专家小组对每个问题的投票细节可在《肿瘤学年鉴》在线版的补充附录S2中获取。
