Dana-Farber Cancer Institute, Boston, MA.
ASCO, Alexandria, VA.
J Clin Oncol. 2020 Jun 1;38(16):1849-1863. doi: 10.1200/JCO.19.03120. Epub 2020 Feb 14.
To develop recommendations concerning the management of male breast cancer.
ASCO convened an Expert Panel to develop recommendations based on a systematic review and a formal consensus process.
Twenty-six descriptive reports or observational studies met eligibility criteria and formed the evidentiary basis for the recommendations.
Many of the management approaches used for men with breast cancer are like those used for women. Men with hormone receptor-positive breast cancer who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years; those with a contraindication to tamoxifen may be offered a gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor. Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of therapy. Men with early-stage disease should not be treated with bone-modifying agents to prevent recurrence, but could still receive these agents to prevent or treat osteoporosis. Men with advanced or metastatic disease should be offered endocrine therapy as first-line therapy, except in cases of visceral crisis or rapidly progressive disease. Targeted systemic therapy may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women. Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy regardless of genetic predisposition; contralateral annual mammogram may be offered to men with a history of breast cancer and a genetic predisposing mutation. Breast magnetic resonance imaging is not recommended routinely. Genetic counseling and germline genetic testing of cancer predisposition genes should be offered to all men with breast cancer.
制定男性乳腺癌管理相关建议。
ASCO 召集专家小组，基于系统评价和正式共识程序制定建议。
26 项描述性报告或观察性研究符合纳入标准，成为建议的证据基础。
许多用于男性乳腺癌的管理方法与用于女性的方法相似。有激素受体阳性乳腺癌且适合辅助内分泌治疗的男性，应给予他莫昔芬初始治疗 5 年；不能使用他莫昔芬的患者可给予促性腺激素释放激素激动剂/拮抗剂加芳香化酶抑制剂。已完成 5 年他莫昔芬治疗、耐受治疗且仍有高复发风险的男性，可考虑再接受 5 年治疗。早期疾病的男性不应使用骨修饰剂来预防复发，但仍可使用这些药物来预防或治疗骨质疏松症。晚期或转移性疾病的男性应首选内分泌治疗，除非存在内脏危象或疾病快速进展的情况。对于晚期或转移性癌症，可根据女性提供的适应证和联合用药方案，使用靶向全身治疗。无论是否存在遗传易感性，曾接受保乳术治疗的乳腺癌男性，都应每年接受同侧乳房 X 线钼靶检查；曾患有乳腺癌且有遗传易感性突变的男性，可每年接受对侧乳房 X 线钼靶检查。不建议常规进行乳房磁共振成像。所有乳腺癌男性均应提供乳腺癌遗传易感性基因的遗传咨询和胚系基因检测。
