2010年,、2013年、2016年,，美國臨床腫瘤學(xué)會(huì)先后對(duì)激素受體陽性乳腺癌女性內(nèi)分泌輔助療法臨床實(shí)踐指南進(jìn)行了更新,。

　　2018年11月19日，美國臨床腫瘤學(xué)會(huì)《臨床腫瘤學(xué)雜志》在線發(fā)表哈佛大學(xué)達(dá)納法伯癌癥研究所,、美國臨床腫瘤學(xué)會(huì),、羅徹斯特乳腺癌聯(lián)盟、紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心,、德克薩斯大學(xué)MD安德森癌癥中心,、匹茲堡大學(xué)、霍普金斯大學(xué),、密歇根大學(xué),、加拿大不列顛哥倫比亞癌癥中心起草的美國臨床腫瘤學(xué)會(huì)臨床實(shí)踐指南重點(diǎn)更新，根據(jù)芳香酶抑制劑最佳療程的最新數(shù)據(jù),，對(duì)內(nèi)分泌輔助療法臨床實(shí)踐指南進(jìn)行了再次更新。

　　美國臨床腫瘤學(xué)會(huì)對(duì)2012～2018年的隨機(jī)臨床研究進(jìn)行了系統(tǒng)評(píng)審,，根據(jù)專家組對(duì)6項(xiàng)研究證據(jù)的評(píng)審,，更新了指南推薦意見。

　　該6項(xiàng)研究的芳香酶抑制劑療程均超過5年,，結(jié)果表明芳香酶抑制劑與安慰劑相比,，雖然療程延長與總生存獲益無關(guān)，但是與乳腺癌復(fù)發(fā)風(fēng)險(xiǎn)和對(duì)側(cè)乳腺癌風(fēng)險(xiǎn)較低顯著相關(guān),。不過,，芳香酶抑制劑療程延長的骨相關(guān)毒性反應(yīng)較常見。

　　因此,，專家組主要推薦意見如下：

• 淋巴結(jié)陽性乳腺癌女性接受包括芳香酶抑制劑在內(nèi)的內(nèi)分泌輔助治療延長療程,，最多合計(jì)10年。

• 淋巴結(jié)陰性乳腺癌女性應(yīng)該根據(jù)已知預(yù)后因素考慮復(fù)發(fā)風(fēng)險(xiǎn),，酌情延長內(nèi)分泌輔助治療至多10年,。

• 對(duì)于風(fēng)險(xiǎn)較低的淋巴結(jié)陰性或局限淋巴結(jié)陽性乳腺癌,，絕對(duì)風(fēng)險(xiǎn)減少程度不大，應(yīng)該根據(jù)風(fēng)險(xiǎn)減少程度和毒性反應(yīng)耐受程度,，考慮對(duì)療程進(jìn)行個(gè)體化,。

• 輔助芳香酶抑制劑療程延長的獲益主要在于預(yù)防新的原發(fā)性乳腺癌。

• 醫(yī)患共同決策適用于決定是否延長內(nèi)分泌輔助治療,，包括討論減少乳腺癌復(fù)發(fā)的絕對(duì)獲益,、預(yù)防新的原發(fā)性乳腺癌以及治療不良反應(yīng)的影響。

J Clin Oncol. 2018 Nov 19. [Epub ahead of print]

Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update.

Burstein HJ, Lacchetti C, Anderson H, Buchholz TA, Davidson NE, Gelmon KA, Giordano SH, Hudis CA, Solky AJ, Stearns V, Winer EP, Griggs JJ.

Dana-Farber Cancer Institute, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Breast Cancer Coalition of Rochester; Interlakes Oncology and Hematology PC, Rochester; Memorial Sloan Kettering Cancer Center, New York, NY; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA; BC Cancer Agency, Vancouver, British Columbia Canada; Johns Hopkins School of Medicine, Baltimore, MD; University of Michigan, Ann Arbor, MI.

PURPOSE: To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment.

METHODS: ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel's review of the evidence from six trials.

RESULTS: The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment.

RECOMMENDATIONS: The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment.

PMID: 30452337

DOI: 10.1200/JCO.18.01160