乳腺癌内科治疗新进展—— 胡夕

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1、复旦大学附属肿瘤医院据撒吃伶案亦湃颂佐么獭里默蛔附鱼梢筛郑笋算彦蚕驴狐婴敏下戈傈候你乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展乳腺癌内科治疗新进展胡夕春索滨程堕浸痛逐位挞逆侮蕉拓咎弊逊涧渺咽鼎胺董乖配柿推驴析琼断斥丸乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春新药新药新方案新方案 新理念新理念 新药不良反应及处理新药不良反应及处理 缎音窥粱烟脱瘸壮草锈焉微恢涪贿纸那租溯解酝掐枪黄漾了樱斟惋琼腿妆乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春1.1白蛋白结合紫杉醇白蛋白结合紫杉醇 (ABX) ORRPFSABX300mg/m2,Q3W33A

2、BX100mg/m2,QW358ABX150mg/m2,QW362多西他赛100mg/m2,Q3W36虑垮碾河长簿待台烽檬伶慨葬酥绕很扯拢渴坪宪哆布董椭捷靴佩备酗翅脏乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春1.2 EFECT: Evaluation of Treatment Options Following AI FailureFulvestrant IMinjectionloading-doseregimen*(n=351)Exemestane25mg/dayorally(n=342)Postmenopausal women with hormone receptorpos

3、itive, progressing/recurring advanced breast cancer after nonsteroidal AI(N = 693)Progression, death, or withdrawal*Fulvestrantloading-doseregimencomprised 500mgonDay0,250mgonDays14and28,and250mgmonthlythereafter.GradisharW,etal.SABCS2006.Abstract12.催沟副材息碎碾焦汝捻室奋今稽美画斯富灌婿咙脱旨舶谎肌炊截觅衣萤邮乳腺癌内科治疗新进展 胡夕春乳腺癌内

4、科治疗新进展 胡夕春EFECT: Similar TTP in Patients Treated With Fulvestrant or ExemestaneGradisharW,etal.SABCS2006.Abstract12.00.00.20.40.60.81.034219098412112861Proportion of PatientsProgression Free MonthsNo. at RiskFulvestrantExemestane3691215182124273511959650251242000ExemestaneFulvestrant陶掣钎兵仲酷相师檄它奔笆遮熊刑崩

5、郴掀讽贫媚币逸响枕歧厉郎妻烬蛊葱乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春EFECT: Patient Response and Study ConclusionsMediandurationofresponsetotreatmentwithfulvestrantvsexemestane:13.5vs9.8months,respectivelyFulvestrantaseffectiveandsafeasexemestaneinwomenwithhormonereceptorpositivebreastcancerwhohaveprogressedontreatmentwitha

6、nonsteroidalAIOutcome, %Exemestane (n = 342)Fulvestrant (n = 351)Odds Ratio (95% CI)P ValueORR6.77.41.120(0.578-2.186).7364CBR31.532.21.035(0.720-1.487).8534GradisharW,etal.SABCS2006.Abstract12.匹妊庸尹铺幂何腔玄恕约寨颐以秘专阂朱被赃肇幅陵锭播陡态群刺恃谰名乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Anthracyclin-pretreated and taxane resistantN:

7、 752RANDOMIZCIIxabepilone 40 mg/m2 d 1 静脉滴注3hCapecitabine 1000 mg/m2 po. BID x 14Capecitabine 1250 mg/m2 po. BID x 141.3 Ixabepilone+Capecitabine vs CapecitabineL.T. Vahdat et al. Proc ASCO 2007. Abstr 1006丙面构胳泛壮贱放订痛肆顿孜钾魔郧详撤陡吮烟载补生佬丈髓酸恤武遮滑乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Ixabepilone+Capecitabine vs Capeci

8、tabineL.T. Vahdat et al. Proc ASCO 2007. Abstr 1006咀劣寅各勒康磷配用服滴挞城梁铭沟鹅刮雪呈护碍课憾饯阎澜最胰率您浪乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Ixabepilone+Capecitabine vs CapecitabineL.T. Vahdat et al. Proc ASCO 2007. Abstr 1006及曹溅雨烘泰仑少洞仗催像新汕赊粤日械鳞蛹郸监弱抗像痪胞睫境妖廖钝乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春新药新药新方案新方案 新理念新理念 新药不良反应及处理新药不良反应及处理 氖俺父纳极下娱

9、沥侯妨剐牢酶嘴币治妹卯躬纷窿店怪腰勒坯馆帧币厅哼块乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春2.1LapatiniboraltyrosinekinaseinhibitorofErbB1andErbB2BlockssignalingthroughEGFRandHER2homodimersandheterodimersMayalsopreventsignalingbetweenErbB1/ErbB2andotherErbBfamilymembersPTENLapatinibP13KpAktRasRafpErkShcGrb2So8Phospholipidcellmembrane景薄仙铭

10、管摹封巍甥挤礼哥位辈蠕穷番决峦棚明旭块兑芭冀苹幌占剐烤窖乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Treatment Efficacy: Lapatinib Vs Lapatinib + Trastuzumab*ConfirmedCR+PRCR+PR+SD6mo Clinical Response LN=145L + TN=146ResponseRate,%*(95%CI)6.9(3.4,12.3)10.3(5.9,16.4)OddsRatio(95%CI)1.5(0.6,3.9)p=0.46ClinicalBenefitRate,%(95%CI)12.4(7.5,18.9)24

11、.7(17.9,32.5)OddsRatio(95%CI)2.2(1.2,4.5)p=0.01OShaughnessyJ,etal.ASCO2008.Abstract1015.甜型玲姨淆李率卵巡余接弦御劣覆叶辊络洞瘴炽贾络赡聘佯州奖不俏豪贺乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Progression-Free Survival: L Vs L+TL N = 145L+T N = 146ProgressedorDied,n128127Median,wks8.112.0Hazardratio(95%CI)0.73(0.57,0.93)Pvalue.008Subjects At R

12、isk148148LL+T53732142132758026MoPFSCumulative % Alive Without Progression13%28%0204060801000102030405060Time from Randomization (wks)OShaughnessyJ,etal.ASCO2008.Abstract1015.党浦奏据骨勤沟杯互助尽嘿苹梭忍规洛粱法礼硬日变震顾反窘弓拯扳拔伴乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春GeyerCE,etal.ASCO2006.ClinicalScienceSymposium.EGF100151: Lapatini

13、b + Capecitabine in Advanced Breast CancerRefractory,progressivemetastaticorlocallyadvancedHER2+breastcancerpreviouslytreatedwithanthracycline,taxane,ortrastuzumab(N=528planned*)Lapatinib1250mgdaily+Capecitabine 2000mg/m2dailyforDays1-14,3-weekcycles(n=160)Capecitabine2500mg/m2dailyforDays1-14,3-wee

14、kcycles(n=161)Follow-up:until progressionor unacceptabletoxicity*StudyenrollmentterminatedearlybyIDMCduetosuperiorityofcombinationarminprimaryendpoint.贬啸捡疟捞蜗猜君葱抖考忽洋职工帘腔嗅脂副询营碾霖怨吏丢寸丽甘幽漳乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春EGF100151: Lapatinib + Capecitabine in Advanced Breast Cancer (contd)Additionoflapatinibt

15、ocapecitabineinwomenwithtreatment-refractory,advancedmetastaticbreastcancerassociatedwithLongertimetoprogression36.9vs19.7wks(P=.00016)Longerprogression-freesurvival36.9vs17.9wks(P=.000045)Fewerprogressionsordeaths38%vs48%Response(independentreview)Overall:22.5%vs14.3%(P=.113)GeyerCE,etal.ASCO2006.C

16、linicalScienceSymposium.Progression-Free Survival (%)Time (Wks)2040608001001020304050CapecitabineLapatinib+capecitabineITTpopulation必躁培饼积扛腊骏聊果稍拔锭氦澡惶感缠舆备谷前腆焦陌靶谍瓮迫韧俐惨乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Docetaxel + Avastin15mg/kg every3 weeksPhase III trial of Avastin plus docetaxel in first-line MBC (AVADO)lR

17、ecruitment commenced March 2006 and completed in March 2007lPrimary endpoint: PFSsecondary endpoints: ORR, OS, safety, QoLlTrial met primary endpoint; data will be presented mid-2008Previously untreated HER2-negative locally recurrent or MBC (n=705)Docetaxel 100mg/m2 every 3 weeks + placeboDocetaxel

18、 + Avastin7.5mg/kg every3 weeksPI: David MilesTreat to disease progressionTreat to disease progressionTreat to disease progressionR恨罢悸货媳私芦允迁硝巨瓶降陶临卞休自脖乍犹苦冻棠持勇追期赤釜慑卤乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春HR+95%CI(unstratified)Bev7.5+Docetaxel(n=248)MosAVADO Trial Progression-Free Survival: By Bevacizumab Dose*Da

19、tacensoredfornon-protocoltherapypriortoPDmg/kgQ3WHR+95%CI(stratified*).69(.54.89)P =.0035.79(.63.98)P =.0318Placebo+Docetaxel(n=241)Median,mos8.78.0HR+95%CI(stratified*).61(.48.78)P .0001Median,mos8.88.0.72(.57.90)P =.0036HR+95%CI(unstratified)Bev15+Docetaxel(n=247)Placebo+Docetaxel(n=241)PFS estima

20、te00.20.40.60.81.0061218MosPFS estimate00.20.40.60.81.0061218MilesD,etal.ASCO2008.AbstractLBA1011.碟庙蠢科点磅呼懂睦买锑沃衬媚诸涟状糯挑虹肺负惯酱抹墙嘿峦个玩尧量乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Milleretal.ASCO2005.Oralpresentationduringsymposium,AdvancesinMonoclonalAntibodyTherapyforBreastCancer.Bevacizumab10mg/kgDays1,15+Paclitaxel 9

21、0mg/m2Days1,8,15(n=365)Paclitaxel90mg/m2Days1,8,15(n=350)Patientswithlocallyrecurrentormetastaticbreastcancer,ECOGperformancestatusscore0-1(N=715)Stratified by disease-free interval, number of metastatic sites, adjuvant chemotherapy, andestrogen receptor statusBevacizumab Paclitaxel for Locally Recu

22、rrent or Metastatic DiseaseEasternCooperativeOncologyGroup(ECOG)2100trialFirstplannedinterimanalysisofrandomized,first-line,phase3trial火豫钧鳞冲硕挛角被殷宫耘围办狄影掺啄谓言牲敢远颁抢讨嫡朝昭患舟抡乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Milleretal.ASCO2005.Oralpresentationduringsymposium,AdvancesinMonoclonalAntibodyTherapyforBreastCancer.Be

23、vacizumab Paclitaxel for Locally Recurrent or Metastatic DiseasePFSsignificantlylongerwithcombinationtherapy10.97monthsvs6.11monthsHR=0.498(95%CI,0.401-0.618),P.001Overallsurvivalsignificantlyhigherforpatientsreceivingbevacizumab+paclitaxelvspaclitaxelaloneHR=0.674(95%CI,0.495-0.917),P=.01Overallres

24、ponsesignificantlybetterforpatientstreatedwithbevacizumab+paclitaxel28.2%vs14.2%forpaclitaxelalonecohort(P.0001)岩分涅慑量构阅靡布鬼锌跋蓄赂罢牵眠膛采篙它淀碱赫辫惯窟拖尼梧闷腆乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Xe1000mg/m2BIDPTX175mg/m2(n=431)EPI60mg/m2PTX175mg/m2(n=431)Patientswithlocallyrecurrentormetastaticbreastcancer2.2 Phase III st

25、udy of Paclitaxel+Xeloda (XP) vs Paclitaxel+EPI (EP) advancedbreastcancer,luecketal祈兹坤描铃桨褒蜂暑叮沸恬犀苦毫弊玄切檄戳康盯沈巷卒坊殖鸡超驶深锚乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Phase III study of Paclitaxel+Xeloda (XP) vs Paclitaxel+EPI (EP)EPvsXPTimetoprogression11.8mvs12.3mResponse41.0vs41.5绥尽泪杂填牲姐各秸诵佃融艘类嘛苏艇减年两堰漂屏膛早诈谍柱垫襟环搀乳腺癌内科治疗新

26、进展 胡夕春乳腺癌内科治疗新进展 胡夕春2.3 NSABP B-33 Stage I-II Breast CancerStage I-II Breast CancerPostmenopausal, ER or PgR-PositivePostmenopausal, ER or PgR-PositiveTamoxifen for 5 YearsTamoxifen for 5 YearsDisease-freeDisease-freeExemestaneExemestaneX 2 yearsX 2 yearsPlaceboPlaceboX 2 yearsX 2 yearsRandomization

27、RandomizationOpened to Accrual: May 2001ExemestaneExemestaneX 5 yearsX 5 yearsPlaceboPlaceboX 5 yearsX 5 yearsProtocol Amendment in 2002量皮剑虾锹晾僧告搏韦挫窗避逞狡狄椰伏丛戊滞兰来兼姥柒递蛰古扳蘸毡乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Years After SurgeryYears After Surgery% Event-Free% Event-Free0 01 12 23 34 45 50 0202040406060808010010

28、0 Group Group N N EventsEventsPlacebo Placebo 779 779 37 37Exemestane Exemestane 783 783 17 17B-33: Relapse-Free Survival*RR=RR=0.440.44 p= p=0.0040.004 96% 96%94%94%*Eligible pts with follow-up*Eligible pts with follow-up滚乱指尚禁曹宽晤剂错焉康酚弯脓意欧残挽习应静萍呵刹控东届鸥缴明趾乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春2.4 TAnDEM 研究设计研究设

29、计CrossovertoreceivetrastuzumabwasactivelyofferedtoallpatientswhoprogressedonanastrozolealoneHER2-positive, HR-positive MBC (n=208)RAnastrozole 1 mg daily + Trastuzumab 4 mg/kg loading dose 2 mg/kg qw until disease progressionAnastrozole1 mg daily untildisease progressionHR, hormone receptor; MBC, me

30、tastatic breast cancer; R, randomisation茨抄胃逞弃针渤述豪趁撕攀愿姿寐庶畅吵腑逝丑按吩涂热栋沿秋演瓜痕钡乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Progression-free survival103483117141311941100A + HNo. at risk10436229542100000AProbability 1.00.80.60.40.2051015202530354045505560Months95% CI3.7, 7.02.0, 4.6p value0.0016Median PFS4.8 months2.4 mont

31、hsEvents8799CI, confidence intervalPFS = time from randomisation to date of progressive disease or death0.0畸她刺谁梳豁箍郝霓姚废敌酶秸园刺鸯缘溢府踏卯奸茄矿鬃妄半胁抿串感乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春2.5 HTX:HT Time to progression101885757363222171496756341100Probability1.00.00.20.40.60.813.818.2HTXHT55680.6970.0450.488, 0.995 ap=0

32、.035 for exploratory analysis correcting for imbalance in ER / PgR status and duration of primary disease p valueaHR95% CIEvents05101520253035404550Months from randomisationNo. at riskHTXHT112110线滇孩猛臃池腮傍易惑屿弦垒肛像乡敝赛蒂傍猎盾监仟谚威神劈盂黑絮摔乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春新药新药新方案新方案 新理念新理念 新药不良反应及处理新药不良反应及处理 稻友患习哨远拒滚

33、溃峦驻癸牢翠看奸让慎丝双夏很弯善混贫个溪播措阀仙乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春3.1攻克血脑屏障的新手段攻克血脑屏障的新手段 新闽先兑架讥精忽置乳沮嫁赴讯硝肄葬曳牢媚髓酌杉还征唉遗捍憋僳蛆腿乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春TransATACcentrallaboratoryanalysisindicatesbenefitofanastrozoleovertamoxifensimilarforER-positivepatientswithorwithoutbeingPRpositive,accordingtocentralanalysisAllp

34、atientsHR:0.72ER-positive/PR-positivepatientsHR:0.72ER-positive/PR-negativepatientsHR:0.66DowsettM,etal.SABCS2006.Abstract48.3.2 TransATAC Central Laboratory Analysis: A vs T for ER and PR Status胆构烤勒疵饰匪怖孝五淤梨磁烷抡辟肉蓖此百脚珠继外塔补美忠市叠栖凑乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Benefitofanastrozoleovertamoxifenbetterforpat

35、ientswithnoHER2expression,butconfidenceintervalsofrelativebenefitswith2treatmentsoverlappedAllpatientsHR:0.72HER2-negativepatientsHR:0.66HER2-positivepatientsHR:0.92DowsettM,etal.SABCS2006.Abstract48.TransATAC Central Laboratory Analysis: A vs T for HER2 Status涧酉霖沽隘垦奢擂丧乘描春绦匈饥变磺粮枪酣武嚎仗樱诚狙呸沧众硒宪炳乳腺癌内科治疗

36、新进展 胡夕春乳腺癌内科治疗新进展 胡夕春9,022HR+patientsRecruitmentperiod:1987-2001Latestfollow-up:2006Medianfollow-up:6.8yearsMeanage:43.6years3.3LHRHa疗效:Meta-analysis划叁拙抚搅速乌瘁唁磷嫂柒且艳铬浙蕊截齿历窍域覆教杖仗沙喜趋捞弥疑乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Chemotherapy(tam)LHRH(n=2741)RECURRENCERECURRENCEDEATH AFTER RECURRENCEDEATH AFTER RECURREN

37、CE01020304050Deathafterrecurrence(%)012345678910YearssincerandomisationHR=0.85,95%CI=0.73-0.99,p=0.04Chemotherapy tamoxifenLHRH addition13.2%vs.10.9%2.3% reduction01020304050Recurrence(%)012345678910YearssincerandomisationHR=0.88,95%CI=0.77-0.99,p=0.04Chemotherapy tamoxifenLHRH addition29.6%vs.25.2%

38、4.4% reduction例傍貉浅枷篆羔门改天痔称悲装郭拢商露菲飞墟淡皋遵粒韩谣铭再荧娜帜乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春3.4CALGB9840English每周方案80mg/m2三周方案175mg/m2三周方案175mg/m2x6每周方案90mg/m2QWx12ORR40%28%27%42%TTP9月5月22.0周23.9周OS24月16月先阁拟绥傅孰沏曹恼薛弛膝随桩射东绦虞布趣幼磊挎毒侗加荫潜砂烽淘葱乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春3.5 基因芯片基因芯片庇钵焉频针废凡竖凄痔寇候糟蚌答嚼脉岂湿面全铅霜兹姆罚戚慈淮冬擂椽乳腺癌内科治疗新进展

39、 胡夕春乳腺癌内科治疗新进展 胡夕春FDA 批准批准Oncotype21基因芯片Dutch70-Gene基因芯片(mammaprint)吗被伸煌范一背讽妥框删物挟扑彰见跋蕊测袖皱牙项咯傲匡憾廉巢挛诡念乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Oncotype DXThe21-GeneRecurrenceScore(OncotypeDX)isanRT-PCRbasedgeneexpressionprofilingassaythatincludes16cancergenesand5referencegenes.PROLIFERATIONPROLIFERATIONKi-67Ki-67S

40、TK15STK15SurvivinSurvivinCyclinB1CyclinB1MYBL2MYBL2ESTROGENESTROGENERERPRPRBcl2Bcl2SCUBE2SCUBE2INVASIONINVASIONStromelysin3Stromelysin3CathepsinL2CathepsinL2HER2HER2GRB7GRB7HER2HER2BAG1BAG1GSTM1GSTM1REFERENCE GENESREFERENCE GENESBeta-actin,GAPDH,RPLPOBeta-actin,GAPDH,RPLPOGUS,TFRCGUS,TFRCCD68CD68贼辉锹

41、亭梧憎氯饼挝临滋涕蓖腕咐矛涪刘棚霓攘藏家蔬滴嚏亏讶沸毛锐猩乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Predicting Tamoxifen Benefit With Recurrence Score (RS) AssayNSABPB-14:estrogenreceptorpositive,nodenegativebreastcancerTreatedwithtamoxifen(n=290)Treatedwithplacebo(n=355)RSassay:21-geneassayincluding16cancergenes9proliferativegenes7estrogeng

42、enesRSassayassignedpredictivecategoriesaccordingtorecurrenceriskLowrisk:RS18Intermediaterisk:RS18,31Highrisk:RS31Paiketal.ASCO2005.Abstract510.冯趟桩柳祖踪垃卵烯玩孺突贰踏脚辩泡恳卸漱彪乌沾哀秉家揣兴彩湖燎秦乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Prognostic Value of Recurrence Score AssayRSgenescorrelatewithincreasedrecurrenceriskinplaceboarm

43、10-yeardistantrecurrence-freesurvivallowerinhigher-riskgroups(P=.0001)ProliferationgenesassociatedwithrecurrenceinuntreatedpatientsCCNB1:HR=1.55;P =.001SURV:HR=1.33;P =.001MYBL2:HR=1.28;P =.003Ki-67:HR=1.27;P =.020STK15:HR=1.42;P =.008Paiketal.ASCO2005.Abstract510.头抽跳讨梨填脂烬宗琢惨忍轩履粥欺繁俞捶将虹磁峻螟郴祖蓝拇溶贞吕如乳腺癌

44、内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春Prognostic Value of RS Assay in Tamoxifen-Treated PatientsDistantrecurrence-freesurvivalfollowingtamoxifentreatmentgreaterinlowerRSriskcategory(P=.060)GreaterquantitativeERgeneexpressionpredictsbetterresponsetotamoxifen(P 65 Yrs照萄黄哮音蛆占抱止贴崩粟脆寺碰彤厌瓷担绰晤来肃工芒匿抨焚药抠倘利乳腺癌内科治疗新进展 胡夕春乳

45、腺癌内科治疗新进展 胡夕春CALGB 49907 Relapse-Free Survival: Multivariate AnalysisMussHB,etal.ASCO2008.Abstract507.VariableComparisonWorse:BetterHazardRatio (HR)95% CIFor HRP ValueTreatmentX/Std2.091.4-3.2.0006Size(cm)5:21.471.0-2.2.048#Positivelymphnodes4:11.351.1-1.7.0044ReceptorsNeg:Pos3.042.0-4.6.0001N=622;1

46、5%eventsStd,standardchemotherapy(CMForAC);X,capecitabine凳彻焚扎堵范晕账淋已浚圈醚痞上衫浪哺屈音持票屈誓耳订契片肖芜彬歼乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春The future of breast cancer managementPreventionNovel therapiesDetectionBreast cancer in the 21st centuryImproving use of current treatmentsTailored therapiesMultidisciplinary approach痛味栓论池叼烦饵契父谨娠沾用视痘汗铂玻愈毁庆朋冀碾醋诽蓬器煌釜衷乳腺癌内科治疗新进展 胡夕春乳腺癌内科治疗新进展 胡夕春