2018年11月19日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表哈佛大学达纳法伯癌症研究所、美国临床肿瘤学会、罗彻斯特乳腺癌联盟、纽约纪念医院斯隆凯特林癌症中心、德克萨斯大学MD安德森癌症中心、匹兹堡大学、霍普金斯大学、密歇根大学、加拿大不列颠哥伦比亚癌症中心起草的美国临床肿瘤学会临床实践指南重点更新，根据芳香酶抑制剂最佳疗程的最新数据，对内分泌辅助疗法临床实践指南进行了再次更新。

 

　　美国临床肿瘤学会对2012～2018年的随机临床研究进行了系统评审，根据专家组对6项研究证据的评审，更新了指南推荐意见。

 

　　该6项研究的芳香酶抑制剂疗程均超过5年，结果表明芳香酶抑制剂与安慰剂相比，虽然疗程延长与总生存获益无关，但是与乳腺癌复发风险和对侧乳腺癌风险较低显著相关。不过，芳香酶抑制剂疗程延长的骨相关毒性反应较常见。

 

　　因此，专家组主要推荐意见如下：

 

淋巴结阳性乳腺癌女性接受包括芳香酶抑制剂在内的内分泌辅助治疗延长疗程，最多合计10年。

 

淋巴结阴性乳腺癌女性应该根据已知预后因素考虑复发风险，酌情延长内分泌辅助治疗至多10年。

 

对于风险较低的淋巴结阴性或局限淋巴结阳性乳腺癌，绝对风险减少程度不大，应该根据风险减少程度和毒性反应耐受程度，考虑对疗程进行个体化。

 

辅助芳香酶抑制剂疗程延长的获益主要在于预防新的原发性乳腺癌。

 

医患共同决策适用于决定是否延长内分泌辅助治疗，包括讨论减少乳腺癌复发的绝对获益、预防新的原发性乳腺癌以及治疗不良反应的影响。

 

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