Oncology Frontier: Dr. Gradishar， what therapy is most beneficial for maintaining or improving the quality of life of metastatic breast cancer?

　　《肿瘤瞭望》：什么样的治疗对提高转移性乳腺癌患者的生存质量最有利？

　　Dr. Gradishar: Well， patients have pain， so pain control and obviously trying to optimize symptom control from the therapies they are receiving， try to minimize them as best you can， and hopefully by getting that therapy their overall quality of life improves as well.

　　Gradishar教授：转移性乳腺癌患者存在疼痛，因此需要予以控制。另外，需要优化她们所接受的治疗以控制症状，并尽可能减少症状。通过相关治疗措施可能会使转移性乳腺癌患者的总体生存质量得到改善。

　　Oncology Frontier: When it comes to the resistance of treatment for metastatic breast cancer， could you talk about any new developments or strategies of that?

　　《肿瘤瞭望》：当谈到转移性乳腺癌治疗抵抗，您能否介绍一下有哪些新治疗策略？

　　Dr. Gradishar: Well， there are a number of things that are being explored. It would be hard to say that one is clearly better than another. For instance， in hormone sensitive breast cancer， there are a number of new targeted therapies that are being combined with endocrine agents to see if you can enhance or overcome resistance， similarly in HER-2 positive disease， drugs are being added to trastuzumab to see if you can enhance the effect. To date， the effects have been modest， certainly in HER-2 positive disease in hormone sensitive breast cancer there are some drugs that we hope will be approved shortly - palbociclib being one that seems to have a fairly significant effect on how these patients do.

　　Gradishar教授：目前，针对转移性乳腺癌的治疗抵抗有很多措施正在探索中，但很难讲哪种方法比另外一种更优。例如，在激素敏感性乳腺癌患者中，有大量靶向治疗可与内分泌治疗联合应用以观察是否可克服耐药。同样地，在HER-2阳性乳腺癌患者中，在曲妥珠单抗治疗基础上加用其他药物，可以观察能否增强曲妥珠单抗的治疗效果，但迄今为止，这种作用仍比较温和。当然，在激素敏感的HER-2阳性乳腺癌患者中，我们希望有些药物能被批准使用，palbociclib就是其中之一，研究证实这种药物在此类患者治疗中作用明显。

　　Oncology Frontier: Could you talk about the role of rebiopsy on disease progression and any new methods to evaluate the response of treatment?

　　《肿瘤瞭望》：您能否谈一下重新活检在评估疾病进展中的作用？评估治疗反应的新方法有哪些？

　　Dr. Gradishar: With rebiospy， we typically would do， certainly at the time that patients have new disease and new progression of disease at least once. The purpose of that is to characterize whether any changes have occurred molecularly that may help us define the best therapy for the patient. Molecular changes may dictate that what you thought was going on at the onset of diagnosis is no longer applicable， and therapies that could have been useful are no longer useful. We now have clinical trial designs that are based on certain mutations that are present， so it may afford the patient an opportunity to participate in trials based on what is found in a biopsy.

　　Gradishar教授：当然，我们会在转移性乳腺癌的诊疗中使用重新活检这种技术，主要在患者出现新疾病或疾病进展时应用。重新活检的目的是从分子学上观察病变特征是否发生改变，有助于为患者选择最佳治疗方案。若有分子改变，则提示最初诊断不再适用，原来应用的治疗方案可能不再有效。我们现在有基于某些变异设计的临床试验，可能会根据参与研究的患者重新活检发现，为其提供治疗机会。