Oncology Frontier: :For patients with HR-positive， HER2-negative breast cancer， whether chemotherapy or hormonal therapy should be preferred in the event of recurrence?

　　《肿瘤瞭望》：HR阳性、HER-2阴性乳腺癌复发后，是首选化疗还是激素治疗？

　　Dr. Mayer: For patients that have a recurrence and are not in visceral crisis， endocrine therapy should always be prioritized instead of chemotherapy. Endocrine therapies should be exhausted as much as possible before committing a patient to chemotherapy. The only exception to that is in patients that present or develop visceral crisis.

　　Mayer博士：对于肿瘤复发但没有内脏危象的患者，应始终首先内分泌治疗，而非化疗。在对患者化疗前要尽可能发挥内分泌治疗的效用。唯一的例外是患者出现了内脏危象。

　　Oncology Frontier: Whether endocrine treatment is significantly beneficial for hormone-sensitive advanced breast cancer with visceral metastasis?

　　《肿瘤瞭望》：内分泌治疗能否使内脏转移的激素敏感晚期乳腺癌显著获益？

　　Dr. Mayer: If the visceral metastasis are not causing symptoms， i.e. patient is not in visceral crisis， endocrine therapy should be favored even in patients with visceral disease.

　　Mayer博士：前提是内脏转移没有导致症状，如患者没有内脏危象，这种情况下即使内脏转移也应考虑内分泌治疗。

　　Oncology Frontier: What‘s the future directions in the treatment of hormone-sensitive advanced breast cancer?

　　《肿瘤瞭望》：激素敏感型晚期乳腺癌治疗的发展方向？

　　Dr. Mayer: It is hard to say at this time; more data is needed in regards to CDK4/6 inhibitors to tell us if there’s survival advantage or not in administering these drugs with endocrine therapy in patients with newly diagnosed HR+ metastatic breast cancer. Until that benefit is shown， I am hesitant to say that the addition of a CDK4/6 inhibitor should be done in all patients. As for mTOR inhibitors， since they don’t provide survival advantage， not everybody will benefit from them either; it all depends on goals of care for a given patient. The quality of life and tolerance has to be taken in consideration if the only benefit achieved is improvement in progression free survival. As for PI3k inhibitors or methylation agents， data on their benefit is still unclear and results of phase Ⅲ trials are still awaited. The main take home message is: tailor treatment， try to milk endocrine therapy as much as possible.

　　Mayer博士：目前还很难说; 我们还需要更多数据验证CDK4/6抑制剂治疗效果，比如其联合内分泌疗法治疗初诊HR+转移性乳腺癌有无生存期优势。在CDK4/6抑制剂疗效得到充分验证之前，不会建议所有患者采取这类药物治疗。mTOR抑制剂没有显示生存优势，也并非所有患者都能从中获益。这一切都取决于患者的治疗目标。若疗法的唯一获益是改善无进展生存期（PFS），还应该考虑患者生活质量和治疗耐受性。PI3K抑制剂或去甲基化药物的数据目前还不清楚，目前还要等Ⅲ期临床试验结果确认。关于激素敏感型晚期乳腺癌未来治疗进展，最重要的信息是“量身定制的个体化治疗”，最大限度地发挥内分泌治疗的价值。