彰基主辦 - 乳癌專家醫師讀書會

1. 2013 ASCO Hormonal Therapy

2. Adjuvant Chemotherapy in 2013
ASCO Angelo Di Leo MD

27. HR(+) Score
• Clinical Treatment Score (Late recurrence)
• IHC-4 Score
Gene expression
• Oncotype Recurrence Score
• PAM50 Risk of Recurrence Score
• Breast Cancer Index Score

29. IMPAKT 2013

30. IMPAKT 2013

31. IMPAKT 2013

32. ER(+)
• 50% recurrent after 5 yrs
• 2/3 die after 5 yrs

33. 問題
不是要不要打化療
是要不要荷爾蒙治療 5 年以上

34. Adjuvant Therapy in Luminal A
• 不是急打短打(化療)殊死戰
• 是慢打長打(荷爾蒙治療)拉長戰線

35. Who Need Extended Adjuvant H/T
• Clinical Treatment Score (Late recurrence)
T N Grade Age Treatment

37. 5-10年, 次於CTS(Clinical Treatment Score)
• PAM50 Risk of Recurrence Score (ROR)
• Breast Cancer Index Score (BCI)

38. IMPAKT 2013

39. 最經濟實惠
0-5年 IHC 4 Score
5-10年 Clinical Treatment Score

40. Ajuvant H/T
L/N(+) No Chemotherapy
Trial data

41. ATAC Trial

43. ATAC
Anastrozole Tamoxifen Combination
N(+) Total 34.9% 33.5% 33.5%
Adj. C/T 22.3% 20.8% 20.8%
N(+) No C/T 12.6%(36.1%) 12.7%(37.9%) 12.7% (37.9%)
Other high risk factor ?

44. IES

46. IES
Exemestene Tamoxifen
N(+) 44.1% 44%
C/T 32.4% 32.1%
N(+) No C/T 12%(27.2%) 11.9% (27%)
Other high risk factor?

47. BIG 1-98 Trial

49. BIG 1-98
Letrozole Tamoxifen Overall
L/N(+) 1660(41.5%) 1651(41.2%) 3311(41.3%)
Adjuvant C/T 1012(25.3%) 1012(25.3%) 2024(25.3%)
L/N(+) No C/T 16.2%(39%) 15.9%(38.6%) 16% (38.7%)
Other high risk factor?

50. MA.17

52. MA.17
Letrozole Placebo
N(+) 45.3% 45%
C/T 45.6% 45.1%
Other high risk factor?