【重磅】美国临床肿瘤学会指南：激素受体阳性转移性乳腺癌内分泌疗法

　　2016年5月23日，美国临床肿瘤学会（ASCO）官方期刊《临床肿瘤学杂志》（JCO）在线发表美国（加利福尼亚大学、美国临床肿瘤学会、弗吉尼亚癌症研究所、哥伦布肿瘤与血液学会、密歇根大学、明尼苏达州伊代纳患者代表、纽约纪念斯隆·凯特林癌症中心、威尔·康奈尔医学院、萨塞克斯大学、梅奥医院、迈阿密大学、华盛顿大学、北卡罗来纳大学、哈佛医学院达纳法伯癌症中心）和英国（伦敦皇家马斯登医院）起草的《激素受体阳性转移性乳腺癌内分泌疗法：ASCO指南》，包括正文37页、数据10页、方法13页、幻灯PPT版和PDF版各20页、推荐意见汇总表5页、流程图2页，点击左下角“阅读全文”可免费下载↙

　　这是JCO发表的首部转移性乳腺癌内分泌疗法ASCO指南，此前发表的均为早期乳腺癌术后辅助内分泌疗法ASCO指南：

• 2016年5月10日《激素受体阳性乳腺癌女性辅助内分泌疗法：关于卵巢抑制的ASCO临床实践指南更新》J Clin Oncol. 2016;34(14):1689-701. DOI: 10.1200/JCO.2015.65.9573 PMID: 26884586

• 2014年7月20日《激素受体阳性乳腺癌女性辅助内分泌疗法：ASCO临床实践指南更新》J Clin Oncol. 2014;32(21):2255-69. DOI: 10.1200/JCO.2013.54.2258 PMID: 24868023
  

• 2010年8月10日《ASCO临床实践指南：激素受体阳性乳腺癌女性辅助内分泌疗法更新》J Clin Oncol. 2010;28(23):3784-96. DOI: 10.1200/JCO.2009.26.3756 PMID: 20625130
  

　　由于该指南涉及许多中国尚未上市或批准的新药物或新疗法，故仅供乳腺癌专业人士、乳腺癌专业英语爱好者参考，非专业人士、非英语爱好者请直接参考中国指南，谢谢！

J Clin Oncol. 2016 May 23. [Epub ahead of print]

Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline.

Hope S. Rugo, R. Bryan Rumble, Erin Macrae, Debra L. Barton, Hannah Klein Connolly, Maura N. Dickler, Lesley Fallowfield, Barbara Fowble, James N. Ingle, Mohammad Jahanzeb, Stephen R.D. Johnston, Larissa A. Korde, James L. Khatcheressian, Rita S. Mehta, Hyman B. Muss, Harold J. Burstein.

University of California San Francisco Comprehensive Cancer Center; University of California San Francisco, San Francisco; University of California Irvine, Orange, CA; American Society of Clinical Oncology, Alexandria; Virginia Cancer Institute, Richmond, VA; Columbus Oncology and Hematology Associates, Columbus, OH; University of Michigan School of Nursing, Ann Arbor, MI; Patient Representative, Edina, MN; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Sussex; Royal Marsden Hospital, London, United Kingdom; Mayo Clinic, Rochester, MN; University of Miami Sylvester Comprehensive Cancer Center, Deerfield Beach, FL; University of Washington, Seattle, WA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dana-Farber Cancer Center, Boston, MA.

PURPOSE: To develop recommendations about endocrine therapy for women with hormone receptor (HR) -positive metastatic breast cancer (MBC).

METHODS: The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women. This guideline puts forth recommendations for endocrine therapy as treatment for women with HR-positive MBC.

RECOMMENDATIONS: Sequential hormone therapy is the preferential treatment for most women with HR-positive MBC. Except in cases of immediately life-threatening disease, hormone therapy, alone or in combination, should be used as initial treatment. Patients whose tumors express any level of hormone receptors should be offered hormone therapy. Treatment recommendations should be based on type of adjuvant treatment, disease-free interval, and organ function. Tumor markers should not be the sole criteria for determining tumor progression; use of additional biomarkers remains experimental. Assessment of menopausal status is critical; ovarian suppression or ablation should be included in premenopausal women. For postmenopausal women, aromatase inhibitors (AIs) are the preferred first-line endocrine therapy, with or without the cyclin-dependent kinase inhibitor palbociclib. As second-line therapy, fulvestrant should be administered at 500 mg with a loading schedule and may be administered with palbociclib. The mammalian target of rapamycin inhibitor everolimus may be administered with exemestane to postmenopausal women with MBC whose disease progresses while receiving nonsteroidal AIs. Among patients with HR-positive, human epidermal growth factor receptor 2-positive MBC, human epidermal growth factor receptor 2-targeted therapy plus an AI can be effective for those who are not chemotherapy candidates.

DOI: 10.1200/JCO.2016.67.1487