美国国家综合癌症网络乳腺癌指南更新
前情提要
时隔63天，正值世界红十字日、世界微笑日、第二次世界大战欧洲战场胜利75周年，美国国家综合癌症网络（NCCN）于美国东部时间2020年5月8日将《乳腺癌临床实践指南》更新至2020年第4版，全文由231页增至232页，免费注册后仍可免费下载：
NCCN为非国立、非营利、全国综合癌症中心联盟组织，1993年11月成立，1995年1月31日正式宣布成为全国联盟，最初由13个美国知名综合癌症中心组成，目前已经增至30个：
关于本版（2020年第4版）NCCN乳腺癌临床实践指南，其架构仍为临床路径＋循证解读＋参考文献，其依据仍来自权威学术期刊最新发表的大样本多中心随机对照三期临床研究结果。本版指南更新具体如下：
乳腺浸润癌：复发或IV期（M1）病变全身治疗方案：HER2阴性
Invasive Breast Cancer: Systemic Therapy Regimens For Recurrent Or Stage IV (M1) Disease: HER2-Negative (BINV-Q)
其他推荐方案：新增沙西妥珠单抗-戈维替康治疗三阴性乳腺癌（脚注g：转移后至少二线治疗方案失败的成年三阴性乳腺癌转移患者）
Added sacituzumab govitecan-hziy as an other recommended regimen for triple negative breast cancer (TNBC), with the following footnote: For adult patients with metastatic TNBC who received at least two prior therapies for metastatic disease. (BINV-Q, 1 of 7)
推荐用法用量：新增沙西妥珠单抗-戈维替康（三阴性乳腺癌）每21天的第1和8天静脉注射10mg/kg
Sacituzumab govitecan-hziy (for TNBC) 10 mg/kg IV on days 1 and 8, Cycled every 21days. (BINV-Q, 3 of 7)
参考文献
乳腺浸润癌：复发或IV期（M1）病变全身治疗方案：HER2阳性
Invasive Breast Cancer: Systemic Therapy Regimens For Recurrent Or Stage IV (M1) Disease: HER2-Positive (BINV-Q)
其他推荐方案：新增妥卡替尼＋曲妥珠单抗＋卡培他滨（1类推荐）治疗HER2阳性病变（脚注l：转移后至少一线治疗方案失败的成年HER2阳性乳腺癌晚期无法切除或转移患者，包括脑转移患者）
Added tucatinib + trastuzumab + capecitabine (category 1) as an other recommended regimen for HER2-positive disease, with the following footnote: For adult patients with advanced unresectable or metastatic HER2-positive breast cancer, including patients with brain metastases, who have received one or more lines of prior HER2-targeted therapy in the metastatic setting. (BINV-Q, 2 of 7)
推荐用法用量：新增妥卡替尼每天2次口服300mg、曲妥珠单抗每21天静脉注射（首次8mg/kg）6mg/kg、卡培他滨每21天的第1～14天每天2次口服1000mg/m²
Tucatinib + trastuzumab + capecitabine: Tucatinib 300 mg orally twice daily on days 1-21, Trastuzumab 8 mg/kg IV day 1 followed by 6 mg/kg IV day 1 every 21 days, Capecitabine 1000mg/m² orally twice daily on days 1-14, Cycled every 21 days. (BINV-Q, 4 of 7)
参考文献
乳腺浸润癌：复发或IV期（M1）病变其他靶向治疗及其相关生物标志检查：其他靶向治疗用法用量
Invasive Breast Cancer: Additional Targeted Therapies and Associated Biomarker Testing for Recurrent or Stage IV (M1) Disease: Dose Schedules for Additional Targeted Therapies (BINV-R, 2 of 3)
推荐用法用量：新增帕博利珠单抗每6周静脉注射400mg，直至疾病进展或毒性无法耐受或至多24个月。
Dose/administration option added for pembrolizumab: 400 mg IV on day 1, every 6 weeks until disease progression or unacceptable toxicity, or up to 24 months.
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