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晚期Luminal(HER2阴性)型乳腺癌患者的MDT诊疗
作者:曹文明  邓雪英  陈波  杜向慧  陈占红  郑亚兵  Hope Rugo  Geraldine M. Jacobson  郑鸿钧  王晓稼 
单位:浙江省肿瘤医院乳腺癌MDT团队  浙江 杭州 310022 卡罗尔·法郎巴克乳腺中心  加州大学旧金山分校医学院  美国加利福尼亚州 旧金山 94115 西弗吉尼亚大学放射肿瘤科  美国西弗吉尼亚州 摩根城 26506 台湾和信治癌中心医院放射治疗部  中国台湾地区 台北 112 
关键词:乳腺肿瘤 骨肿瘤/继发性 肺肿瘤/继发性 诊断 药物治疗 CDK4/6抑制剂 内分泌药物/治疗应用 
DOI:10.13267/j.cnki.syzlzz.2018.06.002
出版年,卷(期):页码:2018,33(6):502-509
摘要:

本文介绍1例激素受体阳性、人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER2)阴性晚期乳腺癌多线内分泌治疗的多学科诊疗过程。该病例有较长的无瘤生存期(10年),初始复发转移肿瘤分布范围广,涉及两肺多发、多处骨骼及颈部锁骨上等区域多发淋巴结转移,经锁骨上转移淋巴结穿刺病理证实,免疫组织化学检测仍为雌激素受体(estrogen receptor,ER)强阳性/HER2阴性,但是孕激素受体(progesterone receptor,PR)仅小区阳性。经过多学科讨论后患者依次一线接受高剂量氟维司群(500 mg,肌注,28 d/次,首月第14天负荷剂量)内分泌治疗,二线选择哌柏西利(125 mg/d,服21 d,休7 d)+来曲唑(2.5 mg/d),三线接受哌柏西利+氟维司群(同前),其2次进展仅表现为新发淋巴结转移或胸腔积液,并未发现内脏新发病灶或者病灶增大。其一、二线内分泌治疗的无进展生存期(progression free survival,PFS)均为12个月,三线内分泌治疗保留哌柏西利,换用一线的内分泌治疗药物(氟维司群)。临床上,还有全身化疗和局部放疗等选择。由于患者自发病以来一直拒绝接受化疗,术后辅助仅选择阿那曲唑(1 mg/d)辅助内分泌治疗(5年),解救治疗期间同样要求仅选择内分泌治疗。鉴于患者的意愿和肿瘤特征与演变、分子检测与监测,结合MDT专家意见,连续选择内分泌治疗作为解救治疗,取得较长的疾病控制实践,患者维持较好的生活质量。

This study introduces the process of multidisciplinary diagnosis and treatment of advanced breast cancer patient with hormone receptor positive and human epidermal growth factor receptor-2 (HER2) negative who received multiple line endocrine therapy.This case has 10-year disease-free survival.The initial recurrent tumor metastasis included a wide area,involving multiple spots of both lungs,bones,and multiple lymph node metastasis at the neck collar bone area.Confirmed by biopsy of the supraclavicular metastatic lymph node,the tissue was showed to estrogen receptor (ER) strong positive,HER2 negative,and progesterone receptor (PR) weakly positive by immunohistochemistry test.After multidisciplinary discussion,the patient received high-dose Fulvastrant(500 mg injected intramuscularly,every 28-day,loading dose on day 14 of the first month) as the first-line,Palbociclib (125 mg/d for 21 d,7 d interval) and Letrozole (2.5 mg/d) as the second-line,and Palbocic365bet娱乐官网网址lib and Fulvastrant as the third-line.During the treatment,the patient only showed new lymph node metastasis and pleural effusion in the two disease progresses,but with no new visceral lesions or tumor growth.The progression free survival (PFS) for the 1st and 2nd PFS were both 12 months.We thus recommended Palbociclib and Fulvastrant as the 3rd-line hormone therapy.Although other therapeutic options,such as systemic chemotherapy and local radiotherapy are also available for the patient,the patient denied chemotherapy and only accepted anastrozole(1 mg/d) as adjuvant endocrine therapy for 5 years.She also strongly preferred hormone therapy during the recurrence treatment.In view of the patient's willingness,as well as tumor characteristics and evolution,gene mutation detection and monitoring,we adhered to the MDT expert opinions,and continued to select endocrine therapy as the salvage treatment.This strategy achieved a long-term disease control,and the patient maintained a good quality of life.

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