早期乳腺癌最佳辅助化疗方案与人类表皮生长因子受体2阳性乳腺癌辅助靶向治疗选择：依据 ASCO 对 CCO临床实践指南的改编

摘要

Purpose A Cancer Care Ontario( CCO)guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer including adjuvant targeted therapy for human epidermal growth factor receptor 2(HER2) -positive breast cancers was identified for adaptation. Methods The American Society of Clinical Oncology(ASCO)has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The CCO guideline was reviewed for developmental rigor and content applicability. Results On the basis of the content review of the CCO guideline,the ASCO Panel agreed that,in general,the recommendations were clear and thorough and were based on the most relevant scientific evidence,and they presented options that will be acceptable to patients. Recommendations Decisions regarding adjuvant chemotherapy regimens should take into account baseline recurrence risk,toxicities,likelihood of benefit,and host factors such as comorbidities. In high - risk HER2 - negative populations with excellent performance status,anthracycline - and taxane -containing regimens are the standard of care. Docetaxel and cyclophosphamide for four cycles is an acceptable non - anthracycline regimen. In high - risk HER2 - positive disease,sequential anthracycline and taxanes administered concurrently with trastuzumab or docetaxel,carboplatin,and trastuzumab for six cycles are recommended. An alternative regimen in a lower - risk,node -negative,HER2 - positive population is paclitaxel and trastuzumab once per week for 12 cycles. Trastuzumab should be given for 1 year. Platinum salts should not be routinely administered in the adjuvant triple - negative population until survival efficacy data become available.%目的：研究加拿大安大略癌症治疗中心（CCO）关于早期乳腺癌最佳辅助化疗方案，包括人类表皮生长因子受体2（HER2）阳性乳腺癌辅助靶向治疗方案，并对其进行改编。方法按照美国临床肿瘤协会（ASCO）对其他组织临床实践指南改编的策略和程序，对 CCO 临床实践指南的严谨性与内容适用性进行回顾。结果基于对 CCO临床实践指南内容的回顾，ASCO 小组认为，CCO 临床实践指南在整体上清晰全面，以最确切的科学证据为基础，为患者提供可接受的治疗选项。推荐关于辅助化疗方案的决定，应考虑到基线复发风险、毒性、利益可能性和宿主因素（如合并症）。对于高风险 HER2阴性的身体状况良好的人群，蒽环类和紫杉烷治疗方案是标准治疗方案。4个周期的多西他赛和环磷酰胺治疗方案是可接受的非蒽环类治疗方案。对于高风险 HER2阳性患者，推荐蒽环类与紫杉烷序贯疗法联合曲妥单抗或多西他赛、卡铂、曲妥单抗进行6个周期的治疗。对于低风险、非淋巴结转移、HER2阳性人群，推荐每周一次的紫杉醇和曲妥单抗连续进行12个周期的替代治疗。曲妥单抗应持续使用1年。不应采用铂复合盐对三阴性人群进行常规的辅助管理，除非出现有效的生存数据加以支持。