2014年ASCO乳腺癌临床实践指南解读——HER2阴性（或未知）晚期乳腺癌化学和靶向治疗

2014年10月，《临床肿瘤学杂志》发表了美国临床肿瘤学会（ASCO）一项关于人表皮生长因子受体（HER2）阴性乳腺癌化疗和靶向治疗的临床实践指南。该指南在循证医学证据基础上针对HER2阴性晚期乳腺癌提出了最佳治疗方案推荐以及治疗方法的副反应和有效性的详细信息，主要建议：对于激素受体阳性晚期乳腺癌女性，除了有立即危及生命的病变或者对激素治疗产生抗性，应该将激素疗法作为一线标准治疗方案。不同化疗药物应该按顺序依次给药，而非联合给药，以降低副反应和维持生活质量。指南并未明确指出某一个化疗方案作为一线或后续治疗的优选，而是推荐综合考虑药物毒性、病人一般情况、合并症、病人意愿等多个因素来制定最优方案。贝伐珠单抗的使用仍旧饱受争议。目前尚无其他可以增强化疗效果的其他靶向药物出现。

Interpretation of the ASCO practice guideline:Chemotherapy and targeted for women with HER2-Negative (or unknown) advanced breast cancer

Interpretation of the ASCO practice guideline：Chemotherapy and targeted for women with HER2-Negative (or unknown) advanced breast cancer              GAO Guo-xuan，LIU Yin-hua.Breast Disease Center，Peking University First Hospital，Beijing 100034，China
Corresponding author：LIU Yin-hua，E-mail：liuyinhua@medmail.com.cn
Abstract    In October 2014 Journal of Clinical Oncology，it published the Chemotherapy and Targeted for Women With Human Epidermal Growth Factor Receptor 2-Negative (or unknown) Advanced Breast Cancer：ASCO Practice Guideline.Recommendations include：Endocrine therapy is preferable to chemotherapy as first-line treatment for patients with estrogen receptor-positive metastatic breast cancer unless improvement is medically necessary (eg，immediately life-threatening disease).Single agent is preferable to combination chemotherapy，and longer planned duration improves outcome but must be balanced against toxicity.There is no single optimal first-line or subsequent line chemotherapy，and choice of treatment will be determined by multiple factors including prior therapy，toxicity，performance status，comorbid conditions，and patient preference.The role of bevacizumab remains controversial.Other targeted therapies have not so far been shown to enhance chemotherapy outcome in HER2-negative breast cancer.