NCCN Guidelines Updates: Breast Cancer
NCCN Guidelines Updates: Breast Cancer
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DOI：
10.6004/jnccn.2019.5006
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发表时间：
2019-05-01
影响因子：
13.4
通讯作者：
Ward, John H.
中科院分区：
文献类型：
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作者：
Telli, Melinda L.;Gradishar, William J.;Ward, John H.
分子检测的进步迎来了精准医学的新时代。2018年发表的TAILORx试验有助于完善基因表达测定的使用，特别是21基因复发评分，将患者分配给单独的内分泌治疗或化疗。NCCN乳腺癌指南探讨了本研究的临床应用。根据是否存在淋巴结受累的临床证据，对早期乳腺癌腋窝的处理算法进行了进一步改进。根据SOFT和TEXT关键性试验的最新分析，卵巢抑制已被确认为高风险绝经前女性的最佳方法。在转移性背景下，NCCN指南进一步加强了CDK 4/6抑制剂的益处，将“首选”推荐扩展到转移性疾病中所有可用的药物。三阴性乳腺癌的选择现在首次包括免疫抑制剂。
Advances in molecular testing have ushered in the new era of precision medicine. The 2018 publication of the TAILORx trial helped refine the use of genetic expression assays, specifically the 21-gene recurrence score, in assigning patients to endocrine therapy alone or with chemotherapy. The NCCN Guidelines for Breast Cancer explore the clinical applications of this study. The algorithm for managing the axilla in early breast cancer has been further refined, based on the presence or absence of clinical evidence of lymph node involvement. Ovarian suppression has been validated as the optimal approach in higher risk premenopausal women, based on updated analysis of the SOFT and TEXT pivotal trials. In the metastatic setting, the NCCN Guidelines further reinforce the benefit of the CDK4/6 inhibitors, extending the "preferred" recommendation to all the available agents in metastatic disease. Options in triple-negative breast cancer now include, for the first time, an immunotherapeutic agent.