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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。
Objective To study and adapt the optimal adjuvant chemotherapy regimen for early breast cancer in the Ontario Cancer Treatment Center of Canada (CCO), including adjuvant targeted therapies for human epidermal growth factor receptor 2 (HER2) positive breast cancer. Methods The CCO clinical practice guidelines were reviewed in terms of rigor and content suitability according to ASCO guidelines and procedures adapted from other organizations’ clinical practice guidelines. Results Based on a review of the CCO clinical practice guidelines, the ASCO team concluded that the CCO guidelines for clinical practice are generally clear and comprehensive and provide the patient with acceptable treatment options based on the most accurate scientific evidence. The decision to recommend adjuvant chemotherapy regimens should take into account the risk of baseline relapse, toxicity, likelihood of benefit, and host factors such as comorbidities. Anthracycline and taxane regimens are standard treatment regimens for high-risk, HER2-negative, well -being people. The 4 cycles of docetaxel and cyclophosphamide regimens are acceptable non-anthracycline regimens. For high-risk patients with HER2-positive, anthracycline and taxane sequential therapy combined with trastuzumab or docetaxel, carboplatin, trastuzumab for six cycles of treatment. For low-risk, non-lymph node metastatic, HER2-positive individuals, weekly weekly paclitaxel and trastuzumab regimens are recommended for 12 consecutive cycles of replacement therapy. Trastuzumab should be continued for 1 year. Platinum compound salts should not be used to routinely assist triple-negative populations unless valid survival data emerge.