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1 北海道外科雑誌 ( ) 59(2): 転移再発乳癌に対する内分泌療法北海道内医師のアンケート調査からの考察 高橋將人, 大村東生, 北田正博, 九冨五郎, 細田充主, 増岡秀次, 渡邊健一, 渡部芳樹, 山下啓子, 平田公一
2 ER. ER, ER
3 高 橋 將 人 他 Ｑ１ は４問設定した 142 閉経前ホルモン受容体陽性乳癌術後治療として 再発治療に関する４つの質問の回答結果をグラフに LH-RH アゴニスト併用したタモキシフェン５年間投 まとめ 道内医師の選択の傾向 現在の標準的治療の 与した 投薬終了２年後に再発した場合今後の治療を 確認 結果が割れた理由などにつき２月に回答者が集 どのように行いますか まり討議した 88 の医師が, 術後補助療法と同一の LH-RH アゴ ニスト タモキシフェンを行うと回答した 化学療法 を選択したのは９ 高用量トレミフェンの選択は３ であった Ｑ２ LH-RH アゴニスト タモキシフェン投与中の再 発 今後の治療をどのように行いますか 55 の医師が LH-RH アゴニスト + アロマターゼ阻 害薬を選択した 次に多いのは化学療法で23 そ の他はほぼ同数で 高用量 トレミフェン LH-RH ア ゴニスト + フルベストラント 合成黄体ホルモン剤 MPA などが選択されていた 化学療法を選択した回答者から LH-RH アゴニス ト + アロマターゼ阻害薬の有効性についてエビデン スとしては認めながらも 保険査定の可能性があり実 施出来ないという意見が出された Ｑ３ 閉経後ホルモン受容体陽性乳癌治療としてアロ マターゼ阻害薬５年間投与した 投薬終了５年後に再 発した場合今後の治療をどのように行いますか アロマターゼ阻害薬を再び投与すると選択した医師 が81 と最も多く タモキシフェンの選択は８ 高 用量トレミフェンの選択は５ であった Ｑ４ 非ステロイドアロマターゼ阻害薬投与中の再発 今後の治療をどのように行いますか ステロイド性アロマターゼ阻害薬の選択が50 タ モキシフェンが26 フルベストラントが18 であっ た 高用量 トレミフェンと化学療法はそれぞれ３ であった 二次内分泌治療として何を選択すべきか回答者の意 見が割れた 新規薬剤フルベストラントは日常診療で の治療経験が少なく 選択すべきかどうかについては 今後の課題であるという意見が出された 27施設35人の医師から回答が得られた 回収率66 平成26年12月 34
4 143 QOL quality of life ER Hortobagyi ER de novo acquired resistance hormone dependency Q hormone dependency ER data CHAT PFS OS LH-RH LH-RH A LH-RH Q ER LH-RH de novo acquired resistance Q de novo LH-RH + LH-RH + - LH-RH LH-RH Q Q Q PFS OS
5 144 ER II FIRST PFS III ER SERMs.... EFECT TTP. PFS mtor PFS..OS QOL Davies C, Pan H, Godwin J, et al: Long-term effects of continuing adjuvant tamoxifen to years versus stopping at years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet - Goss PE, Ingle JN, Pater JL, et al: Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete years of tamoxifen. J Clin Oncol - Davies C, Godwin J, Gray R, et al: Relevance of breast cancer hormone receptors and other factors to the ef cacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet - Hortobagyi GN: Treatment of breast cancer. N Engl J Med - Cardoso F, Costa A, Norton L, et al: st International consensus guidelines for advanced breast cancer ABC. Breast - Klijn JG, Blamey RW, Boccardo F, et al: Combined tamoxifen and luteinizing hormone-releasing hormone LHRH agonist versus LHRH agonist alone in
6 145 premenopausal advanced breast cancer: a meta-analysis of four randomized trials. J Clin Oncol - :., Forward DP, Cheung KL, Jackson L, et al: Clinical and endocrine data for goserelin plus anastrozole as secondline endocrine therapy for premenopausal advanced breast cancer. Br J Cancer - Robertson JF, Llombart-Cussac A, Rolski J, et al: Activity of fulvestrant mg versus anastrozole mg as rstline treatment for advanced breast cancer: results from the FIRST study. J Clin Oncol - Chia S, Gradishar W, Mauriac L, et al: Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptorpositive, advanced breast cancer: results from EFECT. J Clin Oncol - Di Leo A, Jerusalem G, Petruzelka L, et al: Results of the CONFIRM phase III trial comparing fulvestrant mg with fulvestrant mg in postmenopausal women with estrogen receptor-positive advanced breast cancer. J Clin Oncol - Baselga J, Campone M, Piccart M, et al: Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med - Masato Takahashi, Tousei Ohmura, Masahiro Kitada Goro Kutomi, Mitsuchika Hosoda, Hideji Masuoka Ken-ichi Watanabe ), Yoshiki Watanabe Hiroko Yamashita, Koichi Hirata Department of Breast Surgery, NHO Hokkaido Cancer Center Department of Breast Surgery, Higashi Sapporo Hospital First Department of Surgery, Asahikawa Medical College First Department of Surgery, Sapporo Medical College Department of Breast Surgery, Hokkaido University Hospital Sapporo Kotoni Breast Clinic Sapporo Breast Surgical Clinic Unlike estrogen receptor ER -negative breast cancer, half of the recurrences of ER-positive breast cancer are or more years after adjuvant endocrine treatment. In fact, ER-positive breast cancer can recur more than ten years after surgery. There is considerable clinical heterogeneity underlying the difference in the timing of recurrence. In January we conducted a survey of medical doctors engaged in breast cancer treatment at Japanese Breast Cancer Society-authorized facilities in Hokkaido. This survey included four clinical questions about hormonal treatment for ER-positive recurrent breast cancer. We obtained replies from doctors in facilities a response rate of. and analyzed the data thus obtained. Herein we review the questionnaire survey and analyze the different strategies utilized for recurrent breast cancer patients in the facilities. Our ndings emphasize the importance of developing a standard clinical strategy for the treatment of ER-positive recurrent breast cancer.
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教育セミナーテーマ : 転移 再発乳癌 ( 治療 ) 要望テーマ :Hortobagyi のアルゴリズムの改変 川崎医科大学乳腺甲状腺外科 山本裕 第 14 回日本乳癌学会中国四国地方会教育セミナー平成 29 年 9 月 17 日 ( 日 ) はじめに 転移 再発乳癌の治療法を選択する際に 様々な考え方があり 正解 というものは導き出せない 時間的にすべての subtype を網羅できないため 今回の症例は
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