编者按：由中国抗癌协会乳腺癌专业委员会、上海市抗癌协会等单位联合主办的第十八届上海国际乳腺癌论坛（SIBCS）于12月15日在上海成功召开，以促进全国乳腺癌领域工作者的沟通、交流、合作，共同提高中国乳腺癌诊治水平。会议上来自奥地利维也纳医科大学的Michael Gnant教授进行了“早期乳腺癌：走向治愈”的报告，《肿瘤瞭望》特邀Michael Gnant教授进一步分享如何提高乳腺癌患者生存等相关话题。

 

Michael Gnant教授：早期诊断对于乳腺癌治愈率的提高非常重要，同时能够确保“以患者为中心”，并且可避免不必要的副作用。对于乳腺癌而言，我们越早发现，治愈的可能性就越大。目前全球的很多国家均实行了乳腺癌筛查计划，而且非常成功：例如，在35岁时可进行首次乳腺X线检查，45~75岁间每2年进行1次乳腺X线检查；有时还应包括超声检查和MRI等内容，特别对于年轻女性以及高风险人群（具有家族史、遗传学背景）。

 

Oncology Frontier:How do you think screening should be done to detect more early-stage breast cancer for early diagnosis and treatment?

 

Dr.Michael Gnant:Early diagnosis is important for increasing the cure rate，and enabling patient-centered and side-effect sparing treatment.The earlier we detect breast cancer，the better the chances for cure.In many countries，national screening programs have been very successful-e.g.first mammography at the age of 35，biennial mammography from age 45 to 75-sometimes also including sonography and MRI，particularly for younger women，and in particular persons at increased risk(family history，genetics).

Michael Gnant教授：当代指南呼吁对晚期乳腺癌进行一系列的内分泌干预，目前还包括CDK4/6抑制剂等药物。一些新的药物已经可用于二线治疗，如alpelisib（针对PI3K突变）、Elacestrant（针对ESR-1突变），并且最近出现的ADC（如T-DXd）在后线治疗中也可能会取代传统化疗。综上所述，激素受体阳性转移性乳腺癌的平均生存时间已延长至5年以上（20年前仅为12~18个月）。

 

Oncology Frontier:Endocrine therapy has greatly improved the survival of patients with HR+breast cancer.But for patients who progress，how should follow-up treatment options be selected?

 

Dr.Michael Gnant:Contemporary guidelines call for serial endocrine intervention for advanced breast cancer.This nowadays includes a CDK 4/6 inhibitor.New agents are available for combination in second line，such as alpelisib(for PI3K mutations)，Elacestrant(for ESR-1 mutations)，and probably soon ADCs such as T-Dxd substituting for traditional chemotherapy in later lines.In summary，the average survival times for hormone-receptor positive metastatic breast cancer have increased to more than 5 years(from 12 to 18 months 20 years ago).

 

Michael Gnant教授：临床研究的重点是更准确地识别具有特定生物标志物的患者群体，使他们能够成为降阶治疗或升阶治疗的候选人群。同时，进一步的个性化治疗方案是当代转化和临床研究的目标。

 

Oncology Frontier:How do you think breast cancer treatment drugs will be developed in the future to further improve patients’survival time and quality of life?

 

Dr.Michael Gnant:Clinical research is focusing on identifying more accurately patient subset with specific biomarkers that make them candidates for de-escalation or escalation of treatment，respectively.Further personalizing our treatments is the goal of contemporary translational and clinical research.

 

Michael Gnant教授

奥地利维也纳医科大学外科教授

奥地利乳腺癌和结肠直肠癌研究小组主席