Expert consensus on neoadjuvant treatment of breast cancer in China (2022 edition)

doi:10.19401/j.cnki.1007-3639.2022.01.011

Abstract

CLC Number:

R737.9

Expert group of expert consensus on neoadjuvant treatment of breast cancer in China ( edition) . Expert consensus on neoadjuvant treatment of breast cancer in China (2022 edition)[J]. China Oncology, 2022, 32(1): 80-89.

Figures/Tables 1

题目	投票结果
题目	同意	不同意	弃权或无法确定
临床实践中,初诊不可手术患者,病灶穿刺明确病理学检查结果（浸润性癌）后,何时常规推荐等待IHC结果以制订后续治疗策略：
A.只要化疗方案选择合适（如先蒽环类药物序贯紫杉类药物）,不需等待IHC结果,后续调整即可;	7%	92%	0%
B.所有患者均需等待IHC结果后方制订方案。	84%	15%	0%
临床实践中,初诊可手术患者,拟行新辅助治疗,病灶穿刺明确病理学检查结果（浸润性癌）后, 具有以下特征时,推荐等待IHC结果：
A.只要化疗方案选择合适（如蒽环类药物序贯紫杉类药物）,所有患者均不需等待IHC结果;	12%	87%	0%
B.肿块超过2 cm但cN₀期;	59%	40%	0%
C.肿块超过5 cm但cN₃期;	79%	20%	0%
D.腋窝淋巴结阳性cN₁期;	96%	4%	0%
E.所有患者均需等待IHC结果后方制订方案。	92%	7%	0%
对于腋窝临床体检阴性的患者,新辅助治疗前仍建议进行超声评估腋窝状态	100%	0%	0%
如腋窝临床体检阴性但超声提示可疑腋窝淋巴结,建议超声引导下行穿刺明确	92%	7%	0%
新辅助治疗前,所有患者均需行基线的下述哪项检查,以完整评估原发灶范围：
A.超声;	100%	0%	0%
B.乳腺X线;	89%	7%	3%
C.乳腺磁共振。	86%	10%	3%
新辅助治疗前,哪些患者需行骨扫描：
A.全部患者;	23%	69%	7%
B.仅T₃期和（或）N₂期及以上患者;	67%	25%	7%
C.无需。	0%	96%	3%
新辅助治疗前,哪些患者需行PET/CT：
A.全部患者;	0%	100%	0%
B.仅T₃期和（或）N₂期及以上患者;	75%	17%	6%
C.无需。	11%	85%	3%
仅新辅助治疗前cN₁期及以下患者,新辅助治疗降期后才能进行前哨淋巴结活检（即cN_2-3期患者新辅助治疗降期后也不适合SLNB）。	72%	24%	3%
新辅助治疗降期后,行前哨淋巴结活检时建议常规采用双示踪（蓝染+核素）,其他的替代方法有：
A.采用荧光染料示踪替代核素示踪;	33%	48%	18%
B.对于有经验的操作者,可用蓝染单示踪。	56%	26%	17%
已确认新辅助治疗前,乳腺原发灶需进行标识（内标记marker & 外标记体表投影纹身）,若进行内标记,推荐marker放置的部位为：
A.病灶中央放置marker;	75%	17%	6%
B.病灶中央及边缘放置marker。	67%	21%	10%
已确认新辅助治疗前,乳腺原发灶需进行标识（内标记marker & 外标记体表投影纹身）,若无内标记,应该通过表面病灶投影如纹身或图示等方法外标记。	92%	7%	0%
ER⁺HER²⁺患者,哪些可采用靶向（双靶或单靶抗体药物）联合内分泌治疗：
A.所有患者,基于药敏尝试;	13%	81%	4%
B.高选择的不能耐受化疗患者;	100%	0%	0%
C.ER高表达、淋巴结阴性的绝经后患。	37%	50%	12%
ER^-HER²⁺患者,是否可采用仅用双靶治疗：
A.所有患者,基于药敏尝试;	3%	96%	0%
B.高选择的不能耐受化疗患者;	82%	13%	3%
C.淋巴结阴性的患者。	11%	88%	0%
TNBC患者,患者充分告知并且药物可及时,可推荐新辅助PD-1/PD-L1免疫治疗：
A.所有患者;	7%	88%	3%
B.仅PD-1/PD-L1阳性患者;	37%	51%	11%
C.不常规推荐。	80%	11%	7%
具有较重肿瘤负荷（cN₊期）的TNBC患者,新辅助治疗首选方案：
A.蒽环类药物联合/序贯紫杉类药物;	96%	3%	0%
B.蒽环类药物序贯紫杉类药物和铂类药物;	53%	38%	7%
C.紫杉类药物、铂类药物联合方案（后续序贯或不序贯蒽环类药物）;	66%	33%	0%
D.蒽环类药物、紫杉类药物方案+PARP抑制剂;	3%	88%	7%
E.蒽环类药物、紫杉类药物、铂类药物联合方案+PARP抑制剂。	0%	100%	0%
gBRCAmut患者,新辅助首选方案：
A.蒽环类药物联合/序贯紫杉类药物;	73%	26%	0%
B.蒽环类药物序贯紫杉类药物和铂类药物;	84%	11%	3%
C.紫杉类药物、铂类药物联合方案（后续序贯或不序贯蒽环类药物）;	76%	19%	3%
D.化疗联合PARP抑制剂;	17%	72%	10%
E.仅PARP抑制剂。	3%	96%	0%
Luminal型患者新辅助内分泌治疗适用于：
A.所有患者,基于药敏平台;	7%	92%	0%
B.不能耐受化疗的患者;	88%	7%	3%
C.ER高表达、cT_1-2N₀期患者;	37%	59%	3%
D.除临床试验外,不常规推荐。	59%	37%	3%
Luminal型患者如果使用新辅助内分泌治疗,推荐采用：
A.AI（绝经前+OFS）;	81%	18%	0%
B.氟维司群（绝经前+OFS）;	28%	60%	12%
C.CDK4/6抑制剂+AI（绝经前+OFS）。	42%	53%	3%
2个疗程评估退缩不佳的患者,需考虑治疗策略的改换（局部和或全身治疗）	57%	32%	10%
4个疗程评估退缩不佳的患者,需考虑治疗策略的改换（局部和或全身治疗）	96%	0%	3%
可手术乳腺癌,4个疗程临床评估SD时,HER2阳性,初始化疗+HP双靶治疗：
A.更改化疗方案+HP;	7%	80%	11%
B.更改化疗方案+TKI;	46%	53%	0%
C.更改化疗方案+TKI+曲妥珠单抗;	48%	51%	0%
D.手术;	75%	21%	3%
E.继续原方案。	0%	0%	0%
可手术乳腺癌,4个疗程临床评估SD时,TNBC,初始EC新辅助治疗：
A.继续序贯紫杉类药物方案;	61%	30%	7%
B.序贯紫杉类药物+铂类药物;	75%	20%	4%
C.手术。	69%	26%	3%
可手术乳腺癌,4个疗程临床评估SD时,TNBC,初始TEC新辅助治疗：
A.更改为含铂类药物方案;	50%	42%	7%
B.更改为NX方案;	30%	57%	11%
C.手术;	86%	13%	0%
D.继续TEC 2个疗程。	0%	96%	3%
可手术乳腺癌,4个疗程临床评估SD时,TNBC,初始PCb新辅助治疗：
A.更改为EC;	32%	64%	4%
B.手术;	92%	7%	0%
C.继续PCb 2个疗程。	0%	100%	0%
在规范的新辅助治疗评估,以及足疗程治疗后,初始cN₁期的TNBC或HER₂⁺患者新辅助治疗后cN₀期,前哨淋巴结活检仅获得2枚,均阴性,腋窝如何处理：
A.腋窝淋巴结清扫;	50%	41%	8%
B.腋窝区域放疗;	63%	18%	18%
C.腋窝不处理。	25%	70%	4%
在规范的新辅助治疗评估,以及足疗程治疗后,初始cN₁期的TNBC或HER²⁺患者,新辅助治疗后cN₀期,前哨淋巴结活检仅获得1枚,阴性,腋窝如何处理：
A.腋窝淋巴结清扫;	73%	23%	3%
B.腋窝区域放疗;	33%	58%	8%
C.腋窝不处理。	4%	84%	12%
在规范的新辅助治疗评估,以及足疗程治疗后,初始cN₁期患者,新辅助治疗后cN₀期,前哨淋巴结活检3枚及以上的石蜡包埋切片病理学检查仅1枚ITC时,后续腋窝如何处理：
A.腋窝淋巴结清扫;	50%	50%	0%
B.腋窝区域放疗。	60%	34%	4%
在规范的新辅助治疗评估,以及足疗程治疗后,初始cN₁期患者,新辅助治疗后cN₀期,前哨淋巴结活检3枚及以上的石蜡包埋切片病理学检查仅1枚微转移时,后续腋窝如何处理：
A.腋窝淋巴结清扫;	88%	12%	0%
B.腋窝区域放疗。	50%	41%	8%
在规范的新辅助治疗评估,以及足疗程治疗后,初始cN₁期患者,新辅助治疗后cN₀期,前哨淋巴结活检3枚及以上的石蜡包埋切片病理学检查仅1枚宏转移时,后续腋窝如何处理：
A.腋窝淋巴结清扫;	96%	3%	0%
B.腋窝区域放疗。	13%	78%	8%
初始不可保乳患者,新辅助治疗降期后,临床需慎重保乳的因素：
A.多灶病灶;	100%	0%	0%
B.TNBC;	15%	84%	0%
C.gBRCAmut。	57%	38%	3%
新辅助治疗后实施保乳手术,石蜡包埋切片病理学检查提示切缘不典型增生,后续除了放疗外的处理：
A.残腔广泛切除;	48%	48%	3%
B.全切;	0%	100%	0%
C.不处理。	63%	31%	0%
新辅助治疗后实施保乳手术,切缘阴性的定义：
A.No ink on tumor;	80%	16%	4%
B.1 mm;	48%	40%	11%
C.2 mm;	51%	44%	3%
D.5 mm;	12%	84%	4%
E.10 mm。	0%	96%	3%
HER2阳性,HP双靶+化疗,新辅助治疗后pCR,辅助治疗策略为：
A.继续完成满1年双靶;	100%	0%	0%
B.如新辅助治疗前肿瘤负荷较小（T₂N₀期）,仅使用曲妥珠单抗满1年;	39%	60%	0%
C.如新辅助治疗前肿瘤负荷较大[T₃期和（或）N₂期],辅助HP治疗后,继续TKI治疗1年。	40%	54%	4%
HER2阳性,HP双靶+化疗,新辅助治疗后non-pCR,T-DM1是当前标准的辅助治疗策略,以下情况：
A.残留肿瘤负荷较小时（MP4或RCB1）,可仅HP双靶治疗;	59%	36%	4%
B.残留肿瘤负荷较小时（MP4或RCB1）,可HP双靶治疗后,延长TKI治疗1年;	28%	60%	12%
C.退缩不明显、残留肿瘤负荷较大时（MP1-2或RCB3）可采用T-DM1后再延长TKI治疗1年。	20%	70%	8%
TNBC标准足疗程的新辅助治疗后,pCR,辅助强化治疗：
A.无需进行强化治疗;	91%	8%	0%
B.如新辅助治疗前肿瘤负荷较大[T₃期和（或）N₂期]继续卡培他滨节拍用法1年。	36%	52%	12%
TNBC标准足疗程的新辅助治疗后,non-pCR,卡培他滨是当前标准的辅助治疗策略。如采用PCb新辅助治疗6个疗程后,辅助强化治疗策略为：
A.EC3~4个疗程+/-卡培他滨;	40%	55%	5%
B.卡培他滨。	95%	4%	0%
Luminal（HER2^-）型标准足疗程的新辅助治疗后,non-pCR,辅助治疗策略除了标准内分泌治疗（AI+/-OFS）外：
A.卡培他滨;	37%	62%	0%
B.CDK4/6抑制剂。	77%	13%	9%

References 31

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Expert consensus on neoadjuvant treatment of breast cancer in China (2022 edition)

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