美国达纳法博癌症中心Harold J. Burstein教授

　　Oncology Frontier: A few days ago， ASCO updated its guidelines on adjuvant endocrine therapy for women with stages I-III hormone receptor-positive breast cancer. The main updates have to do with the duration of tamoxifen treatment. You are a co-chair of ASCO’s Expert Panel that wrote the guidelines. Could you please explain these updates?

　　《肿瘤瞭望》：不久前，美国临床肿瘤学会（ASCO）对女性I~III期激素受体阳性乳腺癌辅助内分泌治疗的指南进行了更新，主要集中在他莫西芬治疗时间上。作为该指南的ASCO专家组联合主席，能否请您解释一下这些更新呢？

　　Dr Burstein: We recently updated the ASCO endocrine therapy guidelines and as you acknowledged， we recommended more women consider extended therapy up to a total of ten years of tamoxifen， or five years of tamoxifen and then five years of an aromatase inhibitor. We did that because of two global trials， the ATLAS and aTTom studies， that suggested that ten years reduced the risk of recurrence and improved overall survival compared to five years. The difference is relatively small but most women tolerate these drugs reasonably well so the panel felt that the trade-offs favored a general recommendation toward longer durations. There are no data that durations beyond ten years are valuable so usually we would stop at ten years.

　　Burstein教授：正如大家所知道的，我们最近更新了ASCO内分泌治疗指南。我们推荐更多的患者考虑将他莫西芬治疗时间延长至10年，或者前5年以他莫西芬治疗，后五年以芳香化酶抑制剂治疗。这是基于2项全球临床试验的结果，即ATLAS和aTTom研究。研究显示，相比他莫西芬治疗5年的患者，延长至10年的患者复发风险低、且生存时间长。虽然两者间差异相对较小，但大部分女性患者能够很好地耐受这些药物。因此专家组再三权衡，认为服药时间延长应予推荐。目前，暂无有价值的数据支持患者用药超过10年，因此我们建议患者10年后即停止服药。 上述更新对于绝经前期的女性患者来说尤为重要，而芳香化酶抑制剂仅用于绝经后的患者。因此，对于许多确诊乳腺癌的年轻女性来说，他莫西芬治疗10年研究结果的揭晓是一个福音，因为该药物的效果不受绝经状态的影响。此外，我们还对指南中该药物的序贯使用及不良反应进行了细节的修改，但总体来说，治疗时间是本次指南更新的重点。

　　Oncology Frontier: Are there any other notable updates to the guidelines that would be of interest?

　　《肿瘤瞭望》：关于芳香化酶抑制剂方面，我们在应用该药物时，是否能够预测、监测及预防骨质疏松？

　　Dr Burstein: This update was particularly important for women who are pre-menopausal. Aromatase inhibitors are only valuable in post-menopausal women so for many of the younger women who are diagnosed with breast cancer， it was nice to know that there were data for ten years of tamoxifen which works regardless of menopausal status. We had some other smaller changes in the guidelines in terms of sequencing the drugs and side effect updates but the big take-home message was about the duration of therapy.

　　Burstein教授：芳香化酶抑制剂的其中一个副作用就是骨质疏松。对这些患者，我们监测其骨质减少的发生，如果她们确实发生骨质疏松，我们通常会按照国际指南来治疗。常用的治疗方法是使用双膦酸盐药物，这些药物既有口服也有静脉用剂型。

　　Oncology Frontier: A number of studies are trying to make predictions of survival or treatment sensitivity for triple negative breast cancer， by testing androgen receptor expression， tumor-infiltrating lymphocytes， platelet count levels， neutrophil to lymphocyte ratios， or even trying to classify molecular subtypes. How do we evaluate these methods?

　　《肿瘤瞭望》：许多研究试图通过检测雄激素受体表达水平、肿瘤浸润淋巴细胞、血小板计数水平、中性粒细胞与淋巴细胞比值，甚至进行分子水平亚型分类，来预测三阴乳腺癌的生存及治疗敏感性。我们对这些方法应该如何评估？

　　Dr Burstein: Triple negative breast cancer remains a challenging disease to treat. We have lots of different chemotherapy options but we don’t have a target to go after. There is tremendous interest in identifying such a target whether it is immunological therapy based on tumor-infiltrating lymphocytes or anti-androgen therapies based on an androgen receptor or many other targets. These are important studies but they are still very much works-in-progress.

　　Burstein教授：三阴乳腺癌在治疗上仍然是一个棘手的疾病。我们有多种不同大的化疗方案可供选择，但却没有一个明确的靶点。靶点的寻找，不论是基于肿瘤浸润淋巴细胞的免疫治疗，还是针对雄激素受体的抗雄激素治疗，都倾注了我们极大的注意力。这些研究很重要，但目前仍没有取得明显的进展。