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1、2024.V1版NCCN指南更新：乳腺癌用药选择2024年1月25日，乳腺癌NCCN指南更新至2024.V1版，此次药物治疗方面的更新主要涉及化疗药物的选择和剂量的调整，具体更新内容如下。并且本文汇总了最新版乳腺癌NCCN指南推荐的靶向、免疫药及方案选择，仅供参考。01、术前/辅助治疗方案HER2阴性的三阴性乳腺癌（TNBC）其他推荐方案调整：紫杉醇+卡钳（不同给药方式）调整为2A类证据多西他赛+卡钳删除“仅用于新辅助治疗”，调整为2A类证据National Comprehensive Cancer Network-NCCN Guidelines Version 1.2024 Invasive
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15、Version1.2024InvasiveBreastCancerPBMfMr(Vw*tof 1Z wa*aW Tfuruna 4 mgfQfVwlMf(l 00M Qf PJun*n. m99 Z v(y2i d* m ba IMd to*VQ Z 60Mon & pUx Z 9ca*t 1 yo V* IV or 17， OReDWid， Dec*Ml 79 Jbo0M(M Cywy2l etof6ey tn Nturat 8 ngM Wg 1.ruvwfrM0 2 rv，i：FLtd*Wwf*MWrWerotwr*nMVq02全身治疗方案ER和/或PR阳性复发不可切除（局部或区域）或IV
16、期（Ml）乳腺癌其他推荐治疗方案调整：修改第二条：选择性ER下调剂（氟维司群）+非俗体芳香化酶抑制剂（阿那曲哇、来曲嘎）（1类），删除氟维司群的“1类推荐”iv.NCCNGuidelinesVersion1.2024弑黑kInvasiveBreastCancer复发性不可切除（局部或区域）或IV期（Ml）疾病靶向治疗和相关生物标志物检测调整:新增任何亚型的生物标志物检测：胚系BRCAl或BRCA2突变，胚系测序，FDA批准用药为奥拉帕利、他拉理帕利，NCCN指南的证据类别为1类，NCCN指南推荐为首选方案HR阳性/HER2阴性的生物标志物检测修订为：PIK3CA或AKTl激活突变或PTEN突变
17、；NGS检测的样本类型修改为：血液或如果血液阴性则使用肿瘤组织National Comprehensive Cancer Network*其他检测的样本类型修改NCCNNCCNGuidelinesVersion1.2024InvasiveBreastCancerTARGETEDTHERAPIESANDASSoClATEDBIOMARKERTESTINGFORRECURRENTUNRESECTALE(LOCALORREGIONAL)ORSTAGEIV(M1DISEASEBINVO 6 OF 14BiomerkersAwocietedwitFDA-ApprovedTr*pBfttCncrS*Jt*
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20、药物：卡培他滨150Omg口服，每日两次，第1-7天和第1521天，每28天循环NCCNNational Comprehensive Cancer NetworkeNCCN Guidelines Version 1.2024 Invasive Breast CancerNCCN Gtxlelnes ItxtexTbte of Contents DtscusoDOSING: SYSTEMIC THERAPY REGIMENS FOR RECURRENT UNRESECTABLE (LOCAL OR REGIONAL) OR STAGE IV (M1) DISEASEHER2NgJtv Rggim
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27、r BnAMltfMa C*N*kaFCOTlVUCO ,taal Mi *l C e9aMB9t * *BMMMCLCOntinUedBINV-Q8 OF 14现将2O24.V1版乳腺癌NCCN指南推荐的靶向、免疫药物及使用方案汇总如下：Ol术前/辅助治疗方案HER2阴性首选方案：奥拉帕利，如果基因检测为胚系BRCAl/2突变高危的三阴性乳腺癌（TNBC）:术前帕博利珠单抗+卡伯+紫杉醇，随后术前帕博利珠单抗+环磷酰胺+阿霉素或表柔比星，随后辅助帕博利珠单抗脚注：c.以下情况考虑加用奥拉帕利辅助治疗1年,胚系BRCAI/2突变且:三阴性乳腺癌（TNBC）,如果1）pT2或）pNl辅助化疗后，
28、或2）新辅助化疗后残留病灶。*HR阳性，HER2阴性，如果1）辅助化疗后4个阳性淋巴结（2A类），或2）术前治疗后残留病变和临床分期、病理分期、雌激素受体状态和肿瘤分级（CPS+EG）评分3。辅助奥拉帕利可与内分泌治疗同时使用。d.OlympiA研究中的患者未接受卡培他滨治疗，因此没有先后顺序或一种方案优于另一种的证据。e.High-risk高危标准包括1111I期TNBC。辅助帕博利珠单抗（2A类）的使用可能需要个体化。NCCNNational Comprehensive Cancer NetworkNCCN Guidelines Version 1.2024 Invasive Breast
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31、 Capocltabino(maintenancetrapyforTNBCafteraduvantCbomothOraPy)OtMrRecommecxSedRgit: ACfollowed5docUxlvy3wksb EC(prubidrVcyclophosphamd) TAC(d8mRcMgProprUv3AQuMtTrpy(BVL3HER2阳性首选方案：紫杉醇+曲妥珠单抗TCH（多西他赛/卡粕/曲妥珠单抗）TCHP（多西他赛/卡铛/曲妥珠单抗/帕妥珠单抗）如果术前治疗后无残留病灶或未接受术前治疗：使用曲妥珠单抗（1类）士帕妥珠单抗完成长达一年的抗HER2靶向治疗如果术前治疗后残留病灶：单独
32、使用恩美曲妥珠单抗（T-DMI）（I类）o如果因毒性停用恩美曲妥珠单抗（T-DMl）,则使用曲妥珠单抗（1类）帕妥珠单抗完成一年的治疗。如果初始淋巴结阳性，采用曲妥珠单抗+帕妥珠单抗（1类）在某些情况下使用：多西他赛+环磷酰胺+曲妥珠单抗AC序贯T+曲妥珠单抗（阿霉素/环磷酰胺序贯紫杉醇+曲妥珠单抗，多种方案）AC序贯T+曲妥珠单抗+帕妥珠单抗（阿霉素/环磷酰胺序贯紫杉醇十曲妥珠单抗+帕妥珠单抗，多种方案）来那替尼（仅辅助治疗）紫杉醇+曲妥珠单抗+帕妥珠单抗恩美曲妥珠单抗（T-DMD（仅辅助治疗）其他推荐方案：AC序贯多西他赛+曲妥珠单抗（阿霉素+环磷酰胺序贯多西他赛+曲妥珠单抗）AC序贯多西他赛+曲妥珠单抗+帕妥珠单抗（阿霉素/环
