乳がんの生物学的特徴 - csp.or.jp

1 State of the art 15 2007/9/23 24 1 9 23 ( )CSPOR CRC 2 ( )3 80% (ER) (PgR) ER PgR ER PgR ER PgR HER2 20% HER2 HER2 HER2 HER2 LH-RH 6 CH3 OHHO OOHCH3CH3 state of the art 15 2007/9/23 24 27 = 8 = 1aminoglutethimide( testolacotone( 2fadrozole ( )formestane3anastrozole ( )letrozole ( ) exemestane( )10 = ER(++), PgR(++), HER2(-) : ER PgR HER2 ER(-), PgR(-), HER2(+).))

2 ER PgR HER2 state of the art 15 2007/9/23 24 313 The HER(Human Epidermal Growth Factor Receptor)Adapted from Tzahar and Yarden. Biochim Biophys Acta. 1998;1377 Harari, P. M. et al. J Clin Oncol; 25:4057-4065 2007 Schematic illustration of epidermal growth factor receptor (EGFR) signaling inhibition and modes of interaction with radiation and chemotherapy15 HER HER HER 16 HER2 HER2 PrimaryTreatmentComplex 38,000 / 10,000 / 400 / QOL state of the art 15 2007/9/23 24 4 Curative Chemotherapy Palliate symptoms, Prevent symptomsProlong survival QOL Harrison's Principles of Internal Medicine (III )

3 Harrison's Principles of Internal Medicine Harrison's Principles of Internal Medicine Harrison's Principles of Internal Medicine Harrison's Principles of Internal Medicine state of the art 15 2007/9/23 24 5 Harrison's Principles of Internal Medicine 27 The First Milan Trial 386 CMF 12 cycles(179 )(207 )C: CyclophosphamideM: MethotrexateF: 5-fluorouracilC M F C Cyclophosphamide M Methotrexate F 5 FluorouracilCMF (Milan Trial)

4 State of the art 15 2007/9/23 24 631 32 0102030405060708090100012345678910 33 0102030405060708090100012345678910 34 state of the art 15 2007/9/23 24 7 12 24 36 48 60 72 84 96 108 120 132 144274 (1988 - 1993) 19980 (1)1.

5 QOL 2. 3. 4. 5. 6. HER2 7. (2)8. 9. 10. HER2 HER2 3+ FISH +) 11. visceral crisis 12. 13. 14. LHRH LHRH 62 18 n=0 2006 6 Letrozole + capecitabine 0100200300400500600ST439CA15-3capecitabi neletrozoleIU/L state of the art 15 2007/9/23 24 862 Letrozole + capecitabine PD (AC) (Taxanes) Hortobagyi G New Engl J Med 339.

6 974 1998 18 1 NSAIDs 2