CPG มะเร็งเต้านม

78 á¹Ç·Ò§¡ÒõÃǨ¤Ñ´¡Ãͧ ÇÔ¹Ô¨©Ñ áÅÐÃÑ¡ÉÒâäÁÐàÃç§àµŒÒ¹Á

Á¡Õ ÒÃÈ¡Ö ÉÒẺrandomizedcontrolledtrialâ´ÂSlamonDJetal.ã¹¼»ÙŒ dž ·àÕè »¹š ÁÐàçç àµÒŒ ¹ÁÃÐÂÐ
á¾Ã‹¡ÃШÒ·èÕÁÕ HER2 ໚¹¼ÅºÇ¡·èÕäÁ‹à¤Â䴌ÃѺ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒà¤ÁպӺѴÁÒ¡‹Í¹ â´Âà»ÃÕºà·ÕºÃÐËNjҧ
¡ÒÃãˌÂÒà¤ÁպӺѴÍ‹ҧà´ÕÂÇ (doxorubicin ËÃ×Í epirubicin / cyclophosphamide ËÃ×Í paclitaxel) ¡Ñº¡ÒÃãˌ
ÂÒà¤ÁºÕ Óº´Ñ ÃNj Á¡ºÑ trastuzumab¾ºÇҋ ¼»ŒÙ dž ¡ÅÁ‹Ø ·äÕè ´ÃŒ ºÑ ÂÒà¤ÁºÕ Óº´Ñ ÃNj Á¡ºÑ trastuzumabÁÍÕ µÑ ÃÒ¡Òõͺʹͧ
¢Í§âä·´Õè ¡Õ Çҋ (50% vs 32%, p < 0.001) median time to disease progression ·ÂèÕ ÒÇ¡Çҋ (7.4 à´Í× ¹ vs 4.6 à´Í× ¹,
p < 0.001) áÅÐÁÍÕ µÑ ÃÒ¡ÒÃÃÍ´ªÇÕ µÔ ·ÁèÕ Ò¡¡Çҋ â´ÂÁÕ median survival 25.1 à´Í× ¹ à·ÂÕ º¡ºÑ 20.3 à´Í× ¹ (p = 0.046)
â´ÂÁռŢŒÒ§à¤Õ§·èÕÊӤѭ ¤×Í ¡Ò÷ӧҹ¢Í§¡ÅŒÒÁà¹×éÍËÑÇã¨Å´Å§ «èÖ§¾ºä´ŒÊÙ§¶Ö§ 27% 㹡Å؋Á¼ŒÙ»†Ç·èÕ䴌ÃѺ
anthracycline / cyclophosphamide ËÇÁ¡Ñº trastuzumab áÅоºä´Œ 13% 㹡ŋØÁ·èÕ䴌ÃѺ paclitaxel ËÇÁ¡Ñº
trastuzumab ¨§Ö äÁዠ¹Ð¹ÓãË㌠ªŒ trastuzumab ÃNj Á¡ºÑ ÂÒ㹡ÅÁ‹Ø anthracycline

· ¼»ÙŒ dž ·¨èÕ Ðä´ÃŒ ºÑ trastuzumab µÍŒ §ä´ÃŒ ºÑ ¡ÒõÃǨ¡Ò÷ӧҹ¢Í§ËÇÑ ã¨¡Í‹ ¹ä´ÃŒ ºÑ ÂÒ áÅÐãªÂŒ Ò
ä´ãŒ ¹¡Ã³·Õ ÁÕè Õ left ventricular ejection fraction ³ 50% ¼»ŒÙ dž ¤ÇÃä´ÃŒ ºÑ ¡ÒõÃǨ»ÃÐàÁ¹Ô ¡Ò÷ӧҹ¢Í§ËÇÑ ã¨·¡Ø
3 à´Í× ¹ ã¹ÃÐËÇҋ §·äÕè ´ÃŒ ºÑ trastuzumab ÍÂً

ÃдºÑ ¤Óá¹Ð¹Ó 2A
㹡óշÕè¼ÙŒ»†ÇÂÁÕ¡Òõͺʹͧ¢Í§â䵋͡ÒÃÃÑ¡ÉÒ´ŒÇ taxanes / trastuzumab áÅÐàÃÔèÁÁÕ¼Å
¢ŒÒ§à¤Õ§¨Ò¡ taxanes ÁÒ¡¢Öé¹ ÍÒ¨¾Ô¨ÒóÒãˌ trastuzumab µ‹Í໚¹ monotherapy áÅФÇþԨÒóÒËÂØ´ÂÒ
trastuzumab ËÅ§Ñ ä´ÂŒ Ҥú 1 »‚
· äÁ‹á¹Ð¹Óãˌ㪌 trastuzumab ËÇÁ¡ÑºÂÒà¤ÁպӺѴª¹Ô´Í×è¹ ã¹¡Ã³Õ·ÕèâäÅØ¡ÅÒÁÁÒ¡¢Öé¹ã¹
¢³Ð·äèÕ ´ÃŒ ºÑ trastuzumab

ÃдºÑ ¤Óá¹Ð¹Ó 2A
· á¹Ð¹Óãˌ㪌 trastuzumab 㹡ÒÃÃÑ¡ÉÒÁÐàÃç§àµŒÒ¹ÁÃÐÂÐá¾Ã‹¡ÃШÒ·ÕèÁÕ HER2/neu ໚¹
¼ÅºÇ¡â´ÂãªàŒ »¹š ÂÒª´Ø ááÃNj Á¡ºÑ ÂÒà¤ÁºÕ Óº´Ñ ª¹´Ô ͹×è ä´áŒ ¡‹ vinorelbine 㹡ó·Õ ¼èÕ »ŒÙ dž Âà¤Âä´ÃŒ ºÑ adjuvant
chemotherapy ´ÇŒ ÂÂÒ¡ÅÁ؋ taxanes áÅÐâÃ¤Å¡Ø ÅÒÁã¹ÃÐÂÐàÇÅҹ͌ ¡Çҋ 1 »Ë‚ Å§Ñ Ë嫯 taxanes

ÃдºÑ ¤Óá¹Ð¹Ó 2A
ÁÕ¡ÒÃÈÖ¡ÉÒà»ÃÕºà·Õº¡ÒÃ㪌ÂÒ trastuzumab ËÇÁ¡ÑºÂÒ㹡ŋØÁ taxanes ¡Ñº trastuzumab ËÇÁ¡Ñº
vinorelbine໹š ÂÒª´Ø áá㹼»ÙŒ dž ÂÁÐàçç àµÒŒ ¹ÁÃÐÂÐá¾Ã¡‹ ÃШÒ·ÁÕè ÕHER2໹š ¼ÅºÇ¡äÁ¾‹ ºÇҋ Á¤Õ ÇÒÁᵡµÒ‹ §
¡¹Ñ 㹴Ҍ ¹ÍµÑ ÃÒ¡Òõͺʹͧ áÅÐ time to disease progression

· 㹡ó·Õ ¼èÕ »ŒÙ dž Âà¤Âä´ÃŒ ºÑ trastuzumab໹š adjuvanttreatmentáÅÐÁ¡Õ ÒÃ¡ÅºÑ à»¹š «Óé ¢Í§âäã¹
ÃÐÂÐàÇÅÒà¡¹Ô 1 »‚ ÊÒÁÒö¹Ó trastuzumab ¡ÅºÑ ÁÒãªãŒ ËÁä‹ ´Œ

ÃдºÑ ¤Óá¹Ð¹Ó 2A
· á¹Ð¹Óãˌ㪌 lapatinib 㹡ÒÃÃÑ¡ÉÒ¼ŒÙ»†ÇÂÁÐàÃç§àµŒÒ¹ÁÃÐÂÐá¾Ã‹¡ÃШÒ·èÕÁÕ HER2/neu
໹š ¼ÅºÇ¡·ÁèÕ âÕ Ã¤ÅØ¡ÅÒÁã¹¢³Ð·Õèä´ÃŒ ѺËÃ×ÍËÅ§Ñ ¨Ò¡ä´ÃŒ Ѻ¡ÒÃÃÑ¡ÉÒ´ŒÇ trastuzumab â´ÂãˌãªÃŒ ‹ÇÁ¡ÑºÂÒ
capecitabine

ÃдºÑ ¤Óá¹Ð¹Ó 2A

54-117_pc22.pmd 78 19/2/2551, 20:59