HR+/HER2+转移性乳腺癌的MDT诊断策略

MDT strategy for HR-positive/HER2-positive metastatic breast cancer

本文介绍1例改良根治术后复发转移的乳腺癌病例的多学科诊治过程。患者术后8年复查发现双肺、颈淋巴结转移,经过多学科讨论后患者接受靶向药物联合化疗控制病情,后续联合内分泌治疗维持。随访近2年后再次发现颈淋巴结转移,经多学科讨论后治疗再次获得缓解。19月后复查发现肝转移灶,经多学科讨论,于部分肝切除术成功的基础上行全身化疗,使用创新性联合抑制雌激素受体(estrogen receptor,ER)、人表皮生长因子受体2(human epidermal growth receptor-2,HER2)、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,m TOR)方案,患者获益显著,无进展生存期>27月。该病例的诊治过程说明,分析病例需要把握病情发展中的主要问题,需要多学科交流以避免出现认识上的误区和局限。应当普及多学科讨论以进一步保证治疗方案的合理性和优化。

Here we described the process of multidisciplinary team（ MDT） strategy for a breast cancer patient with successive multiple metastases. In this case,metastases in bilateral lungs and a cervical lymph node were found after a modified radical mastectomy with axillary lymph node dissection performed 8 years ago. The patient received targeted therapy combined with chemotherapy to control disease progression,followed by targeted therapy plus endocrine therapy to maintain the therapeutic effect. Cervical lymph node recurrence was detected 24 months later. After MDT discussion,the patient received radiotherapy and obtained complete response. At the end of 19-month follow-up,liver metastatic lesion was discovered. After a second MDT discussion,the patient underwent resection of liver metastasis,followed by innovative treatment of co-inhibition of estrogen receptor（ ER）,human epidermal growth receptor-2（ HER2） and mammalian target of rapamycin（ m TOR）. Remarkable clinical benefits were achieved afterwards,reaching over 27 months of progression-free survival（ PFS）. The treatment process of this case indicated the significance of distinguishing and grasping the major problems during the disease progression,as well as the necessity of MDT discussion to avoid misunderstandings and cognitive limitations.Overall,MDT discussion should be popularized to further ensure the rationality and optimization of each therapeutic regimen.