Professor Jiang Zefei: 10 hot topics during breast cancer diagnosis and treatment during the epidemic situation
Recently, Professor Jiang Zefei from the Fifth Medical Center of the General Hospital of the PLA and Professor Li Jianbin from the Institute of Biological Engineering of the Military Medical Research Institute published in the “Thinking of Ten Hot Issues of Breast Cancer Diagnosis and Treatment of New Coronatte Virus Pneumonia” in “Chinese Medical Journal” , I will share it with you now ~
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At the beginning of 2020, the sudden new type of coronary virus pneumonia was swept across the country, which had a huge impact on all walks of life. The closed management of cities and communities, more medical resources invested in the anti -epidemic war. Daily medical care.
The diagnosis and treatment of breast cancer also need to deal with the relationship between control and disease treatment. Therefore, how to reasonably adjust the treatment plan based on evidence -based medical evidence and expert experience, and under emergencies such as new coronary virus pneumonia epidemic, professional doctors to deal with medical issues are undoubtedly a severe test.
To this end, we are paying attention to hotspots recently, combined with the revised “Guidelines for Breast Cancer Diagnosis and Treatment of the Chinese Clinical Oncology Society in 2020”, and put forward our suggestions Correct reference and criticism.
1
Suspected of malignant breast tumor treatment
Breastloperia, image grading Bi-RADS level 4, can observe 1 to 2 months of review. Patients who are highly suspected of vicious, encourage puncture biopsy and clear diagnosis as soon as possible [1].
There is no cancer cells in puncture, you can observe the review after 1 to 2 months, and then decide whether to do lesions.
Poch cancer cells, but the pupils are <3 cm, and the outpatient surgery can be locally removed by the primary stove.
Poch cancer cells, and the mass of ≥3 cm, should be prioritized according to pathological diagnosis and molecular typing, and prioritize the appropriate preoperative neo -assisted treatment.
2
Pre -operation new assisted treatment
Human epidermal growth factor receptor HER2 positive patients with new assisted treatment of surgery. It is recommended to use Twozumab combined with palag. For those who have conditions, Polfuzumab can be added. Bacon canine can be used as white protein, because there is no need for hormone pre -treatment and can be treated, and other chemotherapy is no longer combined with as much as possible. Patients with positive hormone receptors are recommended to assist endocrine therapy, prioritize aromatase inhibitors, and combined with ovarian inhibitory drugs before menopamental. Three -negative breast cancer can use chemotherapy alone, such as leukelin paclitaxel, or can be combined with carplatinist periability, closely observe the treatment reaction, and adjust the medication in time according to the blood image.
Patients who are undergoing new assisted therapy are performed according to the original plan. However, according to the specific situation of the patient and the local epidemic, refer to the above opinion to adjust the treatment plan, and replace the dual -targeted therapy with low toxicity and good curative effects such as: white protein paclitaxel combined with ball monocidils + Puffzab; hormone; hormone; Handicated patients can consider changing endocrine therapy, but the tumor condition is recorded as much as possible when replacing the plan, and the efficacy evaluation is completed.
Patients who have completed neo -assisted therapy have previously required to complete surgery within 4 cycles of neo -assisted ending, but special circumstances, effective patients allow appropriate delayed surgery, which does not affect the efficacy. Patients with effective treatment of new assisted therapy, such as temporarily unable to surgery, based on subsequent possible postoperative adjuvant treatment, in order to maintain the coherence of therapeutic, drug treatment can be considered: hormone receptor -positive can be feasible endocrine therapy; HER2 positive patients can discontinue chemotherapy and continue Original targeted therapy; patients with triple -negative breast cancer can consider starting oral Cape Betabin. In the case of temporarily unable surgery, first use low toxic, effective, and easy to manage drug treatment, wait for conditions permit, and then surgical treatment.
3
Surgery
During the epidemic, surgery can be reasonably selected and extended appropriately: Those with benign diagnosis of clinical diagnosis can be observed first after 1 to 2 months, and then the surgery can be determined; suspicious diagnosis can puncture biopsy first to confirm that patients with priority will be considered for the treatment of new assisted drugs.
Patients who need surgery can use existing resources to open outpatient surgery, reduce the scope of surgery as much as possible, and shorten the surgery time. Those with small tumors and negative armpits can adopt macular resection + outdoor lymph nodes to avoid full milk resection and armpit lymph nodes cleansing. Those who are not suitable for milk protection can be improved, but it is not recommended to perform breast reconstruction during the same period.
The epidemics of various places have different severity. For patients who need surgery in the condition, they encourage peer experts to “recognize each other and continue the treatment”. It is recommended that patients go to hospitals that can surgery in the province and cities, or hospitals in relatively low -risk areas to receive surgery nearby surgery. Essence
4
Postoperative Auxiliary Treatment Plan
Strictly grasp the auxiliary chemotherapy and avoid unnecessary chemotherapy. Patients who need chemotherapy, carefully weigh the advantages of chemotherapy, try to choose chemotherapy programs with low risk of granulocytes, strictly calculate the dose of chemotherapy, will not exceed the standard recommended dosage. Amide (TAC) is a strong chemotherapy.
The postoperative chemotherapy time can be delayed appropriately, and the preventive granulocyte stimulation factor treatment is strictly processed. It is recommended that the first -level prevention of long -acting granulocyte stimulation factor. In principle, you can consider using a polybine combined with cyclophenate (AC) chemotherapy. Patients with relatively low danger can be 4 cycles of AC. High-recurring risk, sequential pair of pair of pairs (AC-T); HER2-positive patients, sequential pair of “AC-T + HP). Although the Chinese Clinical Oncology Society does not recommend leukin paclitaxel for assisting treatment, in special cases, if severe granulation has severe fever after previous ricibility, or potential grains of heat risk, Considering the safe albumin pawnacolic chemotherapy. Patients with positive hormone receptors assist endocrine therapy and can be used after chemotherapy or directly used for low -risk, no chemotherapy. After menopause patients, oral aromatic enzyme inhibitors are preferred; patients with low -risk pre -menopamental patients can take him orally, and high -risk patients who need ovarian function suppression can be used for long -acting preparations once every 3 months, such as temporarily temporarily temporarily Can’t go to the hospital to inject ovarian inhibitory drugs, you can use him Moqifen first.
Auxiliary radiotherapy needs to be completed within 6 months after surgery, but at present, if the epidemic can not go to the hospital for radiotherapy, or to avoid frequent radiotherapy in the hospital and the community, and worrying about the decline in physical resistance caused by radiotherapy, it is recommended to delay 1 ~ Starting 2 months, you can receive auxiliary endocrine or targeted drugs first.
5
Management in postoperative assisted treatment
The auxiliary endocrine treatment treatment is 5 to 10 years. During the epidemic, the outpatient clinic is “long -pressed” and insists on treatment at home. However, even if it is temporarily interrupted for 1 to 2 months for some reason, it has little effect on the treatment effect.
The treatment of auxiliary targeted therapy is 12 months, and the forced extension of 2 to 4 weeks has little impact on the overall curative effect. After recovery, the load dose can be given or appropriately adjusted the subsequent drug gap period to ensure the intensity of the full treatment dose.
Patients in auxiliary chemotherapy can refer to the plan of the auxiliary treatment in part 4, combined with the patient’s condition and reasonable adjustment in a timely manner, which must not only reduce the impact of epidemic on treatment to the greatest extent, but also minimize the risk of infection caused by decreased resistance. For some patients with positive hormone receptor in chemotherapy, if the auxiliary chemotherapy is forced to be interrupted and it is estimated that it cannot be restored in the short term, it can also be careful of endocrine therapy.
6
Regular review changes to the option review
Patients who have been completed after surgery do not need to be restrained every 3 to 4 months of review requirements, and can be postponed 1 to 2 months before reviewing.
Patients who are undergoing endocrine therapy are recommended to prescribe “long -presses” to continue medication without rush to go to the hospital for examination. Patients who receive targeted therapy can complete the blood and heart safety examination. If there are symptoms, the necessary examination is added, but the lung CT and bone scanning are not required for the time being. Patients who are undergoing chemotherapy need to observe adverse reactions closely before each treatment, and adjust the dose in time to ensure the safety of chemotherapy.
Patients with recurrence and metastasis should be appropriately simplified and checked according to the patient’s symptoms and tumor loads, focusing on checking organs with obvious symptoms or obvious symptoms. CT CT is not only commonly used for breast cancer patients, but also an important diagnosis and investigation method for new coronary virus pneumonia. It can be considered. The baseline check -negative and stable patients with stable symptoms are not recommended for routine bone scanning and nuclear magnetic examination.
7
Hormonal receptor positive recurrence metastasis breast cancer treatment
Patients with positive recurrence of hormone receptors can choose endocrine therapy priority, which can reduce the flow of personnel and reduce the risk of infection. The National Medical Security Bureau has introduced the “long -standing” reimbursement policy, supporting medical institutions to reasonably increase the amount of dosage of single prescriptions according to the actual situation of the patient, and reduce the number of patients to obtain drugs in medical institutions.
Endocrine therapy combined targeting drugs can improve the curative effect. Patients with conditions can consider combined treatment. However, based on safety considerations, the adaptation of joint treatment should be strictly grasped, and drugs with low pulmonary toxicity should be selected, such as CDK4/6 inhibitors, Sidamamine [3], etc. If you use Baccilla, you can first use the dose of 100 mg per day, the visual effect and adverse reactions, and then adjust the dose. You can also use endocrine treatment alone, and then decide whether to add targeting drugs after 2 to 4 weeks.
Patients with positive patients who are undergoing chemotherapy are not continuing chemotherapy during special periods. Endocrine therapy can be considered. There is no need to wait for chemotherapy to be invalid or not tolerated chemotherapy, but the tumor lesions should be recorded as much as possible.
8
HER2 -positive recurrence metastatic breast cancer treatment
HER2 positive recurrence metastasel patients with breast cancer, first -line treatment of the first choice of palag chemotherapy combined (Pa) boring monoclonal antibodies, those with effective treatment, the original solution treatment should be continued under the conditions. Those who have been effective in 4 to 6 cycles have been completed, which can be discontinued to retain dual targets as maintenance treatment.
Peninib combined with Koriobin, generally used for advanced patients after Tuskomoto monoclonal treatment, but for HER2 -positive patients who cannot continue infusion, this “double -oral” drug scheme can be used. Patients with HER2 positive second -line or above use oral targeting drugs as much as possible, and can be used or combined with oral chemotherapy drugs. Hormonal receptor -positive can also combine endocrine therapy.
9
Three -negative recurrence metastatic breast cancer treatment
Chemotherapy is the main treatment method for patients with advanced breasts. Such patients are advised not to be combined with chemotherapy, single drug chemotherapy can be used, and weekly therapy can be adopted to facilitate safety management and timely adjustment plans. Oral chemotherapy is given priority, such as Koriocbine, Changchun Rinbin, and foot leafylide. Patients who cannot continue receiving liquid chemotherapy can also be changed to oral chemotherapy. The purpose of early palliative chemotherapy is to “extend the life”. Based on the principle of “long water flow”, the strategy of “beat therapy” can be considered. For patients with small tumors or weak constitution after multi -line treatment, the beats can be slower and slower. Some, even suspension of chemotherapy, performed the best support treatment, ensure the quality of patients’ life to the greatest extent, and provide more home time.
10
Patient management in special periods
During the epidemic, the whole process of the patient needs to be strengthened. The overall principle:
Prefer endocrine therapy, oral chemotherapy drugs, and short -range infusion treatment.
It is recommended that chemotherapy may cause white blood cells to decline, take primary prevention, and give priority to long -acting preparations [4].
The level of breast cancer diagnosis and treatment in my country has greatly improved. The level of diagnosis and treatment in various places is more homogeneous. As long as everyone follows the diagnosis and treatment guide, combines clinical experience, and respects patients’ wishes. Using convenient modern communication technology, conditions can also be introduced to the Chinese Clinical Oncology Society of Breast Cancer Artificial Intelligence Auxiliary Decision -making methods [5], and patients can also receive standard treatment without going far away.
In short, under the new coronary virus epidemic, professional doctors must comply with the spirit of “scientific decision -making and humanistic services”. While actively participating in the anti -epidemic, patients with the initiative to actively take the initiative to minimize the impact of the epidemic on treatment. Protecting tumor patients from virus infections and ensuring the continuity of treatment. I hope that through the efforts of everyone, the effective treatment measures accumulated in the special period of the epidemic will ensure how to ensure the safety and effectiveness of the treatment of tumor patients in the face of emergencies or patients in the face of emergencies or patients in the treatment period. Provide extremely valuable experience.
