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UQJPQ"PMEEIQLR• о᩿Ǜʑ༞ƞƤǔƜƱưᲦͻƷ඙ၷǛǹȈȃȗƞƤƯƠǇƏŵ• о᩿ƔǒЎඣƞǕǔӲᆔƷžኬᏘ঺ᧈ‫܇׆‬ſǛԈƍӕƬƯᔕႆƞƤᲦኬᏘ঺ᧈ‫܇׆‬ƕо᩿ƴ΁ƘƷǛ‫ܹڳ‬ƠƯƍǔŵ• ǬȸǼƷዡႸƕͻƴ᫢ƍᡂǈᲦǬȸǼǛеƕƢ଺ƴЈᘉƢǔŵƦƷƨǊᲦ඙ǓƔƚƨͻǛƞǒƴफ҄ƞƤǔŵ• ǬȸǼƕͻƴƘƬƭƘƨǊᲦǬȸǼʩ੭ƢǔƱ᩼ࠝƴၘƍŵ
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ᏎၶᘐࡸᲢ፭ᣀฌXU፭ᣀฌᲣǢǦȈǫȠᲴϐႆྙƱဃ‫ྙ܍‬ʐƕǜ৖ᘐᘐࡸƷ‫٭‬ᢟᲢଐஜʐၶ‫˟ܖ‬ǢȳǱȸȈᛦ௹Უ80(%)Ꮯሂภ‫܍‬ʐ৐Џᨊᘐʐ৐ภ‫܍‬ᘐᏟሂӳ́ʐ৐Џᨊᘐ

60

Hazard ratio

P-value

Recurrence free survival

1.08

0.56

Overall survival

1.03

0.85

4020
ਘ‫ٻ‬ʐ৐
Џᨊᘐҥኝʐ৐Џᨊᘐ

0‘80

Sasako M et al. N Engl J Med 2008;359:453-62.

቟‫&(׎‬#১ᛐᕤƱϐႆʐƕǜƷʖࢸ

‘85

‘90

‘95

‘00

‘05

ૼᙹᕤдᐮ࠿‫ݰ‬λƱϐႆࢸʖࢸYearᢎㄆ⸆’01-’08 (n=237)’92-’00 (n=170)0'$QGHUVRQ&& ౛ ͂͂͂͂͂͂෌Ⓨᚋ ⏕Ꮡ ⋡⸆ ရᩘ䝝䞊䝉䝥䝏䞁䚸䜰䝸䝭䝕䝑䜽䝇2002

䜰䝻䝬䝅䞁2003䝊䝻䞊䝎2004㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌㻌㻌㻌㻌㻌㻌2005

TS-12006

䝣䜵䝬䞊䝷䚸䝌䝯䝍20072008

2001



2009

䝍䜲䜿䝹䝤2010䝆䜵䝮䝄䞊䝹䚸䜰䝤䝷䜻䝃䞁2011䜰䝞䝇䝏䞁䚸䝝䝷䞂䜵䞁䚸䝣䜵䝋䝻䝕䝑䜽䝇䚸䜹䝹䝪䝥䝷䝏䞁͂͂͂͂V V V V V

Giordano SH et al. Cancer 100:44-52, 2000



Year after recurrenceShigematsu H, Ohno S, et al. BMJ 2010ϐႆʐƕǜƷ඙ၲ঺ጚଐ቟ƴƓƚǔ১ᛐ଺஖Ʒࠀ
0'$QGHUVRQ&& ౛  ஑ᕞࡀࢇࢭࣥࢱ࣮㸦౛㸧১ᛐƷࠀ቟‫׎‬ଐஜ ᴤᴂᴧᴈᴯᕤдӸ࠰’‘ ᴤᴂᴗᴳᴛᴶᴇᴐᴕ

࠰’‘ ᴉᴰᴨᴛᴶᴇᴐᴕ

࠰’‘ ᴔᴶᴂᴩᴓᴶᴈᴱ

࠰’‘ ᴘᴏᴗᴈᴱ࠰’’ ᴖᴶᴳᴈᴘᴶ

࠰’’ ᴉᴤᴶᴯᴏᴓᴵ

࠰’’

 ᴗᴶᴪᴘ

࠰’‘ ᴉᴳᴧᴔᴵ

࠰’’ ᴘᴏᴗᴛᴈᴱ࠰‘‘ ᴢᴈᴖᴤᴷᴙᴵ

࠰’’ ᴘᴊᴑᴱᴤᴶ࠰’’ ᴢᴯᴋᴶᴂᴵ࠰’’



’01-’08 (n=237)’92-’00 (n=170)

͂͂͂͂͂͂෌Ⓨ ᚋ⏕Ꮡ ⋡͂͂͂͂෌Ⓨᚋᖺᩘឋᛦૢဃ‫࠰܍‬ʙ̊ǛᡫƠƯǢǦȈǫȠǛᎋƑǔ
3#.;UᲴSWCNKV[CFLWUVGFNKHG[GCTUᑐ㇟
Kondo MBr J Cancer
2009

἞⒪

ቑศ㈝⏝ຠᯝẚ21㑇ఏᏊRT124䡚300୓෇
PCR᳨ᰝ䠋ᖺ䠄Oncotype DX䠅䝸䞁䝟⠇㌿⛣㝜ᛶ䝩䝹䝰䞁ཷᐜయ㝧ᛶங䛜䜣

Shiroiwa
Breast Cancer HER2㝧ᛶ᪩ᮇங ⾡ᚋ䝖䝷䝇䝒䝈 220䡚330୓෇
Res Treat䛜䜣
䝬䝤䠋෇
2008
Okubo㛢⤒ᚋ䝩䝹䝰䞁
Gan to䝺䝖䝻䝌䞊䝹 vs55୓෇䠋ᖺឤཷᛶ㌿⛣෌ⓎKagaku ryoho䝍䝰䜻䝅䝣䜵䞁ங䛜䜣୍ḟ἞⒪2005• 37ബŴ᧍ኺЭ‫ࣱڡ‬• ଏ۟Ტኽ۟3࠰Ŵ‫پ‬40ബŴ‫̓܇‬ƳƠᲣ• ේ๾ࣱʐሥၶŴᏽၨࢲ2.5cmŴȪȳȑ
ራ᠃ᆆƳƠŴᐥ֥᠃ᆆƳƠᲢStage IᲣ• grade 2ŴǨǹȈȭǲȳӖܾ˳ࣱᨗ
Ტ90ᲟᲣŴȗȭǲǹȆȭȳӖܾ˳ࣱᨗᲢ90ᲟᲣŴHER2ᨏࣱ'$/ƷᲯƭƷǹȆȃȗ
5VGR ွբໜƷਁЈŴଢᄩ҄
[TITLE]

5VGR ऴ‫إ‬ӓᨼ
5VGR ऴ‫إ‬Ʒ৤Йႎӿԛ
5VGR धᎍǁƷᢘࣖ
5VGR 5VGRᲧƷᚸ̖
Presented By Ann H. Partridge, MD, MPH at 2013 ASCO Annual MeetingွբໜƷਁЈŴଢᄩ҄ᘐࢸᕤཋၲඥƷʐƕǜരʧถ‫ݲ‬јௐǢȳǹȩǵǤǯȪȳኒ vs no chemo

Comparison

˴ǛƢǔƱ৖ᘐ→ᘐࢸᕤཋၲඥ

Breast cancer mortality

ExposureǿȢǭǷȕǧȳ5࠰ vs no TAM
50ER+

40
Control
32.7%

30
24.8%

20
17.8%

11.8%

23.6%
≈5 years
tamoxifen

10˴ƴ‫ݣ‬ƠƯ৖ᘐƷǈ%㼼SEPatient37ബŴ‫ࣱڡ‬ƲǜƳधᎍƴ
Stage IƷʐƕǜ

8.6%15-y gain 9.1% (SE 1.0)
Logrank 2p Ჶ0.00001

00

51015(years)

Death rates (%/year: total rate-rate in women without recurrence ) & logrank analyses

OutcomeƲƏƳǔƔʖࢸŴஊܹʙᝋŴᝲဇŴဃ෇ǁƷ᝟ਃ

AllocationTamoxifenControl

Years 0-4
1.79 SE 0.09
2.44 SE 0.10

Years 5-9
2.24 SE 0.11
3.16 SE 0.13

Years 10-14
1.49 SE 0.11
2.26 SE 0.15

Years 15+
1.49 SE 0.16
1.86 SE 0.19

Rate ratio, from(O-E)/V

0.71 SE 0.05
-81.6/237.5

0.67 SE 0.06
-88.6/225.1

0.66 SE 0.08
-39.5/95.9

0.87 SE 0.14
-6.0/41.7

EBCTCG, Lancet 2011඙ၷƷӧᏡࣱƕᲫᲟưǋƋǕƹи˺ဇƷࢍƍ҄‫ܖ‬ၲඥǛӖƚλǕǒǕǔƔᲹBartholomew’s and Homerton Hospital in LondonधᎍƸƲǕƩƚƷ$GPGHKVƕƋǕƹ҄‫ܖ‬ၲඥǛӖƚǔƔ䠂

100
60
5080

4060

3040

20

1020

0025% 15% 10%

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ᏮൗᲭᏮൗμ៲͎࣭ज़μ៲͎࣭ज़Ხ

඙ၲǁƷɧ‫ܤ‬඙ၲǁƷɧ‫ܤ‬ܼʙȷˁʙǁƷࢨ᪪Ჯ඙ၲ଺᧓ƷᧈƞƏƭཞ७ᅈ˟෇ѣǁƷࢨ᪪Ჰද‫ݧ‬Ʒɧࣛज़ܼଈǁƷࢨ᪪ࣱज़ถᡚᲱԠԈ̟ᡐɧ‫ܤ‬ᇌƪƘǒǈ

Ჲμ៲͎࣭ज़ܼʙȷˁʙǁƷࢨ᪪ɦၚ

Ჳ

ზ჈ᨦܹ

֓ӻ˳᣻ถ‫ݲ‬ᲫᲪ ܼଈǁƷࢨ᪪‫ބٶ‬ऒЏǕ

Eur J Cancer Clin Oncol (’83), Ann Oncol (’96), Cancer (’02)धᎍƞǜƷ٣ž঺ыƱƸſи˺ဇƕƳƘŴ඙ၲǛஇࢸǇưӖƚǔƜƱƲƷǑƏƳ඙ၲǛӖƚǔƔኛࢽƠƯƔǒ඙ၲǛӖƚǔƜƱƩƱ࣬ƍǇƢधᎍƞǜƷ٣ž‫ڂ‬૗ƱƸſи˺ဇƸʖेǛᢏƔƴឬƑƨǋƷưŴၶǑǓ৴ƕǜдưരƵƷƔƱ࣬ƏǄƲƭǒƘ᎑ƑᩊƍǋƷưƠƨи˺ဇƕᠲƘƯǋŴϐႆȷ᠃ᆆƠƳƍƜƱƕɟဪƷ঺ы࣎ƷǱǢǋ঺ыƷᦆƩƱ࣬ƍǇƢᒊƠƘƯǋϐႆƠƳƚǕƹ঺ыƔǋƠǕǇƤǜŵƨƩϐႆƢǔŴƠƳƍƴƔƔǘǒƣधᎍᐯ៲ƕኛࢽƠƨኽௐưƋǕƹ঺ыƱƠƯƍƍƷưƸƳƍưƠǐƏƔधᎍƞǜƷ٣žኛࢽƢǔƨǊƴƸſ඙ၲǛ‫ܦ‬᡾ưƖƣŴϐႆŴ᠃ᆆƠƯƠǇƏƜƱŵ‫ܦ‬᡾ưƖƯᐯЎƕưƖǔƜƱǛμƯǍƬƯƍǕƹϐႆƠƯǋ‫ڂ‬૗ƱƸ࣬ƍƨƘƳƍи˺ဇǁƷऀࣨ࣎Ɣǒ৴ƕǜдǛӖƚǇƤǜưƠƨƕŴƦǕ
ǋɧ‫ܤ‬ưƢኛࢽưƖƳƍ඙ၲǍҔၲᎍƱƷǳȟȥȋǱȸǷȧȳɧឱƸ‫ڂ‬૗ƩƱ࣬ƍǇƢ'$/ 'XKFGPEGDCUGFOGFKEKPG ᐯЎƕ৆ƏႻ৖ǛჷǔƜƱƕ‫ٻ‬ʙưƢŵƦƷƏƑưҔၲᎍƕधᎍͨƴᇌƪૅƑƯƘƩƞǔƱኛࢽƕƍƘ඙ၲǛӖƚǒǕǔƱ࣬ƍǇƢŵ

4GUGCTEJ'XKFGPEGǨȓȇȳǹᅹ‫ܖ‬ႎఌਗҔၲᎍƱƸࠝƴॖ࣬ျᡫƠӳƬƯŴ၏ൢƱ᧭ƬƯƍƨƍƱᫍƬƯƍǇƢŵਃ࢘ҔƷέဃǁƷ̮᫂ࡇƩƚƱ࣬ƬƯƍǇƢŵኛࢽǑǓǋɼ඙ҔƷέဃƷᚕᓶǛ̮ơŴ඙ၲǛӖƚƳƕǒƻƱƭƻƱƭኛࢽƠƯƍƬƯƍǇƢŵɟᚕưᚕƑƹŴɼ඙ҔƱƷ̮᫂᧙̞ƕƋǔƔƲƏƔưƢŵ̮᫂᧙̞ƕưƖǔЭƳǒҗЎƳᛟଢƕƋǕƹኛࢽưƖǔƱ࣬ƍǇƢŵ2CVKGPVUÞ
2TGHGTGPEGधᎍƷ‫ڤ‬ǈŴ̖͌ᚇŴᏑ୎%NKPKECN'ZRGTVKUGҔၲᎍƷኺ᬴Ŵ২Ꮱ

'$/ 'XKFGPEGDCUGFOGFKEKPG '$/ƷᲯƭƷǹȆȃȗ
5VGR धᎍƞǜƷբ᫆ǛଢǒƔƴƢǔ
5VGR բ᫆ƴƭƍƯऴ‫إ‬ǛӓᨼƢǔ
5VGR ऴ‫إ‬Ǜ৤ЙႎƴӿԛƢǔ
5VGR ऴ‫إ‬ǛधᎍƞǜƴᢘဇƢǔ
5VGR ƷȗȭǻǹǛᚸ̖ŴӒႾƠƯഏƴƭƳƛǔžʻŴƜƷधᎍƴƱƬƯஇծƷҔၲƸ˴ƔᲹſž̾ŷƷधᎍƷǱǢƷൿ‫ܭ‬ƴƓƍƯŴஇૼƔƭஇᑣƷఌਗᲢǨȓȇȳǹᲣǛᑣ࣎ႎƴദƠƘଢღƴဇƍǔƜƱſྵ‫נ‬МဇӧᏡƳஇǋ̮᫂ưƖǔऴ‫إ‬ǛǋƱƴŴႸƷЭƷधᎍƞǜƴƱƬƯஇծƷҔၲǛ੩̓Ƣǔŵl ႸƷЭƷधᎍƔǒᩉǕŴǳȳȔȥȸǿȸȷȇȸǿșȸǹƳƲǛဇƍƨǨȓȇȳǹऴ‫إ‬ƷӓᨼŴ৤ЙႎƳ౨᚛ƕɶ࣎l 5VGRƷǈƕ'$/ưƋǔƔƷǑƏƴӖƚഥǊǒǕƯƍǔl ᢅӊƷ'$/૙Ꮛǋཎƴ5VGRᲬƴ᣻ƖƕፗƔǕƯƖƨ#TGCUQHEQPVTQXGTU[̽0GGFHQTFGDCVG 5V)CNNGP 2CVKGPVUÞ2TGHGTGPEGƱƸ

5CEMGVVGVCN$/, •ᐮ࠿ᚾ᬴Ƹä– ɟƭƷ඙ၲƕ˂Ʒ඙ၲǑǓǋΟǕƯƍǔƔƲƏƔǛൿǊǔƨǊƴࢫƴᇌƭ– ඙ၲјௐƷ࠯‫ר‬ႎોծࡇӳƍǛൿǊǔƷƴࢫᇌƭ– ̾ŷƷधᎍǛƲƷǑƏƴ඙ၲƢǔƔǛൿǊǔƷƴƸࢫᇌƨƳƍ• ̾ŷƷधᎍǛ඙ၲƢǔƨǊƴŴƲƷǑƏƳǨȓȇȳǹƕࢫᇌƭƔƸᚐ᣷Ʊ᚛ᜭƷբ᫆ᐯЎᐯ៲ƷҔၲᘍໝƴ‫ݣ‬Ƣǔ৤Йႎӿԛǋ࣏ᙲưƋǔ͌धᎍƕᛅƠƨƍƜƱǛƢǂƯᎥƖЈƠƨƔ࣏͌ᙲƳ៲˳ᚮ‫ݑ‬ǛƢǂƯᘍƬƨƔ͌ွբໜƴƭƍƯѠࢍƠƨƔ͌धᎍƴҗЎƳऴ‫إ‬੩̓ǛƠƨƔ͌ᐯЎƷ૾ᤆǛ਀Ơ˄ƚƯƍƳƍƔҗЎƳऴ‫إ‬ǛɨƑǒǕƨɥưƷRTGHGTGPEGƳƷƔᲹ࣬ƍᡂǈưƸƳƍƷƔᲹஜ࢘ƷൢਤƪƔᲹ৴ၶдƸӖƚƨƘƳƍƷჇॖƸᲹl ƖƭƦƏƩƔǒl ƻƲƘӻƘƔǒl ᭟ƕ৷ƚǔƔǒl ˳ƴǘǔƍƔǒl ƍƍᛅǛᎥƔƳƍƔǒl ȷȷȷȷȷȷl ᐯЎƷ၏ཞǛҗЎྸᚐƠƯƍǔƷƔᲹl ৴ၶдƷјௐƱи˺ဇǛҗЎྸᚐƠƯƍǔƷƔᲹl ৴ၶд඙ၲƷᧈ஖ࢨ᪪ǛჷƬƯƍǔƷƔᲹ'$/ƷᲯƭƷǹȆȃȗ
5VGR धᎍƞǜƷբ᫆ǛଢǒƔƴƢǔ
5VGR բ᫆ƴƭƍƯऴ‫إ‬ǛӓᨼƢǔ
5VGR ऴ‫إ‬Ǜ৤ЙႎƴӿԛƢǔ
5VGR ऴ‫إ‬ǛधᎍƞǜƴᢘဇƢǔ
5VGR ƷȗȭǻǹǛᚸ̖ŴӒႾƠƯഏƴƭƳƛǔ͌૾ᤆǛधᎍ˓ƤƴƠƯƍƳƍƔ͌ᇹɤᎍƷᚸ̖ǛӖƚƨƔȊȩȆǣȖƷᙲእ͌धᎍƷᚸ̖ǛӖƚƨƔŭஇǋ᣻ᙲưƋǓƔƭіщǛᙲƢǔƷƸ5VGRn धᎍƷբ᫆ໜŴ̾ŷƷཞඞᲢᅈ˟ႎŴኺฎႎŴ ࣎ྸႎᲣŴ‫ڤ‬ǈŴ̖͌ᚇƷ৭੮Ŵ‫ݭ‬᣻n ஊјƳ‫ݣ‬ᛅƴǑǓŴ̾ŷƷधᎍƷᛖǓǛधᎍƱ ҔၲᎍƕσஊƢǔᲴ0CTTCVKXGDCUGFOGFKEKPG ƦƷǋƷӸᣂႺ೔ᓸ ዓ'$/ܱោȯȸǯȖȃǯǑǓࡽဇ 6JG)QCNUQH%CTG
• The patient’s goals are
not the doctor’s goals• Goals can change overtime• Frank doctor-patientcommunications are anecessityҔၲƷឋĬ ನᡯᲢ5VTWEVWTGᲣ଀ᚨǍᚨͳƳƲƷཋႎ᝻เŴ‫ᧉݦ‬ҔƷૠƱ‫ٶ‬ಮࣱŴҔၲǹǿȃȕƷኵጢŴ૙ᏋᄂᆮೞᏡŴႳᙻೞᏡĭ ᢅᆉᲢ2TQEGUUᲣ‫ܼᧉݦ‬ƴǑǔҔၲ෇ѣᲢᚮૺŴ඙ၲŴȪȏȓȪȆȸǷȧȳŴधᎍ૙ᏋᲣƱधᎍǍܼଈƳƲƷҔၲǁƷӋьĮ ኽௐᲢ1WVEQOGᲣ
Sledge Jr. GW੩̓ƞǕƨҔၲƴឪ‫׆‬Ƣǔ̾ʴǍᨼ‫ׇ‬ƴƓƚǔ‫٭‬҄ᲢஓǇƠƍǋƷŴஓǇƠƘƳƍǋƷǛԃǉᲣ