zhenduiruxianaidejiyinjianceyouhaojikuan，henduohuanzhesihubingbuqingchutamendezuoyong，zhishizaiyishengdejianyixiajiuxilihutudizuolejiance。jiyinjiancedaodiyoushenmezuoyong？meigehuanzhedougaizuojiyinjiancema？womenyiqilejieyixia。
mubiao：bimianguozhiliaojiyucefufa
womenzhidao，duiyuzaoqiruxianaihuanzheeryan，chulejinxingjubushoushuqiechuyiwai，haixuyaojinxingyewolinbajiefenqiyijiduizhongliuzuzhidejisushouti（er、hr）、shengzhangyinzishouti（her2）jinxingpinggu，cainengjinyibuzhidingyaowuquanshenzhiliaodejutifangan。
这一治疗思路已经被NCCN（美国国立综合癌症网络）接纳，成为早期乳腺癌患者诊疗的基本流程。这是因为激素受体的情况决定了内分泌治疗是否有效，而生长因子受体HER2则决定了可否使用相应的靶向药——qutuozhudankang，houzhedelinchuangyouxiaolvshixianzhugaoyuchuantonghualiaode。
mubiao：huodegengduozhiliaoxuanze
随着二代测序（NGS）的发展，基因检测技术不仅可为早期乳腺癌患者的“精准”诊疗带来福音，也为进展期（远处转移或复发）的患者带来希望。
muqian，zhuyaoderuxianaixiangguanjiyin，zhuyaodejiuzhiyouer、her2、pik3caheakt1。muqianjuyoulinchuangyingyongqianjingdebaxiangzhiliaozhuyaoyeshizhenduitamende。
1 pik3cayizhiji
qizhongdedianxinglizi，moguoyupik3cayizhijialpelisibkeyufulvestrant（fuweisiqun）delianheshiyong。yanjiubiaoming，yijingliguodaliangzhiliaohoufashengzhuanyidejuejinghouruxianai，gailianheyongyaorengjuyouzaoqiliaoxiao。
而使用这项治疗的必要条件则是：肿瘤细胞ER阳性、PIK3CA基因改变必须存在。
2 PARP抑制剂
chulezhongliuxibaoyichuanbianyixiangguandebaxiangzhiliaowai，yanjiurenyuanyuelaiyueguanzhudnasunshangxiufujiyinxiangguandepeixijiyinquexian，yejiushiyinfazhongliufashengdeneixiexiantianxingdejiyinquexian，ru——brca1/2。
yinci，nccnzaizhidingfufahuozhuanyixingruxianaidehualiaofanganshi，duibrca1/2zhongxibianyidehuanzhe，tebiejienaleparpyizhiji——aolapali，zuoweiher-2yinxingzhongliuhuanzhedeyixianzhiliao。
brca1/2jiyinshiruxianaidelianggezhuyaoyiganjiyin，chengchangransetixianxingyichuan，erbrcajiyintubiandaozhidesanyinxingruxianaiyuezhansanyinxingruxianaide20%。
xiangguanyanjiujieguoxianshi，brca1/2jiyintubianderuxianaixibaoduishunbo、kabo、siliemeisudengyaowugengjiamingan。liru2014nianmeiguosheng·andongniaoruxianaihuiyishoucibaodao，2018niangengxinjieguodetntyanjiujieguoxianshi，brca1/2peixitubianhuanzhezhongjieshoukabozhiliaozudekeguanhuanjielvweiduoxitasaizhiliaozude2bei，wujinzhanshengcunqiyanzhang2.2geyue。
中国乳腺癌患者BRCA1/2基因检测与临床应用专家共识（2018版）建议，在晚期或者复发转移行乳腺癌患者中，若存在BRCA1/2胚系突变，制定化疗方案时可以优先考虑铂类药物而非紫杉醇类药物。