Sonoo H, Kurebayashi J
Department of Breast & Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
Breast Cancer. 2000;7(4):297-301. doi: 10.1007/BF02966393.
Predictive markers and variables for response to anticancer therapy provide cancer patients with refinement of therapeutic options and a decreased likelihood of receiving an ineffective therapy. The best-established predictive marker for response to endocrine therapy for breast cancer is the status of estrogen receptors (ER) in the primary breast tumor. However, although patients with ER-positive tumors have a greater than 50% objective response rate to endocrine therapy, other patients can not obtain an objective response. Therefore additional markers, such as better molecular biologic markers, are needed. Our previous study using multivariate analysis revealed that the ER status of primary tumors and the dominant site of metastasis are independent predictors for response to first-line endocrine therapy and that a response to first-line endocrine therapy is only an independent predictor for response to second-line endocrine therapy. However, all these factors are already well-established predictive markers for response to endocrine therapy. Recently, a number of new hormonal agents, such as more selective aromatase inhibitors and specific antiestrogens, have been developed and introduced. However, several questions, such as the best sequences when using hormonal agents, remain to be elucidated. On the other hand, several molecular biologic markers predicting response to endocrine therapy, such as the expression of the HER family of tyrosine kinase receptors, pS2, Bcl-2, and vascular endothelial growth factor, have been reported. To elucidate the most effective use of endocrine therapy for recurrent breast cancer, classical and new predictive factors for response to endocrine therapy are reviewed, and the clinical implications of these factors are discussed.
预测抗癌治疗反应的标志物和变量能为癌症患者优化治疗选择，并降低接受无效治疗的可能性。乳腺癌内分泌治疗反应最明确的预测标志物是原发性乳腺肿瘤中雌激素受体（ER）的状态。然而，尽管ER阳性肿瘤患者对内分泌治疗的客观缓解率超过50%，但其他患者无法获得客观缓解。因此，需要其他标志物，如更好的分子生物学标志物。我们之前使用多变量分析的研究表明，原发性肿瘤的ER状态和转移的主要部位是一线内分泌治疗反应的独立预测因素，而一线内分泌治疗的反应只是二线内分泌治疗反应的独立预测因素。然而，所有这些因素都是内分泌治疗反应已明确的预测标志物。最近，已经开发并引入了一些新型激素药物，如更具选择性的芳香化酶抑制剂和特异性抗雌激素药物。然而，一些问题，如使用激素药物时的最佳顺序，仍有待阐明。另一方面，已经报道了一些预测内分泌治疗反应的分子生物学标志物，如酪氨酸激酶受体HER家族、pS2、Bcl-2和血管内皮生长因子的表达。为了阐明内分泌治疗在复发性乳腺癌中的最有效应用，本文综述了内分泌治疗反应的经典和新的预测因素，并讨论了这些因素的临床意义。
