Matsui Akira, Ikeda Tadashi, Jinno Hiromitsu, Tajima Gengo, Hohjou Takashi, Tokura Hideyuki, Mitsui Yoko, Asaga Souta, Muto Takeshi, Kitajima Masaki
Keio Cancer Center, Keio University Hospital.
Gan To Kagaku Ryoho. 2002 Jul;29(7):1138-45.
After the usefulness of ovariectomy in breast cancer patients was demonstrated, endocrine therapy has been one of the most effective treatments of breast cancer. Thereafter, it became clear that estrogen receptors (ERs) existed in the cells of breast cancer. After it was found that ERs could be used as a predictive factor of endocrine therapy for breast cancer, the validity of endocrine therapy has became more certain. Tamoxifen, a major selective estrogen receptor modulator, is the first agent which has shown evidence of improving survival time and disease-free survival time in the treatment of breast cancer, and is the standard treatment, widely used in the treatment of breast cancer all over the world. LH-RH analogue, commonly used in ablation treatment among premenopausal women, produces the same effect as ovariectomy, and recently has shown good results equivalent to chemotherapy in premenopausal breast cancer treatment. Furthermore, aromatase inhibitors as a form of ablation treatment of postmenopausal women have been used recently. In comparison with tamoxifen, aromatase inhibitors have revealed the same or more effective result in postmenopausal breast cancer treatment. In the near future, endocrine mechanisms in the body and the molecular mechanisms of transcription by ER will be more clearly elucidated, and then new kinds of agent and combined therapies for the endocrine treatment of breast cancer will be developed. Currently, many clinical randomized trials are being conducted to examine the effectiveness of new endocrine treatment. Significant changes are occurring in the endocrine treatment of breast cancer.
在证实卵巢切除术对乳腺癌患者有用之后，内分泌治疗一直是乳腺癌最有效的治疗方法之一。此后，人们清楚地认识到雌激素受体（ERs）存在于乳腺癌细胞中。在发现ERs可作为乳腺癌内分泌治疗的预测因子后，内分泌治疗的有效性变得更加确定。他莫昔芬是一种主要的选择性雌激素受体调节剂，是第一种在乳腺癌治疗中显示出能延长生存时间和无病生存时间证据的药物，也是标准治疗方法，在全世界广泛用于乳腺癌治疗。促性腺激素释放激素（LH-RH）类似物常用于绝经前女性的去势治疗，其产生的效果与卵巢切除术相同，最近在绝经前乳腺癌治疗中显示出与化疗相当的良好效果。此外，芳香化酶抑制剂作为绝经后女性去势治疗的一种方式最近也被使用。与他莫昔芬相比，芳香化酶抑制剂在绝经后乳腺癌治疗中显示出相同或更有效的效果。在不久的将来，体内的内分泌机制和ER的转录分子机制将得到更清晰的阐明，届时将开发出用于乳腺癌内分泌治疗的新型药物和联合疗法。目前，许多临床随机试验正在进行，以检验新内分泌治疗的有效性。乳腺癌的内分泌治疗正在发生重大变化。
