Hortobagyi Gabriel N
Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Breast Cancer Res Treat. 2003;80 Suppl 1:S37-9. doi: 10.1023/a:1025471601342.
Data from the 'Arimidex', Tamoxifen, Alone or in Combination (ATAC) trial have indicated that anastrozole ('Arimidex') may supplant tamoxifen as the preferred adjuvant endocrine therapy for hormone receptor-positive, early breast cancer in postmenopausal women. The acceptability of this change in clinical practice at this time is currently under debate, and depends upon how confident we can be that 4 years' follow-up is sufficient to allow the overall risk:benefit balance to be assessed. The data supporting the benefits of sequential endocrine therapy are more certain, and if anastrozole does become the adjuvant agent of choice, the optimal sequence of endocrine agents will need to be identified for use after recurrence on anastrozole for early disease. It will be important that new endocrine options, such as the estrogen receptor antagonist fulvestrant ('Faslodex'), are suitably incorporated into these sequences. Developments such as the sequential use of endocrine therapies in the management of breast cancer have stimulated evolving concepts in our understanding of the basic cell biology of the disease. This has emphasized the importance of understanding the interactions between the different cell-signaling pathways that underlie the development of endocrine resistance. This will present a range of new opportunities for therapeutic intervention and will provide the foundation for the rational design of clinical trials. The resulting incorporation of more target-oriented approaches and newer endocrine agents into the treatment of breast cancer should stimulate the development of promising treatment paradigms and will ultimately provide further benefit to patients.
“瑞宁得”、他莫昔芬单药或联合用药（ATAC）试验的数据表明，对于绝经后激素受体阳性的早期乳腺癌女性患者，阿那曲唑（“瑞宁得”）可能会取代他莫昔芬，成为首选的辅助内分泌治疗药物。目前，这一临床实践中的变化是否可接受仍存在争议，这取决于我们对4年随访足以评估总体风险效益平衡的信心程度。支持序贯内分泌治疗益处的数据更为确切，如果阿那曲唑真的成为首选辅助药物，那么对于早期疾病在阿那曲唑治疗复发后，需要确定内分泌药物的最佳使用顺序。将新的内分泌治疗选择，如雌激素受体拮抗剂氟维司群（“芙仕得”），适当地纳入这些治疗序列中将非常重要。乳腺癌治疗中内分泌治疗序贯使用等进展，促使我们对该疾病基本细胞生物学的理解不断演变。这凸显了理解构成内分泌耐药基础的不同细胞信号通路之间相互作用的重要性。这将带来一系列治疗干预的新机会，并为合理设计临床试验奠定基础。由此将更多靶向治疗方法和新型内分泌药物纳入乳腺癌治疗中，应能推动有前景的治疗模式的发展，并最终为患者带来更多益处。
