Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes J F, Hoctin-Boes G, Houghton J, Locker G Y, Tobias J S
Christie Hospital, Manchester, UK.
Lancet. 2005;365(9453):60-2. doi: 10.1016/S0140-6736(04)17666-6.
The standard adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer is 5 years of tamoxifen, but recurrences and side-effects restrict its usefulness. The aromatase inhibitor anastrozole was compared with tamoxifen for 5 years in 9366 postmenopausal women with localised breast cancer. After a median follow-up of 68 months, anastrozole significantly prolonged disease-free survival (575 events with anastrozole vs 651 with tamoxifen, hazard ratio 0.87, 95% CI 0.78-0.97, p=0.01) and time-to-recurrence (402 vs 498, 0.79, 0.70-0.90, p=0.0005), and significantly reduced distant metastases (324 vs 375, 0.86, 0.74-0.99, p=0.04) and contralateral breast cancers (35 vs 59, 42% reduction, 12-62, p=0.01). Almost all patients have completed their scheduled treatment, and fewer withdrawals occurred with anastrozole than with tamoxifen. Anastrozole was also associated with fewer side-effects than tamoxifen, especially gynaecological problems and vascular events, but arthralgia and fractures were increased. Anastrozole should be the preferred initial treatment for postmenopausal women with localised hormone-receptor-positive breast cancer.
对于激素受体阳性的绝经后局部乳腺癌女性患者，标准的辅助内分泌治疗是服用5年他莫昔芬，但复发和副作用限制了其效用。在9366例绝经后局部乳腺癌女性患者中，将芳香化酶抑制剂阿那曲唑与他莫昔芬进行了为期5年的比较。经过中位68个月的随访，阿那曲唑显著延长了无病生存期（阿那曲唑组有575例事件，他莫昔芬组有651例，风险比0.87，95%置信区间0.78 - 0.97，p = 0.01）和复发时间（402例对498例，0.79，0.70 - 0.90，p = 0.0005），并显著减少了远处转移（324例对375例，0.86，0.74 - 0.99，p = 0.04）和对侧乳腺癌（35例对59例，减少42%，12 - 62，p = 0.01）。几乎所有患者都完成了预定治疗，且阿那曲唑组的退出治疗患者比他莫昔芬组少。与他莫昔芬相比，阿那曲唑的副作用也更少，尤其是妇科问题和血管事件，但关节痛和骨折有所增加。对于绝经后激素受体阳性的局部乳腺癌女性患者，阿那曲唑应作为首选的初始治疗药物。
