Gralow Julie R
Department of Medicine, Division of Oncology, University of Washington School of Medicine, WA, USA.
Breast Cancer Res Treat. 2005;89 Suppl 1:S9-S15. doi: 10.1007/s10549-005-0143-z.
There is currently no standard care for metastatic breast cancer; consequently, individual patient and tumor characteristics are among several factors considered in treatment decisions. Clinical studies continue to clarify the roles of endocrine therapy, chemotherapy, and biologic therapy, and results have been promising. For patients with hormone receptor-positive disease, several endocrine agents are currently available including selective estrogen receptor (ER) modulators (tamoxifen and toremifene), aromatase inhibitors (anastrozole, exemestane, and letrozole), as well as the selective ER down-regulator, fulvestrant. Effective first- and second-line, single-agent chemotherapeutic treatments include the taxanes, anthracyclines, vinorelbine, capecitabine, and gemcitabine. The benefits of sequential, single-agent versus combination chemotherapy are also being evaluated. Although combination chemotherapy generally results in a greater objective response, it is associated with similar survival and usually greater toxicity compared with sequential, single-agent chemotherapy. Research involving biologic therapy continues to provide encouraging results for patients with metastatic breast cancer. Chemotherapy plus trastuzumab has been shown to result in greater overall survival versus chemotherapy alone in human epidermal growth factor 2 (HER-2)-positive patients. Trastuzumab has been associated with cardiotoxicity when administered with conventional anthracyclines. Newer formulations of anthracyclines have been developed (e.g., liposomal anthracyclines) to decrease the incidence of cardiotoxicity, and these provide additional treatment options for patients with metastatic breast cancer. The potential effect of all of these endocrine, chemotherapeutic, and biologic treatments on quality of life is an important consideration. Additionally, integrating patient concerns into treatment decisions and collaborating with cross-disciplinary healthcare providers can help to manage the disease more effectively.
目前转移性乳腺癌尚无标准治疗方案；因此，个体患者和肿瘤特征是治疗决策中考虑的几个因素之一。临床研究不断明确内分泌治疗、化疗和生物治疗的作用，结果令人鼓舞。对于激素受体阳性疾病的患者，目前有几种内分泌药物可供选择，包括选择性雌激素受体（ER）调节剂（他莫昔芬和托瑞米芬）、芳香化酶抑制剂（阿那曲唑、依西美坦和来曲唑），以及选择性ER下调剂氟维司群。有效的一线和二线单药化疗治疗包括紫杉烷类、蒽环类、长春瑞滨、卡培他滨和吉西他滨。序贯单药化疗与联合化疗的益处也在评估中。虽然联合化疗通常会产生更高的客观缓解率，但与序贯单药化疗相比，其生存率相似，且毒性通常更大。涉及生物治疗的研究继续为转移性乳腺癌患者提供令人鼓舞的结果。在人表皮生长因子2（HER-2）阳性患者中，化疗加曲妥珠单抗已被证明比单纯化疗能带来更高的总生存率。曲妥珠单抗与传统蒽环类药物联合使用时会导致心脏毒性。已开发出新型蒽环类药物制剂（如脂质体蒽环类药物）以降低心脏毒性的发生率，这些为转移性乳腺癌患者提供了更多治疗选择。所有这些内分泌、化疗和生物治疗对生活质量的潜在影响是一个重要的考虑因素。此外，将患者的担忧纳入治疗决策并与跨学科医疗服务提供者合作有助于更有效地管理疾病。
