Cuzick Jack
Wolfson Institute of Preventive Medicine, St. Bartholomew's Medical School, London, UK.
Drugs Today (Barc). 2005 Apr;41(4):227-39. doi: 10.1358/dot.2005.41.4.908563.
Recent trials have indicated that the aromatase inhibitors (anastrozole, letrozole, exemestane) are more effective than tamoxifen, the standard adjuvant treatment for estrogen receptor-positive breast cancer, both in adjuvant and first-line advanced settings. This paper reviews the mode of action and the main clinical trials done with anastrozole, the only aromatase inhibitor currently licensed for use in the adjuvant setting in estrogen receptor-positive tumors. Results from studies using anastrozole as a first-line treatment in advanced disease strongly suggest that this drug should now be considered as an alternative first-line therapy to tamoxifen in postmenopausal women with estrogen receptor-positive advanced breast cancer. As a second-line treatment in tamoxifen failures, anastrozole has shown a better survival rate and a better side-effect profile than megestrol acetate. Similarly, the use of anastrozole in the adjuvant setting has shown a significantly prolonged disease-free survival time and improved tolerability compared to tamoxifen in postmenopausal breast cancer survivors.
近期试验表明，芳香化酶抑制剂（阿那曲唑、来曲唑、依西美坦）在辅助治疗及一线晚期治疗中，比他莫昔芬（雌激素受体阳性乳腺癌的标准辅助治疗药物）更有效。本文综述了阿那曲唑的作用模式以及针对其开展的主要临床试验，阿那曲唑是目前唯一被批准用于雌激素受体阳性肿瘤辅助治疗的芳香化酶抑制剂。在晚期疾病中使用阿那曲唑作为一线治疗的研究结果强烈表明，对于绝经后雌激素受体阳性晚期乳腺癌女性，现在应将该药物视为他莫昔芬的替代一线治疗药物。作为他莫昔芬治疗失败后的二线治疗药物，阿那曲唑已显示出比醋酸甲地孕酮更高的生存率和更好的副作用表现。同样，在辅助治疗中使用阿那曲唑与绝经后乳腺癌幸存者使用他莫昔芬相比，已显示出无病生存期显著延长且耐受性改善。
