Geisler Jürgen, Lønning Per E
Section of Oncology, Institute of Medicine, University of Bergen, Haukeland University Hospital, N-5021 Bergen, Norway.
Crit Rev Oncol Hematol. 2006 Jan;57(1):53-61. doi: 10.1016/j.critrevonc.2005.05.005. Epub 2005 Dec 7.
The development of the novel, third-generation aromatase inhibitors and inactivators represents a major improvement of endocrine therapy in breast cancer. Subsequent to phase III studies revealing clinical superiority of these drugs compared to conventional therapy as second- and first-line treatment for advanced disease, several randomised studies have found these compounds, administered either as monotherapy or in sequence with tamoxifen, to improve relapse-free survival compared to tamoxifen monotherapy in the adjuvant setting. Notably, we lack data on long-term follow-up with respect to efficacy as well as side effects, and there are currently no data on head to head comparisons between the different aromatase inhibitors. Several critical issues, like influences of treatment on bone and blood lipid profiles underline the need for long-term follow-up with respect to clinical events like bone fractures and cardiovascular events. Finally, we need data on cost-utility with respect to the different strategies as well as with respect to patient age and risk profile.
新型第三代芳香化酶抑制剂和灭活剂的研发代表了乳腺癌内分泌治疗的重大进展。在III期研究显示这些药物作为晚期疾病的二线和一线治疗与传统疗法相比具有临床优势之后，多项随机研究发现，在辅助治疗中，这些化合物无论是单药治疗还是与他莫昔芬序贯使用，与他莫昔芬单药治疗相比，均可提高无复发生存率。值得注意的是，我们缺乏关于疗效和副作用的长期随访数据，目前也没有不同芳香化酶抑制剂之间的直接对比数据。一些关键问题，如治疗对骨骼和血脂谱的影响，凸显了对骨折和心血管事件等临床事件进行长期随访的必要性。最后，我们需要关于不同治疗策略以及患者年龄和风险状况的成本效益数据。
