Jordan V C
Department of Human Oncology, University of Wisconsin Clinical Cancer Center, Madison 53792.
Cancer. 1992 Aug 15;70(4 Suppl):977-82.
Tamoxifen has become the endocrine treatment of choice for all stages of breast cancer. Its low incidence of side effects and proven survival advantage observed during adjuvant therapy in postmenopausal women with node-positive disease has encouraged the use of long-term treatment for patients to benefit fully from therapy. The drug has an appropriate level of estrogen-like effects that could be beneficial to maintain bone density and prevent development of coronary heart disease by lowering circulating cholesterol. These effects might be useful in all patients with estrogen receptor-positive breast cancer who currently are receiving no therapy. This antiestrogenic agent could be effective therapy to deter recurrence, and the estrogen-like side effects support the physiologic processes of the patient as hormone-replacement therapy. In the laboratory, a tamoxifen-stimulated breast cancer model has been described in vivo. This form of drug resistance may occur in patients after long-term or indefinite adjuvant therapy. Novel pure antiestrogenic drugs have been discovered that soon will become available as second-line therapy after tamoxifen failure. In addition, tamoxifen is being evaluated in the United Kingdom as chemosuppressive therapy to prevent the development of breast cancer in high-risk women. A similar clinical evaluation is underway in the United States.
他莫昔芬已成为乳腺癌各阶段内分泌治疗的首选药物。其副作用发生率低，且在绝经后淋巴结阳性疾病患者的辅助治疗中观察到已证实的生存优势，这促使人们对患者进行长期治疗，以使他们充分受益于该疗法。该药物具有适当水平的雌激素样作用，通过降低循环胆固醇，可能有助于维持骨密度并预防冠心病的发生。这些作用可能对目前未接受任何治疗的所有雌激素受体阳性乳腺癌患者有用。这种抗雌激素药物可能是阻止复发的有效疗法，且其雌激素样副作用可作为激素替代疗法支持患者的生理过程。在实验室中，已在体内描述了他莫昔芬刺激的乳腺癌模型。这种耐药形式可能发生在长期或无限期辅助治疗后的患者中。已发现新型纯抗雌激素药物，在他莫昔芬治疗失败后不久将作为二线治疗药物上市。此外，他莫昔芬正在英国作为化学抑制疗法进行评估，以预防高危女性患乳腺癌。美国也正在进行类似的临床评估。
