Gould Richard E, Garcia Agustin A
Division of Hematology and Oncology, Cedars Sinai Medical Center, Los Angeles, USA.
Curr Opin Obstet Gynecol. 2006 Feb;18(1):41-6. doi: 10.1097/01.gco.0000192973.54105.86.
Hormonal treatment is one of the cornerstones of management for breast cancer. For many years, tamoxifen represented the gold standard. The development of aromatase inhibitors has, however, challenged the primary role of tamoxifen. Randomized studies evaluating the role of aromatase inhibitors in both the metastatic and adjuvant settings, in postmenopausal women, have been conducted. This article describes the most recent available data for these trials.
The efficacy of aromatase inhibitors for metastatic disease is well established and has not changed recently. Multiple adjuvant aromatase inhibitor trials have been completed and published or presented. These trials vary in the timing of aromatase inhibitor administration, but all show statistically significant reductions in breast-cancer recurrence. An improvement in overall survival has not been observed to date. Tolerability is improved with aromatase inhibitors, the major concern with the use of aromatase inhibitors being the development of osteoporosis and bone fractures.
Aromatase inhibitors are consistently showing improved efficacy and tolerability to tamoxifen for both early and advanced breast cancer. Optimal therapy for postmenopausal women should include an aromatase inhibitor. The optimal sequence of aromatase inhibitors and tamoxifen for adjuvant therapy is still, however, under investigation.
激素治疗是乳腺癌治疗的基石之一。多年来，他莫昔芬一直是金标准。然而，芳香化酶抑制剂的出现对他莫昔芬的主要地位提出了挑战。针对绝经后女性，已开展了评估芳香化酶抑制剂在转移性和辅助性治疗中作用的随机研究。本文介绍了这些试验的最新可用数据。
芳香化酶抑制剂对转移性疾病的疗效已得到充分证实，且近期并无变化。多项辅助性芳香化酶抑制剂试验已完成并发表或公布。这些试验在芳香化酶抑制剂给药时间上有所不同，但均显示乳腺癌复发率在统计学上有显著降低。迄今为止尚未观察到总生存期有所改善。芳香化酶抑制剂的耐受性有所提高，使用芳香化酶抑制剂的主要问题是骨质疏松和骨折的发生。
对于早期和晚期乳腺癌，芳香化酶抑制剂在疗效和耐受性方面均持续显示优于他莫昔芬。绝经后女性的最佳治疗方案应包括芳香化酶抑制剂。然而，芳香化酶抑制剂和他莫昔芬在辅助治疗中的最佳用药顺序仍在研究中。
