Cheung K L, Owers R, Robertson J F R
Division of Breast Surgery, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
Endocr Relat Cancer. 2006 Mar;13(1):251-5. doi: 10.1677/erc.1.01108.
The pure anti-oestrogen fulvestrant has now been licensed for use in advanced breast cancer which has progressed on an anti-oestrogen. Optimal sequencing of various endocrine agents becomes very important in the therapeutic strategy. We report our experience of further endocrine response with another endocrine agent after prior fulvestrant treatment. Among all patients with advanced breast cancer who had been entered into five phase II/III trials using fulvestrant as first- to ninth-line endocrine therapy in our Unit since 1993, 54 patients who fulfilled the following criteria were studied for their subsequent endocrine response: (i) oestrogen receptor positive or unknown; (ii) having been on a subsequent endocrine therapy for > or =6 months unless the disease progressed before; and (iii) with disease assessable for response according to International Union Against Cancer criteria. Eleven patients had received an aromatase inhibitor prior to fulvestrant, which resulted in five CBs (clinical benefit = objective remission/stable disease (SD)) for > or =6 months). Twenty-eight patients achieved CB on fulvestrant. They went on subsequent endocrine therapy with two partial responses, 11 SDs and 15 PDs (progressive disease) at 6 months. The median survival from starting fulvestrant and subsequent endocrine therapy was respectively 46.6 and 18.2 months. Among the remaining 26 patients who progressed at 6 months on fulvestrant, there were three SDs and 23 PDs at 6 months on subsequent endocrine therapy. The median survival from starting fulvestrant and subsequent endocrine therapy was respectively 12.5 and 9.3 months. Of all these 54 patients, 30% (n = 16) therefore achieved CB using another (second- to tenth-line) endocrine agent (anastrozole = 26; tamoxifen = 12; megestrol acetate = 11; others = 5). It would thus appear that further endocrine response can be induced in a reasonable proportion of patients after failing fulvestrant.
纯抗雌激素药物氟维司群现已获批用于在抗雌激素治疗中病情进展的晚期乳腺癌。在治疗策略中，各种内分泌药物的最佳序贯使用变得非常重要。我们报告了在先前使用氟维司群治疗后，使用另一种内分泌药物获得进一步内分泌反应的经验。自1993年以来，在我们科室进行的五项II/III期试验中，所有将氟维司群作为一线至九线内分泌治疗的晚期乳腺癌患者中，54例符合以下标准的患者被研究其后续内分泌反应：（i）雌激素受体阳性或未知；（ii）接受后续内分泌治疗≥6个月，除非疾病在此之前进展；（iii）根据国际抗癌联盟标准，疾病可评估反应。11例患者在使用氟维司群之前接受过芳香化酶抑制剂治疗，其中5例获得临床获益（临床获益=客观缓解/疾病稳定（SD））≥6个月）。28例患者在氟维司群治疗中获得临床获益。他们继续接受后续内分泌治疗，6个月时出现2例部分缓解、11例疾病稳定和15例疾病进展。从开始使用氟维司群及后续内分泌治疗起的中位生存期分别为46.6个月和18.2个月。在其余26例在氟维司群治疗6个月时病情进展的患者中，后续内分泌治疗6个月时出现3例疾病稳定和23例疾病进展。从开始使用氟维司群及后续内分泌治疗起的中位生存期分别为12.5个月和9.3个月。因此，在这54例患者中，30%（n = 16）使用另一种（二线至十线）内分泌药物（阿那曲唑=26例；他莫昔芬=12例；醋酸甲地孕酮=11例；其他=5例）获得临床获益。因此，在氟维司群治疗失败后，相当比例的患者似乎可以诱导出进一步的内分泌反应。
