Juretić Antonio, Sarić Nera, Bisof Vesna, Basić-Koretić Martina
Klinika za onkologiju, KBC Zagreb.
Lijec Vjesn. 2006 Jan-Feb;128(1-2):31-6.
Tamoxifen is considered to be the gold standard in hormonotherapy of patients with estrogen dependent breast cancer (estrogen receptor (ER) and/or progesterone receptor (PR) positive tumors). However, because tamoxifen's beneficial effects diminish after 5 years of use in adjuvant setting and because of its partial agonistic effects and its resistence to tamoxifen in some breast carcinoma, there is a need for new antiestrogens. One of these antiestrogens is fulvestrant which, unlike tamoxifen, has no partial agonistic effects. Its efficacy has been confirmed in preclinical and in recent phase III clinical studies in postmenopausal patients. In disease recurrence after adjuvant tamoxifen or progressive disease on-first-line tamoxifen treatment fulvestrant is comparable with (similar to) anastrozole. When compared with tamoxifen as first-line treatment in patients with advanced cancer, only in patients with ER and/or PR positive tumors similar results have also been obtained. In both trials tolerance to fulvestrant has been good. Following the results of these clinical studies fulvestrant has already been licenced in the USA and EU for the treatment of postmenopausal women with advanced breast cancer who had progressed on prior anti-estrogen therapy.
他莫昔芬被认为是雌激素依赖性乳腺癌（雌激素受体（ER）和/或孕激素受体（PR）阳性肿瘤）患者激素治疗的金标准。然而，由于他莫昔芬在辅助治疗中使用5年后有益效果会减弱，且因其部分激动作用以及在某些乳腺癌中存在他莫昔芬耐药性，所以需要新的抗雌激素药物。其中一种抗雌激素药物是氟维司群，与他莫昔芬不同，它没有部分激动作用。其疗效已在绝经后患者的临床前研究和近期的III期临床研究中得到证实。在辅助他莫昔芬治疗后疾病复发或一线他莫昔芬治疗中疾病进展的情况下，氟维司群与阿那曲唑相当（相似）。在晚期癌症患者中与他莫昔芬作为一线治疗进行比较时，仅在ER和/或PR阳性肿瘤患者中也获得了相似结果。在这两项试验中，对氟维司群的耐受性都良好。基于这些临床研究结果，氟维司群已在美国和欧盟获得许可，用于治疗先前抗雌激素治疗后病情进展的绝经后晚期乳腺癌妇女。
