Carlson Robert W, Hudis Clifford A, Pritchard Kathy I
Department of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA.
J Natl Compr Canc Netw. 2006 Nov;4(10):971-9. doi: 10.6004/jnccn.2006.0082.
Endocrine therapy has a firm role in adjuvant treatment of women with hormone receptor-positive invasive breast cancer. Until recently, tamoxifen was the most commonly used adjuvant endocrine therapy in premenopausal and postmenopausal women. Several randomized clinical trials have studied the third-generation selective aromatase inhibitors (AIs) (anastrozole, letrozole, and exemestane) as adjuvant endocrine therapy in postmenopausal women. These studies compared therapy with an AI alone versus tamoxifen alone; 2 to 3 years of tamoxifen followed by switching to an AI versus continuation of tamoxifen; or extended therapy with an AI after approximately 5 years of tamoxifen therapy. No statistically significant differences in overall survival were observed. A single trial using extended treatment with an adjuvant AI suggests a small, statistically significant survival advantage in women with axillary lymph node-positive disease while showing no statistically significant decrease in survival with the use of an AI. The toxicities of the AIs are generally acceptable, with fewer endometrial cancers, gynecologic complaints, and thromboembolic events, but more bone fractures and arthralgias compared with tamoxifen alone. Three widely disseminated treatment guidelines, the National Comprehensive Cancer Network Breast Cancer Clinical Practice Guidelines in Oncology, the American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors, and the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer, now incorporate AIs in the adjuvant therapy of postmenopausal women with estrogen receptor-positive breast cancer.
内分泌治疗在激素受体阳性浸润性乳腺癌女性的辅助治疗中发挥着重要作用。直到最近，他莫昔芬仍是绝经前和绝经后女性最常用的辅助内分泌治疗药物。多项随机临床试验研究了第三代选择性芳香化酶抑制剂（AIs）（阿那曲唑、来曲唑和依西美坦）作为绝经后女性的辅助内分泌治疗。这些研究比较了单独使用AI治疗与单独使用他莫昔芬治疗；先使用2至3年他莫昔芬后换用AI与继续使用他莫昔芬；或在使用他莫昔芬治疗约5年后使用AI进行延长治疗。在总生存期方面未观察到统计学上的显著差异。一项使用辅助AI进行延长治疗的试验表明，对于腋窝淋巴结阳性疾病的女性，有微小的、统计学上显著的生存优势，同时使用AI并未显示出生存率有统计学上的显著下降。与单独使用他莫昔芬相比，AI的毒性总体上是可接受的，子宫内膜癌、妇科不适和血栓栓塞事件较少，但骨折和关节痛较多。三项广泛传播的治疗指南，即美国国立综合癌症网络《肿瘤学乳腺癌临床实践指南》、美国临床肿瘤学会《芳香化酶抑制剂使用技术评估》以及《早期乳腺癌主要治疗的圣加仑国际专家共识》，现在都将AI纳入了绝经后雌激素受体阳性乳腺癌女性的辅助治疗中。
