Wheler Jennifer, Johnson Melissa, Seidman Andrew
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Semin Oncol. 2006 Dec;33(6):672-80. doi: 10.1053/j.seminoncol.2006.08.018.
Results of five major randomized trials have increased our understanding of the role of aromatase inhibitors in the adjuvant setting. Two of these trials, the Anastrozole or Tamoxifen Alone or in Combination (ATAC) trial and the International Breast Cancer Study Group's BIG 1-98 trial compared an aromatase inhibitor versus tamoxifen as initial hormonal therapy. Three other trial were designed as cross-over studies; the Intergroup Exemestane Study (IES) and the Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 8/German ARNO 95 trial compared a crossover from tamoxifen to an aromatase inhibitor versus continued tamoxifen in women who had completed 2 to 3 years of tamoxifen. The MA-17 trial compared the use of letrozole with placebo for 5 years, following 5 years of tamoxifen. Based on the results of these studies, the use of an aromatase inhibitor for the adjuvant treatment of postmenopausal women with hormone receptor-positive early breast cancer has largely replaced the previous standard of 5 years of tamoxifen. Still unanswered, however, are questions regarding optimal sequencing, selection of aromatase inhibitor, and duration of treatment. This review will provide an overview of the major studies with an emphasis on these important questions.
五项主要随机试验的结果增进了我们对芳香化酶抑制剂在辅助治疗中作用的理解。其中两项试验，即阿那曲唑单药或与他莫昔芬联合应用（ATAC）试验以及国际乳腺癌研究组的BIG 1-98试验，比较了芳香化酶抑制剂与他莫昔芬作为初始激素治疗的效果。另外三项试验设计为交叉研究；国际协作组依西美坦研究（IES）以及奥地利乳腺癌和结直肠癌研究组（ABCSG）的8号试验/德国ARNO 95试验，比较了在完成2至3年他莫昔芬治疗的女性中，从他莫昔芬交叉换用芳香化酶抑制剂与继续使用他莫昔芬的效果。MA-17试验比较了在5年他莫昔芬治疗之后，来曲唑与安慰剂使用5年的效果。基于这些研究结果，对于激素受体阳性的绝经后早期乳腺癌女性，使用芳香化酶抑制剂进行辅助治疗在很大程度上已经取代了先前5年他莫昔芬的标准治疗。然而，关于最佳用药顺序、芳香化酶抑制剂的选择以及治疗持续时间等问题仍未得到解答。本综述将概述主要研究，并着重探讨这些重要问题。
