Cuzick J, Ambroisine L, Davidson N, Jakesz R, Kaufmann M, Regan M, Sainsbury R
Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Lancet. 2007 May 19;369(9574):1711-23. doi: 10.1016/S0140-6736(07)60778-8.
Several trials have been done to assess treatment of premenopausal breast cancer with luteinising-hormone-releasing hormone (LHRH) agonists, but results have been inconclusive, especially for patients with hormone-receptor-positive cancer.
We collected individual patients' data from published trials and did analyses focused on women with tumours positive for oestrogen receptor, progesterone receptor, or both. The main endpoints were recurrence and death after recurrence.
We obtained data for 11 906 premenopausal women with early breast cancer randomised in 16 trials. When used as the only systemic adjuvant treatment, LHRH agonists did not significantly reduce recurrence (28.4% relative reduction, 95% CI consistent with 50.5% reduction to 3.5% increase, p=0.08) or death after recurrence (17.8%, 52.8% reduction to 42.9% increase, p=0.49) in hormone-receptor-positive cancers. Addition of LHRH agonists to tamoxifen, chemotherapy, or both reduced recurrence by 12.7% (2.4-21.9, p=0.02); and death after recurrence by 15.1% (1.8-26.7, p=0.03). LHRH agonists showed similar efficacy to chemotherapy (recurrence 3.9% increase, 7.7% reduction to 17.0% increase; death after recurrence 6.7% reduction, 20.7% reduction to 9.6% increase; both not significant). No trials had assessed an LHRH agonist versus chemotherapy with tamoxifen in both arms. LHRH agonists were ineffective in hormone-receptor-negative tumours.
LHRH agonists provide an additional class of agents for treatment of premenopausal women with hormone-receptor-positive breast cancer. Optimum duration of use is unknown.
已经开展了多项试验来评估促黄体生成激素释放激素（LHRH）激动剂治疗绝经前乳腺癌的效果，但结果尚无定论，尤其是对于激素受体阳性癌症患者。
我们从已发表的试验中收集了个体患者的数据，并对雌激素受体、孕激素受体或两者均为阳性肿瘤的女性进行了分析。主要终点为复发及复发后的死亡情况。
我们获得了16项试验中随机分组的11906例绝经前早期乳腺癌女性的数据。当作为唯一的全身辅助治疗时，LHRH激动剂在激素受体阳性癌症中并未显著降低复发率（相对降低28.4%，95%CI为与降低50.5%至增加3.5%一致，p = 0.08）或复发后的死亡率（17.8%，降低52.8%至增加42.9%，p = 0.49）。在他莫昔芬、化疗或两者基础上加用LHRH激动剂可使复发率降低12.7%（2.4 - 21.9，p = 0.02）；复发后的死亡率降低15.1%（1.8 - 26.7，p = 0.03）。LHRH激动剂显示出与化疗相似的疗效（复发率增加3.9%，降低7.7%至增加17.0%；复发后的死亡率降低6.7%，降低20.7%至增加9.6%；两者均无显著差异）。没有试验评估LHRH激动剂与双臂均使用他莫昔芬的化疗方案的对比。LHRH激动剂在激素受体阴性肿瘤中无效。
LHRH激动剂为治疗绝经前激素受体阳性乳腺癌女性提供了另一类药物。最佳使用时长尚不清楚。
