Nabholtz Jean-Marc, Gligorov Joseph
Breast Cancer Research Institute, La Prandie, Valojoulx, France.
Rev Recent Clin Trials. 2006 Sep;1(3):237-49. doi: 10.2174/157488706778250069.
Adjuvant hormonal therapy for patients with endocrine sensitive breast cancer has been dominated for several decades by the gold standard tamoxifen. Promising data on third generation aromatase inhibitors (AI), anastrozole, letrozole and exemestane, in metastatic setting led to the development of these agents in early breast cancer. If recent results consistently show the superiority of these agents over tamoxifen, the therapeutic strategies of AIs in adjuvant setting remain discussed. Various approaches have been evaluated ranging from: 1. Front line 5 year use of AI instead of tamoxifen for newly diagnosed patients, to 2. Switching to AI after 2 or 3 years of tamoxifen for patients presently on tamoxifen (total of 5 years), or 3. Continuing with an AI after completion of 5 years of adjuvant tamoxifen. However, it is unclear today whether one of these AI strategies is superior to the other ones. The overall therapeutic index of AIs appears superior to that of tamoxifen with proven improved efficacy and better toxicity profile. AIs are all less toxic than tamoxifen in terms of thromboembolic disease and gynaecological complications while musculoskeletal disorders and joint pains are more frequent seen with AIs. This review will explore the results from the available adjuvant AIs trials and will define the present role of AIs in the adjuvant management of postmenopausal patients with breast cancer.
几十年来，内分泌敏感型乳腺癌患者的辅助激素治疗一直以金标准药物他莫昔芬为主导。在转移性乳腺癌治疗中，第三代芳香化酶抑制剂（AI）阿那曲唑、来曲唑和依西美坦显示出了有前景的数据，促使这些药物在早期乳腺癌治疗中得到应用。尽管近期结果一致表明这些药物优于他莫昔芬，但AI在辅助治疗中的策略仍存在争议。已评估了多种方法，包括：1. 对新诊断患者一线使用AI替代他莫昔芬进行5年治疗；2. 目前正在服用他莫昔芬的患者在服用2或3年后换用AI（总共5年）；3. 在辅助性他莫昔芬治疗5年后继续使用AI。然而，目前尚不清楚这些AI治疗策略中是否有一种优于其他策略。AI的总体治疗指数似乎优于他莫昔芬，已证实其疗效更佳且毒性特征更好。就血栓栓塞性疾病和妇科并发症而言，AI的毒性均低于他莫昔芬，而肌肉骨骼疾病和关节疼痛在AI治疗中更为常见。本综述将探讨现有辅助性AI试验的结果，并确定AI在绝经后乳腺癌患者辅助治疗中的当前作用。
