Herold Christina I, Blackwell Kimberly L
Duke Comprehensive Cancer Center, Durham, NC 27710, USA.
Clin Breast Cancer. 2008 Feb;8(1):50-64. doi: 10.3816/CBC.2008.n.003.
For more than 100 years, hormonal therapy has been known to be effective in the treatment of breast cancer. Initially, this therapy was dominated by the selective estrogen receptor antagonists such as tamoxifen. Aromatase inhibitors (AIs) are a distinct drug class with demonstrated activity in the treatment of hormone-sensitive breast cancer. All 3 third-generation AIs, exemestane, anastrozole, and letrozole, have been studied in multiple lines of therapy in advanced breast cancer and have demonstrated equivalence or superiority compared with tamoxifen. While initially developed as a treatment option for advanced disease, the AIs have also shown efficacy in the treatment of curable disease, including the neoadjuvant and adjuvant settings. In addition, the AIs demonstrate a tolerable side effect profile in comparison with tamoxifen, and this has led to their early incorporation as standard of care therapy. Given the proven efficacy of AIs across the spectrum of breast cancer, the remaining questions include definitive sequencing strategy, timing, and duration of use. Ongoing trials include head-to-head comparisons between the AIs in early-stage breast cancer; the results of these trials are eagerly anticipated and should further optimize the use of AIs.
100多年来，人们一直知道激素疗法在乳腺癌治疗中是有效的。最初，这种疗法主要是使用选择性雌激素受体拮抗剂，如他莫昔芬。芳香化酶抑制剂（AIs）是一类独特的药物，在激素敏感性乳腺癌的治疗中已显示出活性。所有三种第三代芳香化酶抑制剂，依西美坦、阿那曲唑和来曲唑，都已在晚期乳腺癌的多线治疗中进行了研究，并且与他莫昔芬相比已显示出等效性或优越性。虽然最初是作为晚期疾病的治疗选择而开发的，但芳香化酶抑制剂在可治愈疾病的治疗中也显示出疗效，包括新辅助和辅助治疗。此外，与他莫昔芬相比，芳香化酶抑制剂的副作用较小，这使得它们早期就被纳入标准治疗方案。鉴于芳香化酶抑制剂在乳腺癌各个阶段已被证实的疗效，剩下的问题包括明确的用药顺序策略、用药时间和用药持续时间。正在进行的试验包括早期乳腺癌中芳香化酶抑制剂之间的直接比较；这些试验的结果备受期待，应该会进一步优化芳香化酶抑制剂的使用。
