Northern Ontario School of Medicine, Regional Cancer Program of Sudbury Regional Hospital, Sudbury, Ontario, Canada.
Ther Clin Risk Manag. 2009 Feb;5(1):91-8. Epub 2009 Mar 26.
Exemestane is a third-generation aromatase inhibitor, which has proven to be a useful drug in the treatment of early stage breast cancer. Several clinical trials have been performed or are currently underway using exemestane as adjuvant therapy in postmenopausal women, which will be the indication reviewed here. A relative reduction in risk of breast cancer recurrence or death of 24% has been shown with exemestane compared with tamoxifen when given after 2 to 3 years of tamoxifen. This corresponded to a 3.3% absolute reduction in recurrence or death at the end of 5 years, for a number needed to treat of 30. The main use of exemestane in the adjuvant setting is as an alternative to tamoxifen, and toxicities are discussed in relation to tamoxifen toxicities. In general, patients receiving exemestane experience less hot flashes and more arthralgias in comparison to tamoxifen, while there is also a reduction in venous thromboembolic events and vaginal bleeding. Patients on exemestane as a group do not appear to have a significantly changed quality of life in comparison to tamoxifen, while having a statistically significant benefit in preventing breast cancer recurrence.
依西美坦是第三代芳香化酶抑制剂，已被证明是治疗早期乳腺癌的有效药物。已经进行或正在进行几项临床试验，使用依西美坦作为绝经后妇女的辅助治疗，这将是这里审查的适应证。与他莫昔芬相比，依西美坦在使用 2 至 3 年后给予时，可使乳腺癌复发或死亡的风险相对降低 24%。这相当于在 5 年结束时，复发或死亡的绝对风险降低了 3.3%，需要治疗的患者人数为 30 人。依西美坦在辅助治疗中的主要用途是替代他莫昔芬，与他莫昔芬的毒性有关。一般来说，与他莫昔芬相比，接受依西美坦治疗的患者出现热潮红的情况较少，关节痛较多，而静脉血栓栓塞事件和阴道出血也有所减少。与他莫昔芬相比，依西美坦组患者的生活质量似乎没有明显改变，但在预防乳腺癌复发方面具有统计学意义的获益。
