Dediu M, Median D, Alexandru A, Vremes G, Gal C, Gongu M
Department of Medical Oncology, Institute of Oncology "Alexandru Trestioreanu", Bucharest, Romania.
J BUON. 2009 Jul-Sep;14(3):375-9.
For decades tamoxifen (TAM) has been the mainstay hormonal treatment for estrogen receptor positive (ER+) breast cancer patients. Nevertheless, during the last years, for postmenopausal women particularly, the third generation aromatase inhibitors (AI) became the preferred alternative. The results of the randomized trials showed that AI were superior to TAM in terms of efficacy, and were accompanied by a different but fairly convenient side effects profile. Subsequently, all updated guidelines recommend the use of AI in the adjuvant setting for this category of patients, either upfront, following 2-3 years of TAM or as extended adjuvant therapy, after 5 years of TAM. However, no consensus has been reached regarding the best strategy to be used, and the expert opinion is divided, based on the available evidence. The controversial aspect of whether AI should be used upfront or following 2-3 years of TAM is further detailed in this manuscript, and some useful recommendations are provided in order to facilitate the decision-making process during the current clinical practice.
几十年来，他莫昔芬（TAM）一直是雌激素受体阳性（ER+）乳腺癌患者的主要激素治疗药物。然而，在过去几年中，尤其是对于绝经后女性，第三代芳香化酶抑制剂（AI）成为了首选替代药物。随机试验结果表明，AI在疗效方面优于TAM，且伴有不同但相对方便的副作用谱。随后，所有更新的指南都推荐在辅助治疗中对这类患者使用AI，可一开始就使用，在服用2 - 3年TAM之后使用，或者在服用5年TAM后作为延长辅助治疗使用。然而，关于最佳使用策略尚未达成共识，基于现有证据，专家意见也存在分歧。本手稿进一步详细阐述了AI应一开始就使用还是在服用2 - 3年TAM之后使用这一有争议的问题，并提供了一些有用的建议，以便在当前临床实践中促进决策过程。
