University of Pittsburgh, Cancer Institute, Pittsburgh, PA 15232, USA.
Breast. 2009 Oct;18 Suppl 3(0 3):S122-30. doi: 10.1016/S0960-9776(09)70286-3.
Endocrine therapy is a pivotal treatment for women with hormone-receptor positive breast cancer. In premenopausal women, endocrine therapy primarily consists of tamoxifen and ovarian suppressive strategies. Younger women experience improvements in the risks of relapse or death from breast cancer with the use of chemotherapy as well, with part of this benefit explained by resultant premature amenorrhea. Unfortunately despite a centuries worth of clinical trials, the most efficacious combination of hormonal therapies and chemotherapy has yet to be determined. This paper serves as a comprehensive review of the substantial data in the adjuvant treatment of premenopausal, hormone receptor-positive women with breast cancer.
PubMed and American Society of Clinical Oncology (ASCO) Proceedings searches from 1896 to present were performed. All of the trials examining the role of ovarian suppression and tamoxifen with and without chemotherapy in premenopausal women were included. The current data suggests that endocrine therapy can be an important alternative to chemotherapy in select patient populations, and improvements in outcome are also seen with the combination of hormonal and chemotherapy strategies in other populations. A majority of the trials examined did not use what is considered to be current standards of care regarding chemotherapy regimens and durations of adjuvant hormonal therapy. Many unanswered questions remain particularly regarding the combined use of ovarian suppression and tamoxifen in women who are also receiving chemotherapy.
There is a persistent need to define optimal endocrine therapy in premenopasusal women with hormone-receptor positive breast cancer. Contemporaneous trials, such as the SOFT trial will provide direction, and additional biomarker and pharmacogenomic data will further supplement individualized patient decision making.
内分泌治疗是激素受体阳性乳腺癌女性的主要治疗方法。在绝经前女性中，内分泌治疗主要包括他莫昔芬和卵巢抑制策略。年轻女性使用化疗也能改善乳腺癌复发或死亡的风险，其中部分益处可以通过导致的早发性闭经来解释。不幸的是，尽管经过了几个世纪的临床试验，仍然未能确定最有效的激素治疗和化疗联合方案。本文旨在全面回顾激素受体阳性乳腺癌绝经前女性辅助治疗的大量数据。
对 1896 年至今的 PubMed 和美国临床肿瘤学会（ASCO）会议记录进行了检索。所有评估卵巢抑制和他莫昔芬联合或不联合化疗在绝经前女性中的作用的试验均被纳入。目前的数据表明，对于某些患者群体，内分泌治疗可以作为化疗的重要替代方案，而在其他患者群体中，激素和化疗策略的联合也能改善预后。大多数研究并没有采用目前认为是化疗方案和辅助激素治疗持续时间的标准治疗方法。特别是对于同时接受化疗的女性，卵巢抑制和他莫昔芬联合使用的许多问题仍未得到解答。
需要持续定义激素受体阳性乳腺癌绝经前女性的最佳内分泌治疗方法。如 SOFT 试验等当代试验将提供指导，并且更多的生物标志物和药物基因组学数据将进一步补充个体化患者决策。
