Breast Unit, Medical Oncology Division, Ospedale Senatore A. Perrino, Brindisi, Italy.
Oncology. 2009;77 Suppl 1:9-13. doi: 10.1159/000258490. Epub 2010 Feb 2.
The impact of endocrine therapies in the adjuvant treatment of premenopausal patients with early breast cancer is well established. However, the right combination and duration of endocrine manipulations currently available (luteinizing hormone-releasing hormone analogs and tamoxifen) remain unclear. Moreover, the role of chemotherapy in addition to endocrine therapies is not clearly defined. The most recent Early Breast Cancer Trialists' Collaborative Group overview has confirmed the efficacy of five years of tamoxifen in reducing the annual recurrence rate and the annual breast cancer death rate by 41 and 34%, respectively, in an estrogen receptor-positive population. These results are largely irrespective of age, use of chemotherapy or other tumor features. Moreover, the expert panel of the St. Gallen Conference accepted both tamoxifen or tamoxifen plus ovarian suppression as standard endocrine therapy for premenopausal breast cancer patients with endocrine-responsive disease. The use of ovarian suppression or ablation also significantly reduced the risk of breast cancer-related death, mainly in the absence of other systemic therapies. Chemotherapy is widely used in this population; however, its role in endocrine-positive premenopausal women with hormone-positive disease treated with optimal endocrine therapy remains unclear.
内分泌治疗在绝经前早期乳腺癌辅助治疗中的作用已得到充分证实。然而，目前可用的内分泌治疗（促黄体生成素释放激素类似物和他莫昔芬）的最佳联合和持续时间仍不清楚。此外，化疗在除内分泌治疗外的作用也不明确。最近的早期乳腺癌试验者协作组综述证实，在雌激素受体阳性人群中，他莫昔芬治疗 5 年可分别降低 41%和 34%的年复发率和乳腺癌年死亡率。这些结果在很大程度上与年龄、化疗的使用或其他肿瘤特征无关。此外，圣加仑会议专家组接受了他莫昔芬或他莫昔芬联合卵巢抑制作为内分泌反应性疾病的绝经前乳腺癌患者的标准内分泌治疗。卵巢抑制或消融的使用也显著降低了乳腺癌相关死亡的风险，主要是在没有其他全身治疗的情况下。化疗在这一人群中广泛应用；然而，在接受最佳内分泌治疗的激素阳性疾病的绝经前内分泌阳性妇女中，其作用仍不清楚。
