Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
Expert Rev Anticancer Ther. 2010 Aug;10(8):1239-53. doi: 10.1586/era.10.54.
Aromatase inhibitors (AIs) are becoming the hormonal treatment of choice for postmenopausal women with early breast cancer. Large, well-controlled clinical studies have established the efficacy and safety of initial adjuvant therapy with letrozole or anastrozole versus the previous standard of 5 years of adjuvant tamoxifen and support using an AI (exemestane, anastrozole or letrozole) following tamoxifen for 2-3 years (early 'switch' treatment) or 5 years (extended adjuvant treatment). Reducing recurrence risk is a primary goal of adjuvant hormonal therapy. There is an early peak of recurrences 2 years after surgery; most are distant metastases rather than local or regional events. Therefore, treatment strategies such as initial therapy with AIs, which reduce early distant recurrence events, can be expected to improve long-term survival outcomes. Switching to an AI following 2-3 years of initial adjuvant tamoxifen is an effective option for patients unable to begin treatment with an AI.
芳香酶抑制剂 (AIs) 正在成为绝经后早期乳腺癌女性的首选激素治疗药物。大型、对照良好的临床研究已经确立了来曲唑或阿那曲唑初始辅助治疗的疗效和安全性，优于之前的标准 5 年辅助他莫昔芬治疗，并支持在他莫昔芬治疗 2-3 年后（早期“转换”治疗）或 5 年后（延长辅助治疗）使用 AI（依西美坦、阿那曲唑或来曲唑）。降低复发风险是辅助激素治疗的主要目标。手术后 2 年内复发风险有一个早期高峰；大多数是远处转移，而不是局部或区域性事件。因此，例如初始使用 AI 治疗等治疗策略可以减少早期远处复发事件，有望改善长期生存结局。对于无法开始 AI 治疗的患者，在初始辅助他莫昔芬治疗 2-3 年后转换为 AI 是一种有效的选择。
