Athens University Medical School, 8, Iassiou str, 11521 Athens, Greece.
Cancer Metastasis Rev. 2010 Dec;29(4):581-94. doi: 10.1007/s10555-010-9248-x.
Breast cancer is one of the leading causes of cancer-related deaths in women. Regardless of prognosis, all women with breast cancer are at risk for early recurrence. Nearly 50% of early recurrences occur within 5 years of surgery, and they peak at 2 years after surgery in women treated with adjuvant tamoxifen. Most early recurrences are distant metastases, which strongly correlate with increased mortality. Treatments that mitigate the risk of early distant metastases (DM) are, therefore, likely to improve overall survival in women with early breast cancer (EBC). Aromatase inhibitors (AIs)--anastrozole, letrozole, and exemestane-have been investigated as alternatives to tamoxifen for adjuvant treatment of hormone receptor-positive (HR+) EBC in postmenopausal women (PMW). AIs are better at minimizing risk of early relapse compared with tamoxifen. However, it is not clear if preferential use of AIs over tamoxifen will benefit all PMW with HR+ EBC. The ability to subtype HR+ breast cancer on the basis of biomarkers predictive of response to AIs and tamoxifen would likely be key to determining the most beneficial hormonal treatment within patient subpopulations, but this process requires thorough investigation. Until then, adjuvant therapies that provide the greatest reduction in risk of DM should be considered for all PMW with HR+ EBC. This article reviews the clinical trials of AI adjuvant therapies for hormone-sensitive breast cancer, particularly in the context of how they compare with tamoxifen in minimizing the risk of relapse, occurrence of DM, and breast cancer-related deaths.
乳腺癌是导致女性癌症相关死亡的主要原因之一。无论预后如何，所有患有乳腺癌的女性都有早期复发的风险。近 50%的早期复发发生在手术后 5 年内，在接受辅助他莫昔芬治疗的女性中，手术后 2 年内达到高峰。大多数早期复发是远处转移，这与死亡率的增加密切相关。因此，减轻早期远处转移（DM）风险的治疗方法可能会改善早期乳腺癌（EBC）女性的总生存率。芳香化酶抑制剂（AIs）——阿那曲唑、来曲唑和依西美坦——已被研究作为绝经后妇女（PMW）激素受体阳性（HR+）EBC 辅助治疗的替代他莫昔芬。与他莫昔芬相比，AIs 更能降低早期复发的风险。然而，目前尚不清楚是否优先使用 AIs 而不是他莫昔芬会使所有 HR+ EBC 的 PMW 受益。基于预测对 AIs 和他莫昔芬反应的生物标志物对 HR+乳腺癌进行亚型分类的能力，可能是确定患者亚群中最有益的激素治疗方法的关键，但这一过程需要深入研究。在那之前，应该考虑为所有 HR+ EBC 的 PMW 提供最大程度降低 DM 风险的辅助治疗。本文综述了 AI 辅助激素敏感性乳腺癌治疗的临床试验，特别是在它们如何与他莫昔芬相比最小化复发风险、DM 发生率和乳腺癌相关死亡方面的临床试验。
