Bristol Oncology and Haematology Centre, Horfield Road, Bristol, UK.
Clin Oncol (R Coll Radiol). 2011 Apr;23(3):209-15. doi: 10.1016/j.clon.2010.11.005. Epub 2010 Dec 4.
The most effective sequence of tamoxifen and both steroidal (SAIs) and non-steroidal aromatase inhibitors (NSAIs) has been extensively studied in the adjuvant setting. However, treatments for women who have failed initial aromatase inhibitor therapy in the metastatic setting have received relatively little attention. A systematic review was undertaken to assess the use of SAIs and NSAIs in metastatic breast cancer.
Medline, Embase and the Cochrane library were searched using free text and MeSH terms. Studies assessing the cross-resistance, efficacy and safety of SAIs and NSAIs for postmenopausal women with advanced metastatic breast cancer confirmed by histology/cytology were included. Patients had progressed/relapsed from previous adjuvant, first- or second-line aromatase inhibitor treatment and had undergone treatment with at least two regimens consisting of aminoglutethimide, anastrozole, letrozole and/or exemestane.
Nine studies reported results for patients treated with an SAI after treatment failure with an NSAI. For SAI after NSAI, clinical benefit was the most frequently reported outcome. The clinical benefit for exemestane (SAI) after any NSAI failure or before treatment ranged from 12% (complete response not recorded, partial response 2%, stable disease 10%) to 55% (complete response 6%, partial response 13%, stable disease 35%) Survival outcomes were infrequently reported; four studies reported disease progression. The time to progression ranged from 3.7 to 5.2 months. Only one study reported a median overall survival with exemestane at 15.2 months. Only one study reported information for an NSAI after SAI and an NSAI followed by another NSAI.
This review suggests that switching from an NSAI to an SAI is a reasonable option. This would be particularly important for patients who would probably respond to further endocrine manoeuvres; strongly oestrogen receptor-positive disease, non-visceral disease, a good prior response or a long duration of response. Further research to optimise the sequence of endocrine therapies in metastatic breast cancer is needed.
在辅助治疗环境中，已经广泛研究了他莫昔芬与甾体（SAIs）和非甾体芳香酶抑制剂（NSAIs）的最有效序贯治疗。然而，对于在转移性环境中最初使用芳香酶抑制剂治疗失败的女性，其治疗方案相对较少受到关注。本系统评价旨在评估 SAIs 和 NSAIs 在转移性乳腺癌中的应用。
使用自由文本和 MeSH 术语对 Medline、Embase 和 Cochrane 图书馆进行了检索。纳入的研究评估了 SAIs 和 NSAIs 在经组织学/细胞学证实的绝经后晚期转移性乳腺癌患者中的交叉耐药性、疗效和安全性。患者在前辅助、一线或二线芳香酶抑制剂治疗中进展/复发，并且至少接受了两种方案的治疗，这些方案包括氨鲁米特、阿那曲唑、来曲唑和/或依西美坦。
有 9 项研究报告了接受 NSAI 治疗失败后接受 SAI 治疗的患者的结果。对于 NSAI 后 SAI，最常报告的结局是临床获益。依西美坦（SAI）在任何 NSAI 失败后或治疗前的临床获益率为 12%（未记录完全缓解，部分缓解 2%，稳定疾病 10%）至 55%（完全缓解 6%，部分缓解 13%，稳定疾病 35%）。生存结局很少报道；有 4 项研究报告了疾病进展。进展时间为 3.7 至 5.2 个月。只有一项研究报告了依西美坦的中位总生存期为 15.2 个月。只有一项研究报告了 SAI 后和 NSAI 后再使用另一种 NSAI 的信息。
本综述表明，从 NSAI 转换为 SAI 是一种合理的选择。对于那些可能对进一步内分泌治疗有反应的患者，这种方法尤为重要；强雌激素受体阳性疾病、非内脏疾病、良好的前期反应或较长的反应时间。需要进一步研究以优化转移性乳腺癌内分泌治疗的顺序。
