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对于希望保留生育能力的激素受体阳性肿瘤患者,辅助治疗用 GnRH 激动剂/他莫昔芬是一个很好的选择。

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility.

机构信息

Center for Human Reproduction Prof. Franco Jr, Ribeirao Preto, Brazil.

出版信息

Med Hypotheses. 2012 Apr;78(4):442-5. doi: 10.1016/j.mehy.2011.12.015. Epub 2012 Jan 28.

DOI:10.1016/j.mehy.2011.12.015
PMID:22284634
Abstract

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.

摘要

不孕是乳腺癌辅助化疗的主要长期后果之一。大约 60-65%的乳腺癌在绝经前妇女中表达核激素受体。辅助内分泌治疗是激素受体阳性 (HR+) 肿瘤患者治疗的重要组成部分。GnRH 激动剂 (GnRHa) 单独或与他莫昔芬联合使用,在 HR+ 乳腺癌患者的无复发生存率和总生存率方面,至少与不同的化疗方案的结果相似。对于希望保留生育功能的 HR+ 乳腺癌 (HR+ 肿瘤) 患者,现在是时候考虑使用 GnRHa 联合他莫昔芬进行辅助治疗了。应在 GnRHa/他莫昔芬治疗结束后 6 个月和 1 年时进行卵巢储备试验(卵泡刺激素 (FSH)、抗苗勒管激素 (AMH)、抑制素 B、窦卵泡计数 (AFC) 和卵巢体积)的评估。应分析无复发生存率和总生存率。这一假设的主要意义在于避免对要求保留生育能力的 HR+ 乳腺癌患者进行辅助化疗。预计在几乎所有情况下都不会改变卵巢功能,并且随后妊娠成为可能。

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1
Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility.对于希望保留生育能力的激素受体阳性肿瘤患者,辅助治疗用 GnRH 激动剂/他莫昔芬是一个很好的选择。
Med Hypotheses. 2012 Apr;78(4):442-5. doi: 10.1016/j.mehy.2011.12.015. Epub 2012 Jan 28.
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Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials.促黄体生成素释放激素激动剂在激素受体阳性绝经前乳腺癌患者中作为辅助治疗的应用:来自随机辅助试验的个体患者数据的荟萃分析
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Gonadotropin-releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma.在辅助化疗中添加促性腺激素释放激素类似物可保护年轻早期乳腺癌女性的卵巢功能并改善临床结局。
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Postoperative adjuvant chemotherapy followed by adjuvant tamoxifen versus nil for patients with operable breast cancer: a randomised phase III trial of the European Organisation for Research and Treatment of Cancer Breast Group.可手术乳腺癌患者术后辅助化疗序贯他莫昔芬与不进行辅助治疗的比较:欧洲癌症研究与治疗组织乳腺癌协作组的一项随机III期试验
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Luteinising hormone releasing hormone agonists (LH-RHa) in premenopausal early breast cancer patients: current role and future perspectives.促黄体生成素释放激素激动剂(LH-RHa)在绝经前早期乳腺癌患者中的作用:现状与展望。
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