Champalimaud Cancer Center, Lisbon, Portugal.
Cancer Treat Rev. 2013 Aug;39(5):457-65. doi: 10.1016/j.ctrv.2012.06.011. Epub 2012 Jul 25.
Endocrine therapy is the corner stone treatment for postmenopausal women with hormone receptor-positive metastatic breast cancer (MBC). Besides tamoxifen and many older agents, recently developed endocrine agents for the treatment of MBC include the third generation aromatase inhibitors (AI) - anastrozole, exemestane, letrozole - and the pure oestrogen receptor antagonist fulvestrant. As treatment of breast cancer evolves, both tamoxifen and the AIs are being increasingly used in the adjuvant setting. As such, a significant proportion of patients with hormone receptor-positive MBC will have previously received tamoxifen, an AI or both, as adjuvant treatment. This has changed the metastatic landscape and has an impact on treatment choices for patients with hormone receptor-positive MBC. In this review, we evaluate the available evidence supporting the use of endocrine therapy for the treatment of hormone receptor-positive MBC. Additionally, we consider the effect of prior adjuvant therapy on treatment choice in the metastatic setting and the optimal treatment sequence. Finally, we discuss endocrine-responsive HER2 positive tumours and the ongoing research initiatives which aim to improve outcomes for patients with MBC.
内分泌治疗是绝经后激素受体阳性转移性乳腺癌（MBC）患者的基石治疗方法。除了他莫昔芬和许多较老的药物外，最近开发的用于治疗 MBC 的内分泌药物包括第三代芳香酶抑制剂（AI）-阿那曲唑、依西美坦、来曲唑-和纯雌激素受体拮抗剂氟维司群。随着乳腺癌治疗的发展，他莫昔芬和 AI 越来越多地用于辅助治疗。因此，相当一部分激素受体阳性 MBC 患者之前曾接受过辅助治疗的他莫昔芬、AI 或两者。这改变了转移性疾病的治疗模式，并对激素受体阳性 MBC 患者的治疗选择产生影响。在这篇综述中，我们评估了支持内分泌治疗用于治疗激素受体阳性 MBC 的现有证据。此外，我们还考虑了既往辅助治疗对转移性疾病治疗选择的影响，以及最佳治疗顺序。最后，我们讨论了内分泌反应性 HER2 阳性肿瘤和正在进行的研究计划，旨在为 MBC 患者改善治疗效果。
