Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
Autophagy. 2012 Dec;8(12):1827-9. doi: 10.4161/auto.21765.
Breast cancer is one of the most prevalent cancers in women, with more than 240,000 new cases reported in the United States in 2011. Classification of breast cancer based upon hormone and growth factor receptor profiling shows that approximately 70% of all breast cancers express estrogen receptor-α. Thus, drugs that either block estrogen biosynthesis (aromatase inhibitors like Letrozole), or compete with estrogen for estrogen receptor (ER) binding (selective ER modulators including tamoxifen; TAM) and/or cause ER degradation (selective estrogen receptor downregulators such as fulvestrant), are among the most prescribed targeted therapeutics for breast cancer. However, overall clinical benefit from the use of these drugs is often limited by resistance; ER+ breast cancers either fail to respond to endocrine therapies initially (de novo resistance), or they respond and then lose sensitivity over time (acquired resistance). While several preclinical studies postulate how antiestrogen resistance occurs, for the most part, the molecular mechanism(s) of resistance is unknown.
乳腺癌是女性最常见的癌症之一,2011 年在美国报告的新发病例超过 24 万例。根据激素和生长因子受体分析对乳腺癌进行分类表明,大约 70%的所有乳腺癌表达雌激素受体-α。因此,能够阻断雌激素生物合成的药物(如来曲唑的芳香酶抑制剂),或者与雌激素竞争与雌激素受体(ER)结合的药物(包括他莫昔芬的选择性 ER 调节剂;TAM)和/或导致 ER 降解的药物(如氟维司群的选择性雌激素受体下调剂),是最常被开处的用于治疗乳腺癌的靶向治疗药物。然而,这些药物的使用带来的整体临床获益往往受到耐药性的限制;ER+乳腺癌要么最初对内分泌治疗无反应(原发性耐药),要么随着时间的推移对治疗有反应但失去敏感性(获得性耐药)。尽管有几项临床前研究推测了抗雌激素耐药性的发生机制,但在大多数情况下,耐药的分子机制尚不清楚。