The University of Manchester, Institute of Cancer Studies, Manchester, UK.
Curr Opin Obstet Gynecol. 2013 Feb;25(1):49-54. doi: 10.1097/GCO.0b013e32835c0410.
Recent advances in the genomic analysis of breast cancers show promise in better defining endocrine sensitive subtypes. In addition, several key trials have recently reported results that better define the optimal sequence of endocrine agents and approaches to overcome endocrine resistance.
In clinical practice 'luminal' breast cancer is commonly used interchangeably with estrogen receptor positivity by immunohistochemistry. Genomic analysis better defines this subgroup of tumours but also highlights the complexity of the genetic landscape. These advances are discussed, along with pivotal data from contemporary clinical trials of endocrine therapy, the treatment modality most relevant to the 'luminal' subgroup. The review focuses on data from trials in advanced breast cancer. Four studies (FIRST, FACT, SWOG S0226 and SoFEA) have recently reported and improved our understanding of the optimal sequence of endocrine agents, in particular the estrogen receptor downregulator fulvestrant. The TAMRAD and BOLERO2 trials reported significant improvements in outcome with tamoxifen and exemestane, respectively, when these standard agents were combined with the mammalian target of rapamycin inhibitor everolimus.
Overall these data represent significant advances for women with metastatic breast cancer that will be translated into the early breast cancer setting in the near future.
最近在乳腺癌的基因组分析方面的进展有望更好地确定内分泌敏感亚型。此外，最近有几项关键试验报告了结果，更好地定义了内分泌药物的最佳序贯和克服内分泌耐药的方法。
在临床实践中，“管腔”型乳腺癌通常通过免疫组化与雌激素受体阳性互换使用。基因组分析更好地定义了这组肿瘤亚群，但也突出了遗传景观的复杂性。这些进展与当代内分泌治疗临床试验的关键数据一起进行了讨论，内分泌治疗是与“管腔”亚群最相关的治疗方式。该综述重点介绍了晚期乳腺癌临床试验的数据。四项研究（FIRST、FACT、SWOG S0226 和 SoFEA）最近报告并提高了我们对内分泌药物最佳序贯的理解，特别是雌激素受体下调剂氟维司群。TAMRAD 和 BOLERO2 试验报告称，当将标准药物与哺乳动物雷帕霉素抑制剂依维莫司联合使用时，他莫昔芬和依西美坦分别在治疗转移性乳腺癌方面取得了显著的疗效改善。
总的来说，这些数据代表了转移性乳腺癌女性的重大进展，这些进展将在不久的将来转化为早期乳腺癌治疗领域。
