Clinique de Genolier, Switzerland.
Breast. 2013 Aug;22(4):488-94. doi: 10.1016/j.breast.2013.01.007. Epub 2013 Feb 27.
In the past few years aromatase inhibitors (AIs) have shown superior efficacy to the previous standard adjuvant endocrine therapy, tamoxifen, and are now recommended as part of current adjuvant endocrine therapy. A range of treatment strategies have been explored.
We assess the role of initial AI therapy for postmenopausal women with hormone receptor-positive breast cancer and consider the relative value of initial therapy with an AI compared with switch or extended (>5-yr) adjuvant therapy.
Both initial AI therapy and switching/sequential tamoxifen followed by an AI are associated with longer disease- and relapse-free survival versus 5 years of tamoxifen alone. Trials comparing initial therapy with the sequence of tamoxifen followed by an AI have not demonstrated any major efficacy differences between the treatment strategies. Several analyses have been conducted to identify prognostic or predictive markers of treatment benefit to enable selection of the most appropriate adjuvant therapy.
Initial and switching/sequential regimens are equally appropriate adjuvant treatment options for postmenopausal patients with hormone receptor-positive breast cancer. The exact tumour biology which allows for initial AI therapy has not yet been determined with certainty.
在过去的几年中，芳香化酶抑制剂（AIs）已显示出优于先前标准辅助内分泌治疗药物他莫昔芬的疗效，目前被推荐作为当前辅助内分泌治疗的一部分。已经探索了一系列治疗策略。
我们评估了初始 AI 治疗对于激素受体阳性乳腺癌绝经后妇女的作用，并考虑了与初始 AI 治疗相比，初始治疗与转换或延长（>5 年）辅助治疗的相对价值。
与单独使用 5 年他莫昔芬相比，初始 AI 治疗和转换/序贯他莫昔芬后使用 AI 均与更长的疾病无进展生存期和无病生存期相关。比较初始治疗与他莫昔芬序贯 AI 治疗的试验并未显示两种治疗策略之间存在任何主要疗效差异。已经进行了几项分析以确定治疗获益的预测或预后标志物，以能够选择最合适的辅助治疗。
初始和转换/序贯方案对于激素受体阳性乳腺癌绝经后患者都是同样合适的辅助治疗选择。最初 AI 治疗的确切肿瘤生物学尚未确定。
