Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
Hematol Oncol Clin North Am. 2013 Aug;27(4):715-36, viii. doi: 10.1016/j.hoc.2013.05.004. Epub 2013 Jun 18.
First-line endocrine therapy by estrogen antagonism or suppression of estrogen achieves objective responses (ORs) and clinical benefit (CB) in around 30% and 50% of estrogen receptor-positive metastatic breast cancer patients, respectively. Aromatase inhibitors (AIs) are the most effective treatment in previously untreated postmenopausal women. Tamoxifen is an effective alternative. The optimal endocrine therapy on relapse remains uncertain. Tamoxifen and fulvestrant achieve CB in around 50% of patients and ORs of 10%. CB of exemestane after nonsteroidal AIs is 30% to 50% but ORs are rare. Targeted agents (eg, everolimus) plus endocrine therapy are likely to become increasingly important in overcoming endocrine resistance.
一线内分泌治疗通过雌激素拮抗或抑制雌激素，分别使大约 30%和 50%的雌激素受体阳性转移性乳腺癌患者达到客观缓解 (OR) 和临床获益 (CB)。芳香酶抑制剂 (AIs) 是绝经后妇女未接受过治疗的最有效治疗方法。他莫昔芬是一种有效的替代药物。复发时的最佳内分泌治疗仍不确定。他莫昔芬和氟维司群使大约 50%的患者获得 CB 和 10%的 OR。非甾体类 AI 后依西美坦的 CB 为 30%至 50%，但 OR 很少见。靶向药物（如依维莫司）加内分泌治疗可能在克服内分泌耐药方面变得越来越重要。
