General Surgery, University of Kansas Medical Center, Kansas, KS, USA.
Ann Surg Oncol. 2013 Oct;20(10):3188-93. doi: 10.1245/s10434-013-3177-1. Epub 2013 Aug 22.
Adjuvant endocrine therapy is often advised for women with hormone receptor positive breast cancer. In premenopausal women, tamoxifen is the primary endocrine therapy option since aromatase inhibitors (AIs) are contraindicated in patients with residual ovarian function. The benefit of ovarian ablation/suppression in premenopausal patients remains controversial. In postmenopausal ER positive patients, treatment with an AI alone, switching strategies with an AI and tamoxifen, or extended therapy with an AI after 5 years of tamoxifen are superior to 5 years of tamoxifen alone. While the data supporting the use of endocrine therapy for ER positive breast cancer is clear, adverse effects occur with variable frequency and severity. The intensity and severity of the most common endocrine therapy adverse effects are mild to moderate for the majority of women, and serious life-threatening adverse effects are uncommon. However, compliance issues are often larger than recognized. Good communication with patients is critical to address concerns and symptoms, and more research is needed to identify effective methods to minimize treatment side effects.
辅助内分泌治疗常用于激素受体阳性乳腺癌患者。对于绝经前女性，由于芳香化酶抑制剂（AIs）在有残留卵巢功能的患者中禁忌使用，他莫昔芬是主要的内分泌治疗选择。在绝经前患者中，卵巢去势/抑制的获益仍存在争议。对于绝经后 ER 阳性患者，与单用 AI 相比，AI 和他莫昔芬转换策略，或在接受 5 年他莫昔芬治疗后延长 AI 治疗，均优于单用 5 年他莫昔芬。虽然支持 ER 阳性乳腺癌使用内分泌治疗的数据明确，但不良反应的发生频率和严重程度存在差异。对于大多数女性，最常见的内分泌治疗不良反应的强度和严重程度为轻度至中度，严重危及生命的不良反应并不常见。然而，遵医嘱问题往往比认识到的更为严重。与患者进行良好的沟通对于解决顾虑和症状至关重要，还需要更多的研究来确定有效方法，以最大程度地减少治疗的副作用。
