Division of Medical Oncology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
Breast. 2013 Aug;22 Suppl 2:S180-3. doi: 10.1016/j.breast.2013.07.035.
Extensive clinical trial experience is available for aromatase inhibitors (AIs) in postmenopausal women upon which to evaluate the balance of potential benefit and toxicities. A meta-analysis revealed an advantage for AIs over tamoxifen in the monotherapy setting for recurrence but not breast cancer mortality, and an advantage in both of these parameters for switching to an AI after several years of tamoxifen. Importantly, no indication of a deleterious effect of AIs was identified in terms of death without recurrence in these meta-analyses. Regarding serious adverse events (AEs), there are data indicating an increase in cardiovascular AEs and bone fractures but a lower incidence of thromboembolic phenomena and endometrial cancer with AIs vis-à-vis tamoxifen. There does not appear to be a difference in cerebrovascular AEs. Musculoskeletal AEs are the most common clinically important AEs as they are the most common cause of discontinuation of therapy, which can have an adverse effect on outcomes. The balance of benefit and toxicity favors the use of AIs in the adjuvant setting but the absolute benefit from AIs can be decreased in patients with advancing age or increasing comorbidities.
芳香化酶抑制剂 (AIs) 在绝经后妇女中的广泛临床经验可用于评估潜在益处和毒性之间的平衡。一项荟萃分析显示，在单药治疗复发方面，AIs 优于他莫昔芬，但在乳腺癌死亡率方面没有优势，在接受他莫昔芬治疗数年后转为 AIs 治疗，这两个参数均有优势。重要的是，这些荟萃分析中没有表明 AIs 会导致无复发死亡的有害影响。关于严重不良事件 (AE)，有数据表明 AIs 会增加心血管 AE 和骨折，但与他莫昔芬相比，血栓栓塞现象和子宫内膜癌的发生率较低。脑血管不良事件似乎没有差异。肌肉骨骼不良事件是最常见的临床重要不良事件，因为它们是导致治疗中断的最常见原因，这可能对结局产生不利影响。在辅助治疗中使用 AIs 的益处和毒性之间的平衡是有利的，但对于年龄较大或合并症增加的患者，AIs 的绝对益处可能会降低。
