Horizon Oncology Center, Lafayette, IN, USA.
Cancer Manag Res. 2015 Jan 21;7:37-46. doi: 10.2147/CMAR.S72592. eCollection 2015.
Endocrine therapy is an important treatment option for women with hormone receptor-positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor(®)), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin(®)) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed.
内分泌治疗是激素受体阳性（HR+）晚期乳腺癌（ABC）的重要治疗选择，但许多肿瘤要么具有内在抗性，要么对这些治疗产生抗性。治疗伴有不良预后的内脏转移的 ABC 患者也是一个问题。对于这一患者群体，存在未满足的有效治疗需求。尽管化疗通常被认为比内分泌治疗更能有效控制内脏转移，但对于那些没有内脏危机的患者，内分泌治疗可能会受益，避免化疗相关的毒性可能会影响生活质量。为了改善结果，正在研究几种靶向治疗与内分泌治疗联合用于内分泌抵抗的 HR+ ABC 患者。尽管现有数据考虑了 HR+ ABC 患者作为一个整体，但在一项 III 期研究的预设分析中，依维莫司（Afinitor®）（一种哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂）与依西美坦（Aromasin®）联合治疗非甾体芳香化酶抑制剂治疗后内脏疾病进展的患者中，有令人鼓舞的数据。在这篇综述中，将评估具有内脏疾病的 HR+ ABC 的管理挑战和治疗选择，包括正在进行临床研究的治疗方法的考虑。
