Di Lascio Simona, Pagani Olivia
Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.
Breast Unit of Southern Switzerland (CSSI), Bellinzona, Switzerland.
Womens Health (Lond). 2015 Jun;11(3):343-54. doi: 10.2217/whe.15.2.
Managing estrogen receptor-positive breast cancer in young women (<40 years) requires a multidisciplinary/personalized approach, covering both clinical and psychosocial aspects. Five years of tamoxifen has been the standard adjuvant endocrine therapy for many years. Recent data from the adjuvant randomized trials TEXT-SOFT show that the aromatase inhibitor exemestane plus ovarian suppression significantly reduces recurrences as compared with tamoxifen plus ovarian suppression. The ATLAS and aTToM trials represent the first evidence of a beneficial effect of extended endocrine therapy with tamoxifen in premenopausal women. Outside of a clinical trial, no data support neoadjuvant endocrine therapy in young women. In the metastatic setting, tamoxifen or aromatase inhibitors, both with ovarian suppression/ablation, should be the preferred choice, unless rapid tumor shrinkage is needed. No data are available with fulvestrant in young patients.
治疗年轻女性（<40岁）雌激素受体阳性乳腺癌需要多学科/个性化方法，涵盖临床和心理社会方面。多年来，5年他莫昔芬一直是标准的辅助内分泌治疗方法。辅助随机试验TEXT-SOFT的最新数据显示，与他莫昔芬加卵巢抑制相比，芳香化酶抑制剂依西美坦加卵巢抑制可显著降低复发率。ATLAS和aTToM试验首次证明了在绝经前女性中延长他莫昔芬内分泌治疗的有益效果。在临床试验之外，没有数据支持对年轻女性进行新辅助内分泌治疗。在转移性情况下，他莫昔芬或芳香化酶抑制剂，两者均联合卵巢抑制/切除，应作为首选，除非需要快速缩小肿瘤。在年轻患者中没有关于氟维司群的数据。
