Saltel-Fulero Aurélien, Donnadieu Anne, Leman-Detours Solenne, Cottu Paul
Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France.
Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France.
Bull Cancer. 2016 Jan;103(1):104-12. doi: 10.1016/j.bulcan.2015.10.011. Epub 2015 Dec 7.
Endocrine therapy is a compulsory step in the adjuvant management of early breast cancer expressing the estrogen receptor, by reducing as much as possible serum and tissue levels of estrogens. Tamoxifen is the standard therapy for non-menopausal women. Ovarian function suppression, in addition to exemestane or tamoxifen, could be an alternative option for young women at high risk of recurrence and non menopausal after adjuvant or neo-adjuvant chemotherapy. Recent studies show a trend for improvement of overall survival and disease-free-survival with aromatase inhibitors among postmenopausal women. However, safety of aromatase inhibitors is controversial and adverse events may lead to switch for tamoxifen with no loss of efficacy. Extension therapy by tamoxifen or aromatase inhibitor after five years of tamoxifen and for a total duration of ten years significantly improves overall survival. There is to date no data supporting the extension therapy after five years of aromatase inhibitor.
内分泌治疗是早期雌激素受体阳性乳腺癌辅助治疗中的必要步骤，通过尽可能降低血清和组织中的雌激素水平来实现。他莫昔芬是绝经前女性的标准治疗药物。对于辅助或新辅助化疗后复发风险高且未绝经的年轻女性，除依西美坦或他莫昔芬外，卵巢功能抑制可能是一种替代选择。最近的研究表明，芳香化酶抑制剂可使绝经后女性的总生存期和无病生存期有改善趋势。然而，芳香化酶抑制剂的安全性存在争议，不良事件可能导致改用他莫昔芬且不影响疗效。他莫昔芬治疗五年后再使用他莫昔芬或芳香化酶抑制剂进行延长治疗，总疗程达十年可显著提高总生存期。迄今为止，尚无数据支持芳香化酶抑制剂使用五年后的延长治疗。
