Rose C, Mouridsen H T
Department of Oncology R, Odense University Hospital, Denmark.
Horm Res. 1989;32 Suppl 1:189-96; discussion 197. doi: 10.1159/000181344.
Recent research has produced several new options for endocrine treatment of advanced breast cancer. Since one of the most intriguing characteristics of endocrine therapy is that new remissions are possible when subsequent endocrine modalities are used, it is important to evaluate their optimal sequence. Tamoxifen has become the most commonly used endocrine therapy for advanced breast cancer due to its few side effects and an overall response rate of 35%. Crossover data from randomised trials, comparing tamoxifen with either ablative, additive or inhibitive treatment, indicate that the highest overall response rate is obtained when tamoxifen is used as first-line endocrine therapy. Furthermore, it seems that oophorectomy in premenopausal, and aminoglutethimide or progestins in postmenopausal patients, are equally effective as second-line endocrine therapy. Despite an obvious clinical rationale for combined endocrine therapy, most trials have failed to show any benefit. Although data from trials combining tamoxifen with prednisolone or androgens seem promising, the use of combined endocrine therapy still has to be considered experimental.
近期研究为晚期乳腺癌的内分泌治疗带来了几种新选择。由于内分泌治疗最引人关注的特性之一是，当使用后续内分泌治疗方式时可能会出现新的缓解情况，因此评估它们的最佳顺序很重要。他莫昔芬因其副作用少且总体缓解率达35%，已成为晚期乳腺癌最常用的内分泌治疗药物。来自随机试验的交叉数据，比较了他莫昔芬与去势、添加或抑制治疗，结果表明，当他莫昔芬用作一线内分泌治疗时，总体缓解率最高。此外，绝经前患者进行卵巢切除术，以及绝经后患者使用氨鲁米特或孕激素作为二线内分泌治疗似乎同样有效。尽管联合内分泌治疗有明显的临床依据，但大多数试验都未能显示出任何益处。虽然他莫昔芬与泼尼松龙或雄激素联合治疗的试验数据似乎很有前景，但联合内分泌治疗的应用仍被视为试验性的。
