Park Woo-Chan
Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
J Breast Cancer. 2016 Dec;19(4):341-348. doi: 10.4048/jbc.2016.19.4.341. Epub 2016 Dec 23.
Historically, endocrine therapy for breast cancer began with ovarian ablation (OA) for the treatment of premenopausal patients. After the identification of estrogen receptors and the development of many antiestrogens, tamoxifen has been approved and used as the standard endocrine therapy for hormonal receptor (HR)-positive premenopausal patients to date. With the development of luteinizing hormone-releasing hormone agonists, the paradigm of endocrine therapy for premenopausal women with HR-positive breast cancer began to change from OA to ovarian function suppression (OFS). To date, the indication for OFS was limited to those premenopausal patients with HR-positive breast cancer who were unable to use tamoxifen as the primary adjuvant endocrine therapy. However, following the definitive demonstration of the therapeutic role of OFS added to tamoxifen or aromatase inhibitor after chemotherapy in large randomized trials, such as Tamoxifen and Exemestane Trial or Suppression of Ovarian Function Trial, the American Society of Clinical Oncology guidelines for the use of endocrine therapy in premenopausal HR-positive breast cancer were recently updated to recommend OFS in high-risk patients who required adjuvant chemotherapy. In contrast, the role of OFS to protect ovarian function during chemotherapy in premenopausal women has remained controversial, and some evidence showing the protective effect of OFS on the ovaries during chemotherapy as well as its therapeutic effect for breast cancer in premenopausal women with HR-negative breast cancer was recently published. Further evaluation is necessary to determine its exact role. In conclusion, the role of OA or OFS has been evolving, not only to improve the efficacy of breast cancer treatment, but also to preserve ovary function. OFS remains a main strategy for premenopausal women with HR-positive early breast cancer, though its exact role should be determined in further studies.
从历史上看，乳腺癌的内分泌治疗始于对绝经前患者进行卵巢去势（OA）。在雌激素受体被发现以及多种抗雌激素药物研发出来后，他莫昔芬已获批并一直作为激素受体（HR）阳性绝经前患者的标准内分泌治疗药物。随着促黄体生成素释放激素激动剂的发展，HR阳性绝经前乳腺癌女性内分泌治疗的模式开始从卵巢去势转变为卵巢功能抑制（OFS）。迄今为止，卵巢功能抑制的适应证仅限于那些无法将他莫昔芬作为主要辅助内分泌治疗药物的HR阳性绝经前乳腺癌患者。然而，在大型随机试验（如他莫昔芬与依西美坦试验或卵巢功能抑制试验）明确证明化疗后将卵巢功能抑制添加到他莫昔芬或芳香化酶抑制剂中具有治疗作用之后，美国临床肿瘤学会关于绝经前HR阳性乳腺癌内分泌治疗使用的指南最近进行了更新，建议在需要辅助化疗的高危患者中使用卵巢功能抑制。相比之下，卵巢功能抑制在绝经前女性化疗期间保护卵巢功能的作用仍存在争议，最近有一些证据表明卵巢功能抑制在化疗期间对卵巢具有保护作用，以及对HR阴性绝经前乳腺癌女性的乳腺癌具有治疗作用。需要进一步评估以确定其确切作用。总之，卵巢去势或卵巢功能抑制的作用一直在演变，不仅是为了提高乳腺癌治疗的疗效，也是为了保留卵巢功能。卵巢功能抑制仍然是HR阳性早期乳腺癌绝经前女性的主要策略，尽管其确切作用应在进一步研究中确定。
