[芳香化酶抑制剂治疗绝经后乳腺癌妇女及影响副作用的可能性]

[Treatment with Aromatase Inhibitors in Postmenopausal Women with Breast Cancer and the Possibility of Influencing Side Effects].

作者信息

Krásenská M

出版信息

Klin Onkol. 2016 Fall;29 Suppl 3:S39-49. doi: 10.14735/amko20163S39.

DOI:10.14735/amko20163S39

PMID:28118723

Abstract

BACKGROUND

The third generation aromatase inhibitors (anastrozole, letrozole, exemestane) have become standard endocrine treatment for postmenopausal estrogen receptor - positive breast cancers in all settings (neoadjuvant, adjuvant, metastatic breast cancer), based on superiority to tamoxifen. Aromatase inhibitors interfere with the conversion of androgens into estrogens by blocking the enzyme aromatase resulting in low estradiol levels. Aromatase inhibitors are contraindicated in women with functional ovaries. Many premenopausal women develop amenorrhea after adjuvant chemoterapy. Aromatase inhibitors may promote recovery of ovarian function which could lead to therapeutic failure or even to unexpected pregnancy. Currently available measures to determine the menopausal status are conflicting.

AIM

This paper focuses primarily on adverse effects of aromatase inhibitors which can lead to non-compliance or to discontinuation of treatment.

RESULTS

Many side effects of aromatase inhibitors are related to estrogen deprivation. On the other hand as aromatase inhibitors lack estrogenic activity, they are not associated with serious adverse events typical for tamoxifen, such as endometrial cancer and thromboembolic disease. Aromatase inhibitors therapy is often associated with vasomotor symptoms (hot flashes), vaginal dryness, dyspareunia, bone loss, arthralgias and myalgias (musculoskeletal symptoms). Management of these side effects can lead to improved adherence and persistence with therapy.Key words: breast cancer - menopause - aromatase inhibitors - ovarian function recovery - adverse effectsThis work was supported by Czech Ministry of Health - RVO (MOÚ, 00209805).The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 10. 7. 2016Accepted: 3. 8. 2016.

摘要

背景

基于比他莫昔芬更具优势，第三代芳香化酶抑制剂（阿那曲唑、来曲唑、依西美坦）已成为绝经后雌激素受体阳性乳腺癌在所有情况下（新辅助治疗、辅助治疗、转移性乳腺癌）的标准内分泌治疗药物。芳香化酶抑制剂通过阻断芳香化酶，干扰雄激素向雌激素的转化，从而导致雌二醇水平降低。芳香化酶抑制剂禁用于有功能卵巢的女性。许多绝经前女性在辅助化疗后会出现闭经。芳香化酶抑制剂可能会促进卵巢功能恢复，这可能导致治疗失败甚至意外怀孕。目前用于确定绝经状态的方法存在矛盾之处。

目的

本文主要关注芳香化酶抑制剂可能导致治疗不依从或停药的不良反应。

结果

芳香化酶抑制剂的许多副作用与雌激素缺乏有关。另一方面，由于芳香化酶抑制剂缺乏雌激素活性，它们与他莫昔芬典型的严重不良事件无关，如子宫内膜癌和血栓栓塞性疾病。芳香化酶抑制剂治疗常伴有血管舒缩症状（潮热）、阴道干燥、性交困难、骨质流失、关节痛和肌痛（肌肉骨骼症状）。对这些副作用的处理可提高治疗的依从性和持续性。