Kolberg Hans-Christian, Aktas Bahriye, Liedtke Cornelia
Department for Gynecology and Obstetrics, Marienhospital Bottrop, Josef-Albers-Str. 70, 46236 Bottrop, Germany.
Department for Gynecology and Obstetrics, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
Rev Recent Clin Trials. 2017;12(2):67-72. doi: 10.2174/1574887112666170201143321.
Primary endocrine therapy is an option in cases of hormone receptor positive and HER2 negative non-metastatic breast cancer. Aromatase inhibitors are considered the therapy of choice in postmenopausal patients. In premenopausal patients aromatase inhibitors in combination with LHRHanalogues are regarded superior to tamoxifen. Three different settings have to be discriminated: • Patients too frail for surgery are candidates for primary endocrine therapy in order to control the disease. Treatment duration is determined by the course of the disease. • Patients with tumors not operable in general or not operable by breast conserving therapy but not fit for or with relative contraindications to chemotherapy either are candidates for neoadjuvant endocrine therapy in order to achieve downstaging. Treatment duration should be at least 6 months and probably not longer than 12 months with the individual duration depending on the experience and skills of the breast surgeon. • Patients in whom the indication for chemotherapy is uncertain due to an intermediate risk neoadjuvant endocrine therapy may undergo endocrine therapy in order to perform in vivo sensitivity testing. Treatment duration should be at least 3 months up to 6 months according to current data. Data from retrospective analyses show that short-term on-treatment assessment of Ki67 by rebiopsy or postoperative assessment of the PEPI score may identify low risk groups with no meaningful expected benefit from additional chemotherapy. In order to retrieve more detailed recommendations, results of ongoing prospective trials have to be awaited. Data regarding on-treatment genomic testing are promising but immature for clinical practice as of yet.
对于激素受体阳性且HER2阴性的非转移性乳腺癌患者，一线内分泌治疗是一种选择。芳香化酶抑制剂被认为是绝经后患者的首选治疗方法。对于绝经前患者，芳香化酶抑制剂联合促性腺激素释放激素（LHRH）类似物被认为优于他莫昔芬。必须区分三种不同情况：
• 身体过于虚弱无法进行手术的患者是一线内分泌治疗的候选者，目的是控制疾病。治疗持续时间由疾病进程决定。
• 一般情况下无法手术或无法通过保乳治疗进行手术，但不适合化疗或有化疗相对禁忌证的肿瘤患者，是新辅助内分泌治疗的候选者，目的是实现降期。治疗持续时间应至少6个月，可能不超过12个月，具体持续时间取决于乳腺外科医生的经验和技术。
• 由于存在中度风险，化疗指征不明确的患者，新辅助内分泌治疗可进行内分泌治疗，以便进行体内敏感性测试。根据目前的数据，治疗持续时间应至少3个月至6个月。回顾性分析数据表明，通过再次活检对Ki67进行短期治疗评估或术后评估PEPI评分，可能识别出从额外化疗中无明显预期获益的低风险组。为了获取更详细的建议，必须等待正在进行的前瞻性试验结果。关于治疗期间基因检测的数据很有前景，但目前在临床实践中还不成熟。
