Manni A
J Lab Clin Med. 1987 Mar;109(3):290-9.
Inhibition of estrogen action at the target tissue level with the antiestrogen, tamoxifen, has proved highly successful in the treatment of hormone-responsive breast cancer. In randomized clinical trials involving postmenopausal patients, tamoxifen has been found to be as effective as high-dose estrogens, androgens, progestins, and the aromatase inhibitor, aminoglutethimide. Because of its remarkable lack of significant toxicity, tamoxifen is now considered the first endocrine treatment of choice of hormone-responsive postmenopausal breast cancer. Although effective in a significant fraction of premenopausal patients, tamoxifen cannot be considered a substitute for ovariectomy because it usually does not suppress menses and because response to castration may occur after progression during antiestrogen therapy. Current evidence suggests that there is no major advantage in combining tamoxifen with other endocrine therapies or chemotherapy. At present, it appears preferable to use different modalities of endocrine therapy sequentially in those patients with hormone-responsive cancers. Chemotherapy should be delayed until maximum benefit has been obtained from endocrine therapy.
用抗雌激素药物他莫昔芬在靶组织水平抑制雌激素作用，已被证明在治疗激素反应性乳腺癌方面非常成功。在涉及绝经后患者的随机临床试验中，已发现他莫昔芬与高剂量雌激素、雄激素、孕激素及芳香化酶抑制剂氨鲁米特效果相当。由于他莫昔芬明显缺乏显著毒性，现在它被认为是激素反应性绝经后乳腺癌内分泌治疗的首选。虽然他莫昔芬对相当一部分绝经前患者有效，但不能将其视为卵巢切除术的替代方法，因为它通常不能抑制月经，且在抗雌激素治疗过程中病情进展后可能出现对去势治疗的反应。目前的证据表明，将他莫昔芬与其他内分泌疗法或化疗联合使用没有主要优势。目前，对于激素反应性癌症患者，似乎最好依次使用不同的内分泌治疗方式。化疗应推迟到从内分泌治疗中获得最大益处之后。
