Hoogstraten B, Fletcher W S, Gad-el-Mawla N, Maloney T, Altman S J, Vaughn C B, Foulkes M A
Cancer Res. 1982 Nov;42(11):4788-91.
The relatively short survival following chemotherapy in patients with metastatic carcinoma of the breast and the introduction of antiestrogens has led to renewed interest in the hormonal therapy of breast cancer. Pritchard et al. (Cancer Treat. Rep., 64: 787-796, 1980) have recently stated that response to the antiestrogen tamoxifen (TAM) strongly predicts a subsequent response to oophorectomy in premenopausal patients. The Southwest Oncology Group administered TAM to pre- and postmenopausal women with first recurrence of breast cancer. Following response and subsequent relapse, or after no response, patients underwent an oophorectomy while continuing on TAM. None of 14 premenopausal patients who responded to TAM had a response to oophorectomy plus TAM, while 5 of 22 had a remission with oophorectomy plus TAM after initially failing with TAM alone. The reverse was seen in postmenopausal women; 4 of 18 responders to TAM subsequently responded to oophorectomy plus TAM, but none of 18 TAM failures responded to oophorectomy plus TAM. These results suggest that in the premenopausal women the TAM dose may be insufficient to block all estrogen action and that oophorectomy, by removing the major source of estrogen, can result in a more effective antiestrogen action of TAM leading to a response. No explanation is readily available for the results in postmenopausal patients.
转移性乳腺癌患者化疗后生存期相对较短，以及抗雌激素药物的引入，使得人们对乳腺癌的激素治疗重新产生了兴趣。普里查德等人（《癌症治疗报告》，64: 787 - 796, 1980）最近指出，绝经前患者对抗雌激素他莫昔芬（TAM）的反应强烈预示着随后对卵巢切除术的反应。西南肿瘤协作组对首次复发的绝经前和绝经后乳腺癌女性患者给予TAM治疗。在出现反应及随后复发后，或在无反应后，患者在继续服用TAM的同时接受卵巢切除术。14名对TAM有反应的绝经前患者中，没有一人对卵巢切除术加TAM有反应，而22名最初单独使用TAM失败的患者中，有5名在接受卵巢切除术加TAM后病情缓解。绝经后女性的情况则相反；18名对TAM有反应的患者中有4名随后对卵巢切除术加TAM有反应，但18名TAM治疗失败的患者中没有一人对卵巢切除术加TAM有反应。这些结果表明，在绝经前女性中，TAM的剂量可能不足以阻断所有雌激素作用，而卵巢切除术通过去除雌激素的主要来源，可使TAM的抗雌激素作用更有效，从而导致反应。对于绝经后患者的结果，目前尚无现成的解释。
