Koyama H, Inaji H, Noguchi S, Motomura K
Dept. of Surgery, Center for Adult Diseases, Osaka, Japan.
Gan To Kagaku Ryoho. 1994 Dec;21(16):2728-34.
Since ER positivity in breast cancer is highest in the early stage of its natural history, hormonal treatment should be given as the initial treatment after both surgery and recurrence. Tamoxifen and medroxyprogesterone acetate have been commonly used as the standard hormonal treatment with a response rate of 20-30% and a median duration of response of 6-10 months. New agents for hormone therapy include tamoxifen analogues, LH-RH analogues and aromatase inhibitors. They are now on or have just cleared phase studies. LH-RH analogue is a unique drug that is active for premenopausal patients and should be used as the first-line therapy for them. Aromatase inhibitors lower serum estrogen levels by inhibiting conversion from andreogens to estrogens, thus inducing regression of ER-positive tumors. They are used as the second-line treatment after tamoxifen failure for postmenopausal patients. An increasing body of information has been accumulated as to how the hormonal treatments affect breast cancer at subcellular levels. New approaches controlling growth factors such as anti-angiogenesis are under way.
由于乳腺癌的雌激素受体阳性在其自然病程的早期阶段最为常见，因此激素治疗应在手术和复发后作为初始治疗。他莫昔芬和醋酸甲羟孕酮一直被普遍用作标准激素治疗，有效率为20%-30%，中位缓解期为6-10个月。激素治疗的新药物包括他莫昔芬类似物、促性腺激素释放激素（LH-RH）类似物和芳香化酶抑制剂。它们目前正在或刚刚完成各阶段研究。LH-RH类似物是一种独特的药物，对绝经前患者有效，应作为他们的一线治疗药物。芳香化酶抑制剂通过抑制雄激素向雌激素的转化来降低血清雌激素水平，从而诱导雌激素受体阳性肿瘤的消退。它们在他莫昔芬治疗失败后用于绝经后患者的二线治疗。关于激素治疗如何在亚细胞水平上影响乳腺癌，已有越来越多的信息积累。控制生长因子的新方法，如抗血管生成，正在研究中。
