Gill P G, Gebski V, Snyder R, Burns I, Levi J, Byrne M, Coates A
Department of Surgery, Royal Adelaide Hospital, South Australia.
Ann Oncol. 1993 Nov;4(9):741-4. doi: 10.1093/oxfordjournals.annonc.a058658.
The antioestrogen tamoxifen and progestins act via different receptors and may therefore have complementary effects against human breast cancer. This possibility was tested in a randomized study which compared the effects of tamoxifen, standard-dose megestrol acetate, and these two agents in combination, in patients with metastatic breast cancer.
184 post-menopausal patients with metastatic breast cancer were randomized to initial treatment with either tamoxifen (TAM) 40 mg daily, megestrol acetate (MA) 160 mgm daily, or the combination of the two administered simultaneously. Patients crossed over to the alternative single agent on relapse or disease progression. Patients were evaluated for response, time to initial and ultimate treatment failure, and survival.
There were no significant differences between the three groups with respect to response rates, nor the other parameters. Patient survival was significantly associated with age > 60 years, ER positive status, and the absence of visceral metastases.
TAM and MA are both equally effective in response induction as initial treatments and the combination has no advantage. Sequential treatment is still optimal, TAM being the preferred initial agent in view of the reported side effects with MA.
抗雌激素药物他莫昔芬和孕激素通过不同受体起作用，因此可能对人类乳腺癌具有互补作用。在一项随机研究中对这种可能性进行了测试，该研究比较了他莫昔芬、标准剂量醋酸甲地孕酮以及这两种药物联合使用对转移性乳腺癌患者的疗效。
184例绝经后转移性乳腺癌患者被随机分为初始治疗组，分别接受每日40毫克他莫昔芬（TAM）、每日160毫克醋酸甲地孕酮（MA）或两者同时给药。患者在复发或疾病进展时改用另一种单一药物。对患者的反应、初始和最终治疗失败时间以及生存率进行评估。
三组在反应率及其他参数方面无显著差异。患者生存率与年龄>60岁、雌激素受体阳性状态以及无内脏转移显著相关。
TAM和MA作为初始治疗在诱导反应方面同样有效，联合使用并无优势。序贯治疗仍然是最佳选择，鉴于MA已报道的副作用，TAM是首选的初始药物。
