Hagen M F, Thürlimann B
Medizinische Klinik C, Kantonsspital St. Gallen.
Ther Umsch. 1996 Nov;53(11):820-8.
In patients with metastatic breast cancer, cure is almost always an exception, irrespective of the therapy given. Thus the preservation of the quality of life or palliation in case of symptoms must be the principal goal. Only a small group of patients with their tumour showing a highly aggressive behaviour should be considered for primary chemotherapy. Aggressive tumour growth is then characterized by negative hormonal receptors, short disease-free interval and predominant visceral tumour growth. For all other patients there is not enough advantage to justify the clearly higher toxicity of a primary chemotherapy. This majority of patients with metastatic breast cancer can profit to a higher degree from hormonal treatment. Irrespective of the type of the hormonal therapy, the response rate is positively correlated with postmenopausal status, high hormonal receptor expression, al long disease-free interval, no previous adjuvant therapy and higher age. Advantages and problems of the various forms of hormonal manipulations are discussed. The recommended sequence of therapy represents only a handrail that needs to be adjusted carefully, according to the individual situation, the needs and expectations of the patient and in due knowledge of the toxicity of each hormonal substance. Combinations of different hormonal agents do not yield an additional benefit and should therefore be dropped for a sequential approach.
在转移性乳腺癌患者中，几乎无论接受何种治疗，治愈都是极为罕见的例外情况。因此，维持生活质量或在出现症状时进行姑息治疗必然是主要目标。只有一小部分肿瘤表现出高度侵袭性的患者才应考虑进行一线化疗。侵袭性肿瘤生长的特征在于激素受体阴性、无病间期短以及主要为内脏肿瘤生长。对于所有其他患者而言，一线化疗明显更高的毒性所带来的益处并不足以抵消其弊端。这一大部分转移性乳腺癌患者能从激素治疗中获得更大程度的益处。无论激素治疗的类型如何，缓解率都与绝经后状态、高激素受体表达、长无病间期、既往未接受辅助治疗以及较高年龄呈正相关。文中讨论了各种激素治疗方式的利弊。推荐的治疗顺序仅仅是一个指引，需要根据个体情况、患者的需求和期望，并充分了解每种激素药物的毒性，谨慎地进行调整。不同激素药物的联合使用并不会带来额外益处，因此应采用序贯治疗方法取代联合治疗。
