Koide S S
Center for Biomedical Research, Population Council, New York, NY 10021, USA.
J Reprod Med. 1998 Jul;43(7):551-60.
To evaluate the efficacy of mifepristone, a potent antagonist of progesterone and glucorticoids, in the management of cancer and disorders related to reproduction.
Reports describing clinical trials of mifepristone treatment of leiomyoma, breast cancer, endometriosis and meningioma were reviewed. Mifepristone is a potent antagonist of progesterone and glucocorticoids. It is an effective contraceptive and abortifacient and in addition has been used in the management of diseases associated with pregnancy and adrenal cortical function. Results of the clinical trials show that it has beneficial and palliative value in some cases. Mifepristone may be used as an adjuvant therapeutic agent in cases of unresectable meningioma and leiomyoma that are refractory to chemotherapy, endocrine treatment or irradiation. In extensive endometriosis, mifepristone is indicated for intractable pain, although its effect on the lesions will be minimal. In the management of unresectable and metastatic breast cancer, mifepristone may be considered after a course of chemotherapy and/or irradiation and only in combination with another agent. In Cushing's syndrome mifepristone may be used to treat the undesirable sequelae of excessive cortisol production-e.g., psychosis. It will have minimal or no effect on the lesions of the adrenal or pituitary. The adverse effects of the long-term use of mifepristone are slight to moderate and reflect antiglucocorticoid effects. During treatment with mifepristone one should be aware of the possibility that the patient will develop Addisonian-like syndrome in the face of elevated blood ACTH and cortisol levels.
Leiomyoma treated with 25 or 50 mg/d of mifepristone underwent a 25-49% reduction in tumor size. Treatment of endometriosis with a daily dose of 50 or 100 mg of mifepristone alleviated pelvic pain and uterine cramps and induced about 55% regression of the lesions. Treatment of metastatic breast cancer with 200 or 400 mg/d of mifepristone resulted in a partial response. Unresectable meningioma treated with 200 or 400 mg/d of mifepristone produced objective improvement in about 25% of subjects.
Mifepristone is beneficial as adjuvant treatment in the management of unresectable, hormone-dependent tumors and disorders of the female reproductive system that are refractory to chemotherapy and irradiation.
评估米非司酮（一种强效的孕酮和糖皮质激素拮抗剂）在治疗癌症及与生殖相关疾病方面的疗效。
回顾了描述米非司酮治疗平滑肌瘤、乳腺癌、子宫内膜异位症和脑膜瘤的临床试验报告。米非司酮是一种强效的孕酮和糖皮质激素拮抗剂。它是一种有效的避孕药和堕胎药，此外还被用于治疗与妊娠和肾上腺皮质功能相关的疾病。临床试验结果表明，在某些情况下它具有有益和缓解症状的价值。对于无法切除且对化疗、内分泌治疗或放疗耐药的脑膜瘤和平滑肌瘤患者，米非司酮可作为辅助治疗药物。在广泛的子宫内膜异位症中，米非司酮可用于缓解顽固性疼痛，尽管其对病变的影响极小。在治疗无法切除的转移性乳腺癌时，米非司酮可在经过一个疗程的化疗和/或放疗后考虑使用，且仅能与另一种药物联合使用。在库欣综合征中，米非司酮可用于治疗皮质醇分泌过多的不良后果，例如精神病。它对肾上腺或垂体的病变影响极小或无影响。长期使用米非司酮的不良反应轻微至中度，反映了抗糖皮质激素的作用。在米非司酮治疗期间，应注意患者在血促肾上腺皮质激素（ACTH）和皮质醇水平升高时可能会出现类艾迪生病综合征。
用25或50毫克/天的米非司酮治疗平滑肌瘤，肿瘤大小缩小了25%至49%。每日剂量50或100毫克的米非司酮治疗子宫内膜异位症可缓解盆腔疼痛和子宫痉挛，并使病变消退约55%。用200或400毫克/天的米非司酮治疗转移性乳腺癌产生了部分缓解。用200或400毫克/天的米非司酮治疗无法切除的脑膜瘤，约25%的患者出现了客观改善。
米非司酮作为辅助治疗，对于无法切除、激素依赖性肿瘤以及对化疗和放疗耐药的女性生殖系统疾病有益。
