晚期乳腺癌内科治疗新进展

2008年San Antonio会议(SABCS)和2009年ASCO会议报道了一系列晚期乳腺癌内科治疗新进展。BSI-201、Dasatinib等新型靶向药物使晚期三阴性乳腺癌治疗有效率显著提高,抗HER-2和VEGF靶向药物联合化疗或内分泌药物的新方案可能是逆转晚期乳腺癌化疗或内分泌治疗耐药的有效手段,提示个体化治疗模式代表了晚期乳腺癌治疗领域发展的新方向。     

激素受体阳性晚期乳腺癌内分泌治疗的优化选择

内分泌治疗是激素受体(HR)阳性晚期乳腺癌治疗的一项重要选择。基于相关的临床研究,笔者综述了HR阳性晚期乳腺癌患者应用ER调节剂、芳香化酶抑制剂、ER阻断剂及内分泌治疗联合靶向治疗等数据,希望能为HR阳性晚期乳腺癌患者的治疗药物选择提供参考。     

晚期乳腺癌内分泌治疗现状及展望

乳腺癌属于激素依赖性肿瘤,其内分泌治疗机制是改变激素依赖性肿瘤生长所需要的内分泌微环境,使癌细胞增殖停止于G_O/G_1期,从而达到防控肿瘤和促其缓解的目的。晚期转移性乳腺癌患者由于机体抵抗力弱或者合并其他禁忌证,对二次手术或化疗一般不能耐受;而内分泌治疗由于不良反应小,临床获益率高等优点易于被患者所接受。正是由于这些优势的存在,使内分泌治疗成为晚期乳腺癌治疗措施中的热点,现就晚期乳腺癌内分泌治疗的现状及未来的展望作一综述。     

乳腺癌的内分泌疗法

自1896年Beatson首次报道卵巢切除治疗晚期乳腺癌获得成功后,从此,开辟了内分泌治疗恶性肿瘤的新途径.1974年Bethesda召开的国际会议上确认激素受体含量与内分泌治疗疗效之间存在正相关后内分泌治疗乳腺癌的研究更是得到深入的发展.内分泌疗法是乳腺癌治疗的主要手段之一.它不仅用于某些晚期乳腺癌的治疗,也可用于可手术乳腺癌的辅助化疗.但内分泌疗法仅适用于激素依赖性乳腺癌,而不适用于非激素依赖性乳腺癌.ER( )(雌激素受体阳性)者内分泌治疗有效率达50～70%,ER     

绝经后激素受体阳性晚期乳腺癌的内分泌治疗

随着内分泌新药的出现及对内分泌治疗耐药机制研究的不断发展,乳腺癌内分泌治疗近年取得显著进步。氟维司群、内分泌药物之间的联合治疗以及内分泌联合靶向治疗成为治疗绝经后激素受体阳性晚期乳腺癌的有效方案。     

中药治疗对晚期乳腺癌患者内分泌治疗依从性及生存期影响的临床研究

目的:研究中药治疗晚期乳腺癌患者内分泌治疗效果及生存期。方法:采用多中心、开放、队列研究方法,选择激素受体阳性的乳腺癌、有骨或软组织转移或无临床症状的肺、肝等脏器转移的晚期乳腺癌患者,三线内分泌治疗选择,接受不同中药治法,试验组配合应用"调畅气机"乳岩宁汤、对照组配合应用其它中医药治疗,观察两组内分泌治疗方案数、生存期的差别。结果:试验组(1个中心,33例)与对照组(4个中心,17例)相比,内分泌治疗方案数明显增多(P<0.01),复发、转移后的生存期也显著延长(P<0.01)。结论:中药治疗晚期乳腺癌患者,可以改善内分泌药物使用的依从性,配合内分泌药序贯治疗可能延长激素受体阳性晚期乳腺癌的生存期。     

激素受体阳性晚期乳腺癌内分泌联合治疗的新进展北大核心CSCD

激素受体阳性晚期乳腺癌作为一种难以治愈的异质性恶性肿瘤,严重影响女性的健康与生命。肿瘤生物学行为的变化及其耐药性问题使内分泌后续治疗的临床疗效不尽如人意。近年来,随着内分泌耐药细胞内信号转导通路机制的研究,许多靶向药物被联合应用于临床实践,可明显改善患者无疾病进展期,提高生活质量,为晚期乳腺癌后续内分泌治疗药物的选择提供了更多的证据。本文就晚期乳腺癌内分泌联合治疗的最新进展作一综述。     

乳腺癌内分泌治疗的基本药物和新动向

乳腺癌的发生、发展与患者体内雌激素密切相关,自1896年Beatson首次使用卵巢切除术治疗晚期乳腺癌以来,内分泌治疗在乳腺癌综合治疗中的地位越来越重要,目前大家已逐渐认识内分泌治疗与化疗是乳腺癌药物治疗的“左膀右臂”。     

对乳腺癌雌孕激素受体检测的认识

自从1896年英国医师Beatson博士应用双侧卵巢切除治疗晚期乳腺癌首获成功、开启内分泌治疗乳腺癌的大幕,迄今已有一百多年了。而ER、PR的发现及其与乳腺癌患者预后的相关性,以及应用ER、PR筛选内分泌治疗优势人群,又把乳腺癌的内分泌治疗推上了新的水平高度。     

三苯氧胺治疗老年人晚期乳腺癌16例报告

三苯氧胺治疗老年人晚期乳腺癌１６例报告林兰珠福建省漳州市医院（３６３０００）晚期乳腺癌除姑息性放疗和化疗外，内分泌治疗愈受重视。本文报告１６例老年晚期乳腺癌内分泌治疗效果，其中１０例由于病情或其他原因不宜做放疗及化疗，仅单纯服用三苯氧胺。临床资料：本...     

Preoperative therapy: recent findings

Preoperative systemic therapy (PST) is the standard treatment for locally advanced breast cancer and a standard option for primary operable breast cancer. PST for breast cancer is as effective as postoperative adjuvant therapy, which permits more lumpectomies and can be used to study breast cancer biology. For locally advanced breast cancer patients, the primary aim of PST is to improve surgical option. For operable breast cancer patients, the primary aim of PST is to obtain freedom from disease. Because of recent advances in treatment and our understanding of the disease, we summarized the current consensus on the adoption and benefits of PST, especially for operable breast cancer patients.     

OK-432治疗晚期乳腺癌临床疗效观察

目的 :观察、分析OK 4 32在晚期乳腺癌治疗中的近期疗效。方法 :选择我院门诊就医的晚期乳腺癌患者 18例 ,应用OK 4 32作临床治疗 ,取病情相似的患者 10例作统计配对 ,观察其治疗效果并作分析。结果 :治疗组的有效率为 94 .5% ,对照组中除 1例稳定外 ,其他病例的病情均恶化。OK 4 32的治疗效果明显好于对照组。结论 :OK 4 32治疗晚期乳腺癌的近期疗效优于一般支持治疗。     

Role of anti-aromatase agents in postmenopausal advanced breast cancer

PURPOSE: Endocrine therapy is a well-recognized approach to the treatment of postmenopausal patients with advanced breast cancer, particularly those with estrogen receptor-positive tumors. The availability of anti-aromatase agents, both reversible (nonsteroidal) and irreversible (steroidal), provides clinicians with additional hormonal treatment options. METHODS: A MEDLINE search was conducted to identify studies that evaluated anti-aromatase therapy in the treatment of postmenopausal women with advanced breast cancer. In selecting studies, priority was given to randomized, controlled trials. RESULTS: Tamoxifen is the standard first-line therapy for advanced breast cancer. However, recent results have demonstrated the efficacy of newer anti-aromatase agents in this setting. Among patients who have progressed after tamoxifen therapy, anti-aromatase agents have emerged as first choice therapy based on their better tolerability and improved efficacy compared with megestrol acetate. Exemestane and anastrozole (irreversible and reversible anti-aromatase agents, respectively) have demonstrated survival benefits over megestrol acetate in second-line therapy. Anti-aromatase agents have also demonstrated efficacy in patients who have failed multiple hormonal therapies. Based on these data, an algorithm for the treatment of postmenopausal women with advanced breast cancer is proposed. CONCLUSIONS: The enhanced tolerability and superior efficacy of anti-aromatase inhibitors compared with megestrol acetate has resulted in these agents becoming the endocrine treatment of choice for women with advanced breast cancer who have progressed after tamoxifen treatment. The increased use of tamoxifen in the adjuvant setting and the demonstrated activity of aromatase inhibitors in first-line therapy will further increase the role of these agents.     

HER-2阳性乳腺癌的新辅助治疗现状及展望

人表皮生长因子受体（HER-2）高表达被视为乳腺癌预后不良的重要预测因素,但随着抗HER 2治疗药物研发的进步、新辅助治疗理念的建立及临床经验的积累,其预后已得到改善。新辅助治疗是局部晚期乳腺癌的标准治疗,并被广泛用于可手术的早期患者,以提高保乳率。新辅助治疗与术后辅助治疗同样可以改善患者的无病生存期（DFS）和总生存期（OS）。近年来曲妥珠单抗等抗HER 2靶向药物及治疗方法发展迅速,新辅助治疗为药物的研究和开发提供很好的研究平台,HER-2阳性乳腺癌新辅助治疗相关问题已成为肿瘤学关注的热点问题,本文将对此作一简要综述。     

乳腺癌药物治疗的现状与展望

术后辅助治疗能够提高乳腺癌病人的总生存率和无病生存率，含蒽环类药方案优于非蒽环类药方案，阿霉素为主方案中加入紫杉醇能进一步提高淋巴结阳性病人的生存率，化疗加用他莫昔芬（TAM）能进一步提高疗效，辅助化疗疗效与一定剂量强度相关，但强烈化疗联合造血干细胞 不能改善病人生存，新辅助化疗对Ⅲ期乳腺癌有效，合理应用内分泌治疗和化疗能改善晚期病人的生活质量，延长高质量的生存期。     

More options for adjuvant treatment of HER2-positive breast cancer: How to choose wisely?

Human epidermal growth factor receptor 2-positivity (HER2) has a prognostic and predictive role in breast cancer. Trastuzumab, an anti-HER2 therapy, has a crucial role in a curative setting in Stage I, II and III breast cancer. In recent years, more anti-HER2 agents have been tested in clinical trials. Newer dosing strategies and combination approaches give us a plethora of options to treat a patient with early-stage and locally advanced breast cancer. It has led to the possibility of providing a risk-adapted treatment for patients with HER2-positive breast cancer. In order to reduce overtreatment and protect patients from adverse effects, a deescalation framework can be used in patients at lower risk for recurrence. Similarly, in those with greater risk for recurrence, escalation of therapy can be considered with the goal of achieving a cure. In this narrative review, we aim to provide a critical appraisal of the recent research findings in the management of early-stage and locally advanced breast cancer.     

Inflammatory breast cancer: Clinical progress and the main problems that must be addressed

Inflammatory breast cancer is a rare but highly aggressive form of locally advanced breast cancer. Historically, this disease was uniformly fatal; however, with the advent of induction chemotherapy and carefully coordinated multimodality treatment, the prognosis of these patients has improved. This article reviews the clinical characteristics of inflammatory breast cancer and the recent advances in therapy.     

New aromatase inhibitors in the treatment of advanced breast cancer

New aromatase inhibitors are an exciting treatment option for postmenopausal women with hormone sensitive breast cancer. They have been shown to reduce tumors in a significant number of patients, and exhibit definite antitumor activity at a relatively low daily dose, and are highly potent, highly selective, and well-tolerated. Results from recent clinical phase III studies have confirmed their efficacy and the key role they have in the therapy for advanced breast cancer in postmenopausal women. The agents available for clinical use are: letrozole, anastrozole, and exemestane. These drugs have demonstrated high activity in women failing tamoxifen in locally advanced or metastatic disease. This communication reviews the clinical use of aromatase inhibitors, particularly in second and first line hormonal treatment of advanced breast cancer.     

Neoadjuvant endocrine therapy for breast cancer: an overview

The clinical benefits of endocrine therapy for patients with hormonosensitive breast cancer remains perfectly established. For instance, tamoxifen, the gold standard of the adjuvant treatment, has largely contributed of the effectiveness of such a therapy. The recent development of new endocrine agents (the third-generation aromatase inhibitors, selective estrogen receptors modulators), provides to physicians the opportunity of a more effective and tolerable therapeutic approach, in the metastatic disease setting or likely in adjuvant setting for breast cancer patients. Preoperative therapy has been widely used for the treatment of initially inoperable locally advanced breast cancers with the main objective of breast-conserving surgery. The benefits of neoadjuvant chemotherapy has widely been demonstrated; however, the success of neoadjuvant endocrine therapy is much recent. The clinical and pharmacological data of the main published studies using neoadjuvant hormonotherapy are presented herein this review. Therefore, clinical and histologic assessments of response brings essential informations about the breast cancer hormonal sensitivity, but may also be predictor of the future (adjuvant or metastatic) treatment responsiveness.