早期乳腺癌辅助内分泌治疗进展(摘要)

在癌症治疗中乳腺癌的激素治疗代表着最早期的分子疗法或靶向治疗。早期乳腺癌采用激素制剂辅助治疗，无论淋巴结状况如何都会减少疾病的复发率和死亡率。直到最近，对于雌激素受体或孕激素受体阳性的早期乳腺癌患者来说，术后口服5年的三苯氧胺仍然是一个重要的选择，芳香化酶抑制剂已经是标准治疗。     

乳腺癌的内分泌治疗

Halsted( 1 894年 )提出乳腺癌根治术 ,经历了漫长的年代后逐渐成为外科治疗乳腺癌的标准术式。 2 0世纪 60年代 ,放射治疗、化学治疗的介入 ,单一手术模式逐渐被综合疗法所取代 ,手术范围渐趋保守。从 2 0世纪 60年代开始至今化学治疗逐步从单一药物向联合用药 ,从静脉给药向口服给药 ,由单途径向多途径给药 (动脉导管介入 ,腔内注射等 )方向发展。放射治疗随着放射生物学和放射物理学的提高也为综合疗法提供了有利的条件。乳癌是一全身性疾病 ,应序贯地、合理地安排各种治疗方法 (包括手术、化疗、内分泌治疗、免疫生物学治疗和各种支持…     

早期乳腺癌后续强化辅助内分泌治疗（MA-17研究结果解读）

1 乳腺癌内分泌治疗：他莫昔芬的益处和局限性 他莫昔芬（TAM）是最常用的乳腺癌内分泌治疗的药物，关于TAM在早期乳癌术后预防复发转移的辅助治疗阶段中应用，最为权威的结论来自发表在Lancet上、对55个临床试验共计37000例患者的综合回顾报告，目前TAM在乳癌辅助治疗中应用的基本共识有：     

早期乳腺癌后续强化辅助内分泌治疗(MA-17研究结果解读)

1乳腺癌内分泌治疗:他莫昔芬的益处和局限性他莫昔芬(TAM)是最常用的乳腺癌内分泌治疗的药物,关于TAM在早期乳癌术后预防复发转移的辅助治疗阶段中应用,最为权威的结论来自发表在Lancet上、对5 5个临床试验共计37 000例患者的综合回顾报告,目前TAM在乳癌辅助治疗中应用的基本共识有:①辅助内分泌治疗的决定因素为激素受体(ER/PR)状况,ER阳性者效果最好,部分ER、阴性PR阳性的患者也可以使用TAM,但ER阴性患者辅助治疗用TAM不能改善生存;②目前认为TAM合适的服药时间为5年,可以显著降低复发风险12%,提高生存率9%。至于再延长用药…     

乳腺癌的化疗及内分泌治疗

乳腺癌是我国妇女最常见的恶性肿瘤之一 ,在城市已占妇女恶性肿瘤的首位。随着人们生活水平的不断提高 ,月经初潮的提前 ,生育、哺乳的减少 ,其发病率仍会继续增长。在我国乳腺癌的发病高峰年龄在 4 0～ 4 9岁。内科的化疗及内分泌治疗在乳腺癌的治疗中 ,已占居了极其重要的地位。1　乳腺癌的化疗全身化疗是乳腺癌得到根治的主要手段之一 ,几乎各期患者都会在一定时期需要进行内科化疗。1 1　乳腺癌术后的辅助化疗　辅助化疗是乳腺癌治疗的重要组成部分 ,无论是绝经前还是绝经后的妇女 ,通过辅助化疗均能提高长期生存率、降低复发率和死亡率…     

CSCO乳腺癌HR阳性晚期乳腺癌内分泌治疗的进展

随着有关CDK4/6抑制剂、HDAC抑制剂、PI3K/Akt/mTOR抑制剂临床研究的不断深入,激素受体阳性晚期乳腺癌的内分泌治疗进入了靶向联合时代。面对诸多新型药物,如何制定最优化和个体化的治疗方案成为广大临床医生关注的焦点。2020年新版CSCO乳腺癌指南充分考量循证医学证据等级、治疗手段可及性及最新研究进展,并针对既往用药情况提出分层策略,对激素受体阳性晚期乳腺癌的内分泌治疗方案予以相应推荐,为广大乳腺癌医学工作者在临床实践中作出合理选择提供了指导依据。     

乳腺癌114例内分泌治疗临床观察

目的 :通过 1994～1997年收治的乳腺癌病人中 ,观察我院收治的乳腺癌患者不同时间、不同年龄的内分泌治疗共 114例的效果。方法 :回顾性分析 1994～1997年收治的乳腺癌病人。手术切除标本用免疫组化APC法进行雌激素受体检测 ,患者ER ,PR 30 %以上为受体阳性 ,30 %以下为受体阴性。结果 :35岁以下受体阳性行手术卵巢去势 15例 ,术后服用TAM2年。术后 5年存活明显优于对照组。P <0 0 5。受体阳性 4 8例 ,化疗后服TAM2年 ,5年存活明显优于受体阴性 32例。P <0 0 5。结论 :内分泌治疗对各期乳腺癌病人均有一定疗效 ,特别对绝经后受体阳性病人疗效明显 ,对复发转移病人 ,延长生命 ,提高生活质量有一定效果。     

老年乳腺癌的内分泌药物治疗

乳腺癌是女性最常见的恶性肿瘤之一.在我国,随着老龄化的加速,老年乳腺癌的患病率也呈逐年上升的趋势.鉴于老年乳腺癌患者激素受体表达阳性率高,表皮生长因子受体(HER2)表达低以及肿瘤细胞增殖指数偏低、组织学分级低的临床病理特点以及伴随其他脏器疾病多的临床特征.在老年乳腺癌的综合治疗及个体化治疗中,毒副作用低的内分泌治疗是最为重要的手段之一[1].     

乳腺癌的内分泌药物治疗

乳腺癌内分泌治疗应用于临床已有 110多年历史 ,主要手段有手术及药物。手术主要用于绝经前的晚期乳腺癌 ,药物是最主要的治疗手段 ,而内分泌治疗在乳腺癌的综合治疗中占有主要地位 ,国内同道需要进一步熟悉和重视 ,现将乳腺癌内分泌治疗的药物分述如下。1　雌激素受体 (ＥＲ)拮抗剂1 1　三苯氧胺 (Ｔａｍｏｘｉｆｅｎｅ ,他莫苷芬 ,ＴＡＭ)　是常用的非甾体类雌激素类药 -抗雌激素类药 ,是三苯乙烯反式同分异构体 ,与合成的乙烯雌酚结构相似 ,抢先与肿瘤胞浆内的ＥＲ结合 ,阻断激素依赖性肿瘤细胞生长 ,达到杀伤肿瘤。但又具有雌激素样作用…     

中国乳腺癌患者辅助内分泌治疗依从性的系统评价

目的 系统评价中国乳腺癌患者辅助内分泌治疗的依从性。方法 计算机检索The Cochrane Library、Web of Science、PubMed、EMBase、CINAHL、CNKI、VIP、WanFang Data和CBM数据库,搜集中国乳腺癌患者辅助内分泌治疗依从性的研究,检索时限均为建库至2022年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行Meta分析。结果 共纳入24个研究。Meta分析结果显示,中国乳腺癌患者辅助内分泌治疗总体依从率为55.0%[95%CI(0.44,0.66)],5年依从率为54.4%[95%CI(0.46,0.63)]。亚组分析结果显示,疾病认知好、文化程度高、家庭月收入高、居住在城市、有效的家庭支持、无药物不良反应、就医便捷度高、定期复查、接受健康宣教、无合并症、服药类型改变的患者依从性更高。结论 我国乳腺癌患者辅助内分泌治疗依从率较低。社会人口学特征、治疗和社会支持不同的乳腺癌患者依从性也有所差异。     

Update on adjuvant hormonal treatment of early breast cancer

Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better disease-free survival, particularly in the worst-prognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.     

Initialization of adjuvant hormonal treatment for breast cancer

The introduction of aromatase inhibitors (AI) has resulted in practice change approaches in the treatment of early breast cancer. In this paper, we analyze the most relevant studies including the ATAC, BIG 1-98, TEAM, MA-17, NSABP B-33, and ABSCG-6 studies. Postmenopausal patients with hormone receptor-positive early breast cancer should be treated with AI for 5 years. For patients who have been initiated with tamoxifen (TAM), switching to an AI to complete 5 years of treatment is also recommended. The results of the extended adjuvant therapy studies recommend the use of an AI (anastrozole, letrozole, or exemestane) after the completion of standard TAM treatment. With regards to premenopausal women, TAM is the recommended adjuvant hormonal treatment for pre- and perimenopausal women. There is no indication for the use of AI in these subgroups of patients. Finally, determination of CYP 2D6 polymorphisms could be considered when choosing the best adjuvant hormonal treatment option.     

Advances in hormonal therapy for breast cancer

OBJECTIVES: To describe recent developments in hormonal therapy for breast cancer, focusing on SERMs and AIs. DATA SOURCES: Published journal articles and texts, research reports and monographs, government publications, and professional organization guidelines. CONCLUSION: Research continues to identify the effectiveness of hormonal therapy in breast cancer, including adjuvant treatment in early and advanced stages as well as a chemopreventive measure. The individual drug profile must be evaluated for safety and efficacy, and the impact on QOL must be considered. IMPLICATIONS FOR NURSING PRACTICE: It is imperative that oncology nurses understand the physiology, application, risks, and benefits of hormonal therapies.     

Predictive factors of hormonal therapy in breast cancer

Breast cancer is a hormone-dependent cancer, and the presence of estrogen receptor (ER) and progesterone receptor (PgR) in tumors is used clinically to predict the likelihood of response to hormonal therapies. This review describes the roles of (1) hormone related factors (ER, PgR, phosphorylated ER, ERbeta, aromatase), (2) growth related factors (HER2, Ki67, p53), (3) ER cofactors (AIB1, NcoR1), (4) estrogen dependent genes derived from gene expression profiling (HDAC6, IGFBP4/5), and (5) gene profiling using cDNA microarray. There are, however, considerable methodological difficulties in identifying useful predictive factors but on the basis of current evidence other biomarkers add little additional information. The prospective and multi-centered analyses will be warranted to develop the predictive factors for directing use of these therapies.     

Treatment guidelines for systemic adjuvant therapy of breast cancer

The rapidly growing body of knowledge provided by an efficient clinical trials process requires periodic revisions of clinical practice guidelines. These guidelines are prepared by experts whose delicate task is to digest the evidence provided by the clinical trials which may indicate a weak or a strong average treatment effect for a patient population and to translate this evidence into implications for individual patient care. Guidelines are thought to enhance the quality of care by reducing under-treatment, over-treatment and wrong treatment. At least one study has shown an adverse impact on overall mortality if treatment guidelines are not followed. Guidelines that have authority in the adjuvant treatment of breast cancer are the NIH and NCCN guidelines, those developed in St. Gallen and those by Japan Breast Cancer Society.