乳腺癌长期三苯氧胺治疗国际会议概述

三苯氧胺(TMX)为非甾体类抗雌激素药物,20年前,首先作为绝经后晚期乳腺癌患者的姑息性治疗,而今,TMX可为各期乳腺癌选择病例提供有益的内分泌治疗.同时已有计划的应用于乳腺癌高危人群,以评价其对乳腺癌预防性治疗的价值.1977年,在英国剑桥会议,实验室研究结果就支持对高危女性乳腺癌辅以长期TMX治疗,可能获得最有益的结果.当时,几组为期1年的TMX辅助治疗研究是基于:①TMX使     

化疗加三苯氧胺治疗复发性乳腺癌30例报告

我院自1987年12月至1991年1月用CMF/CAF化疗方案加三苯氧胺(TAM),共治疗30例复发性乳腺癌,现报告如下。 资料与方法 全组30例,均为根治术后复发的临床Ⅳ期病例,均经病理证实。所有病例治疗前都有时间长短不一的     

三苯氧胺治疗百岁乳腺癌1例

1病案摘要患者孙某,女性,1905年3月9日生。患者于1999年月发现右乳腺外上象限肿块约桃仁大未引起重视,肿块逐渐增大,2003年1月肿块增大至约4.0cm×4.0cm,同时右腋淋巴结肿大2枚约1.0cm×2.0cm,2.0cm×2.0cm。同年6月来院就诊,查体见:右乳腺外上象限肿块5.0cm×5.0cm,质硬,与皮肤粘连无红肿、无破溃,右腋淋巴结2枚均为2.0c×2.0cm。因患者拒行针吸活检,无细胞学及病理学诊断,临床诊断:右乳腺癌腋淋巴结转移,给予小金丹2.0g口服,每日2次,连服1个月;小牛胸腺肽20mg肌注,每日1次,连用1月;独角莲羔腋淋巴结外敷,间断治疗5个月后,于2003年10月来院…     

三苯氧胺与乳腺癌防治研究进展

三苯氧胺应用于乳腺癌已有30余年的历史，其丰富的meta分析资料和多途径的抗肿瘤作用使其在过去的二三十年中成为所有激素受体阳性乳腺癌内分泌治疗的首选药物，并一度成为激素受体阳性乳腺癌术后辅助内分泌治疗的金标准。尽管第三代芳香化酶抑制剂和促黄体生成素释放激素类似物（LHRHa）的应用，使口服三苯氧胺5年作为金标准被逐渐动摇，但其作为标准治疗的地位仍无法被完全取代，三苯氧胺的特性和雌激素受体一起仍然是当前研究热点之一。     

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...     

三苯氧胺在乳腺癌治疗中的应用

自1966年首次生产出三苯氧胺(tamoxifen)新型抗雌激素药物后,从70年代初开始已越来越多地用于治疗乳腺癌。本文就近年来对三苯氧胺治疗乳腺癌的研究情况综述如下。 一、三苯氧胺的作用机理 三苯氧胺治疗乳腺癌的作用有激素相关和非激素相关两方面的机理。三苯氧胺及其代谢物能通过阻断雌激素与其受体结合而发挥抗雌激素作用。雌激素和靶细胞核的受体蛋白结合后刺激细胞生长,增加细胞自身分泌生长因子(TGF-α)和其它蛋白,     

乳腺癌患者长期服用三苯氧胺与子宫内膜癌的关系

ＴＡＭ用于乳腺癌的治疗已有３０余年历史，由于它的雌激素样作用，人们一直担心服用ＴＡＭ的同时，是否增加子宫内膜癌的发病率。本文综述了近年研究结果，认为ＴＡＭ与子宫内膜癌有关，相对危险系数为１．６￣１０．０，提示对长期服用ＴＡＭ的病人，应定期做超声检查或子宫内膜活检，以期早日发现可能并存的子宫内膜肿瘤。     

乳腺癌患者应用三苯氧胺导致的妇科并发症及其监测

三苯氧胺具有抗雌激素和雌激素的双重特性,长期持续使用可导致子宫内膜发生多种病理改变。临床应予以重视,并加以监测。本文就妇科并发症的发生和临床监测方面做一综述,以早发现、并减少并发症的发生。     

雌激素受体阳性可手术乳腺癌三苯氧胺辅助治疗的远期疗效

目的：探讨三苯氧胺（TAM）辅助治疗雌激素受体阳性可手术乳腺癌的远期疗效。方法：414例雌激素受体阳性可手术乳腺癌患者按服用TAM与否分成TAM组和非TAM组，并随访观察至少10年，用Kaplan-Meier法计算两组生存率和无瘤生存率，Log-rank统计分析行显著性检验，Cox模型进行多因素分析，结果：TAM组生存率和无瘤生存率均高于非TAM组，服药时间与生存率和无瘤生存率均呈正相关（P＜0．05），进一步分层比较，腋淋巴结阴性患者两指标无差异（P＞0．05），腋淋巴结阳性患者两指标差异有显著性（P＜0．05），结论：TAM用于雌激素受体阳性可手术乳腺癌患者术后辅助治疗可提高远期生存率和无瘤生存率。     

来曲唑与三苯氧胺在绝经后期乳腺癌新辅助内分泌治疗中的疗效对比

目的 比较来曲唑与三苯氧胺用于绝经后期乳腺癌新辅助内分泌治疗的近期疗效和毒副反应.方法将收治的绝经后期、ER阳性、有合并症的55例乳腺癌随机分为两组,并行新辅助内分泌治疗.来曲唑组25例:2.5 mg/次,1次/d,连续60 ～90 d;三苯氧胺组30例:10mg/次,2次/d,连续60～90 d.比较两组的近期疗效和...     

乳腺癌术后辅助治疗疗效分析

 目的　探索乳腺癌根治术后患者病期、淋巴结情况及治疗方法对生存率的影响。方法对比分析我科收治的乳腺癌术后Ⅱ期110例和Ⅲ期90例,采用术后放疗、术后化疗及术后放疗加化疗进行治疗。结果　Ⅱ期和Ⅲ期乳腺癌患者术后放疗、术后化疗+放疗局部复发率均低于术后化疗(P＜0.05);Ⅲ期患者远处转移率术后放疗高于术后化疗或术后放疗+化疗(P＜0.05);Ⅱ期乳腺癌腋窝淋巴结转移数≥4个,生存率下降;Ⅲ期乳腺癌患者随着N的升级,五年生存率逐渐降低。结论　乳腺癌术后放疗可以减少局部复发率;Ⅲ期乳腺癌术后化疗可降低远处转移率;淋巴结转移数影响5年生存率。     

The Future Shape of Hormonal Therapy for Metastatic Breast Cancer After Adjuvant Tamoxifen or Anastrozole

Mammographic density has been linked with exposure to endogenous and exogenous steroid hormones, and increased breast cancer risk. Variation in breast density may be due, in part, to polymorphisms in steroid hormone biosynthesis, metabolism and signaling genes. We conducted cross-sectional analyses within the Nurses' Health Study (n = 538), to investigate variation in mammographic breast density, by 10 polymorphisms in eight candidate genes (CYP17, CYP19, CYP1A1, CYP1B1, COMT, UGT1A1, AR, and AIB1). Breast density was assessed using a computer-assisted technique. We evaluated whether associations between variant alleles of these genes and breast density differed by menopause and postmenopausal hormone (PMH) use. Polymorphisms in CYP17, CYP19, CYP1B1, COMT, CYP1A1, or AR were not associated consistently with breast density among premenopausal or postmenopausal women. Premenopausal women with the 7/7 UGT1A1 genotype had lower breast density (difference compared to the 6/6 genotype of: –16.5% density; p = 0.04). In contrast, postmenopausal women with the 7/7 UGT1A1 genotype had greater breast density compared to those with the 6/6 genotype (+6.2% density; p = 0.05); this association was strongest among current PMH users (+13.0% density; p = 0.03). In analyses limited to postmenopausal women, breast density was also greater among women carrying short AIB1 alleles (26 glutamine repeats; +4.1% density; p = 0.04). Most of the variants in the candidate breast cancer genes evaluated in this study are not strong predictors of breast density. However, our findings of differences in associations for UGT1A1 and AIB1 genotypes with breast density by menopausal status needs additional corroboration.     

Estrogenic Effects of Toremifene and Tamoxifen in Postmenopausal Breast Cancer Patients

Intrinsic estrogenicities of the selective estrogen receptor modulators (SERMs) toremifene 60 mg daily or 200 mg daily and tamoxifen 20 mg daily (TOR60, TOR200 and TAM20) were compared in a randomized clinical study in postmenopausal women with advanced breast cancer. The study was open label in three parallel groups. Variables for analysis were serum follicle stimulating hormone (FSH), luteinizing hormone (LH), sex hormone binding globulin (SHBG), estradiol (E2), antithrombin III (AT III), aspartate aminotransferase (ASAT) and vaginal cytology. Clinical efficacy and safety have been reported earlier. A total of 648 patients were randomized (221 to TOR60, 212 to TOR200 and 215 to TAM20). Sera were available for the analysis from 148, 165 and 156 and for vaginal cytology from 98, 93 and 86 patients, respectively. All treatment regimens showed tissue-specific and dose-dependent estrogen agonist effect. In the primary measure of in vivo estrogenicity, effect on hypothalamus-pituitary-axis, all three treatment regimens decreased serum FSH (p < 0.001). TOR200 was more potent than the two other treatments (p < 0.05), but surprisingly, TAM20 was more estrogenic than TOR60 (p < 0.001). As could be expected in postmenopausal women, the treatments had no effect on mean serum E2 concentrations and decrease of serum LH was similar to that of FSH. Estrogenic effect on the liver was seen as dose-dependent increase of SHBG with statistically significant differences between the treatment groups (p < 0.001). Trends of transient ASAT elevations in TOR200 group (p = 0.07) and in all treatment groups AT III decrease (p = 0.1) were seen in the beginning of the treatment. TOR60 or TAM20 did not have an effect on mean ASAT values, and AT III decreased in TAM20 group more than in the two other groups (p = 0.1 compared to TOR60 and p < 0.05 compared to TOR200). Estrogenic effects on vaginal superficial cells were higher in TOR60 and TOR200 groups when compared to TAM20 (p < 0.05). Toremifene and tamoxifen had tissue-specific and partially dose-dependent estrogenic effects in hypothalamus-pituitary-axis, in the liver and in the vaginal epithelium of postmenopausal women. In some tissues tamoxifen 20 may be more estrogenic than toremifene 60 mg/day.     

乳腺癌术后辅助化疗的进展

辅助化疗是乳腺癌综合治疗中的重要组成部分,也是预防远处转移的主要手段。本文对近年来乳腺癌术后辅助化疗进展的相关文献进行了回顾,在内科治疗方面,规范化、个体化是乳腺癌辅助治疗的方向。     

Adherence to Adjuvant Endocrine Therapy in Christchurch Women with Early Breast Cancer

Aims

To assess adherence to adjuvant endocrine therapy by a real-world cohort of women in Christchurch and to determine any associated factors.

Tamoxifen and Alpha Interferon in Advanced Breast Cancer

Summary

Thirteen pretreated advanced breast cancer patients received a combination of alpha interferon 5 million IU every 2 days, subcutaneously, plus tamoxifen 10 mg 3 times daily, until disease progression.

The objective response rate was 15.4%: 1 patient achieved a complete response, 1 a partial response and 11 demonstrated stable disease; half of the patients were receptor negative and/or pretreated with hormonotherapy.

Durations of response were 16 and 26 months for the CR and PR patients respectively; median progression-free survival was 4 months (range 0–26). Toxicities were registered according to WHO criteria: 4 patients stopped the treatment with interferon because of severe flu-like symptoms, while in the others the combination was generally accepted with good tolerance.     

乳腺癌内分泌治疗耐药的研究进展

乳腺癌内分泌治疗作为乳腺癌综合治疗的方法之一,具有不可替代的重要性.然而,内分泌治疗的疗效因其耐药性受到限制.文章旨在对乳腺癌内分泌治疗耐药的机制及逆转耐药的治疗进展进行综述,为临床内分泌治疗提供新的方向.