乳腺癌化疗致闭经的利弊及随后的内分泌治疗

化疗致闭经是一个客观过程，影响因素基本明确，而且对激素受体阳性的患者，化疗致闭经可改善无病生存和总生存，所以对一些预后好和希望保留卵巢功能的患者我们可以进行干预尽可能保护卵巢功能；而对一些高危、预后差的患者，如果化疗未致闭经，可以采用进一步卵巢抑制的方法，以达到闭经，从而获得更好的疗效，这是一个客观、容易观察的指标。     

新辅助治疗在局部晚期乳腺癌中的应用

目的：探讨新辅助治疗在局部晚期乳腺癌治疗中的应用。方法：回顾性分析36例局部晚期乳腺癌患者进行新辅助治疗的临床资料：结果：36例患者中29例(80％)经新辅助治疗后病情缓解，可以手术。其中27例由化疗获得，2例由内分泌治疗获得。结论：大多数局部晚期乳腺癌患者可以在1—2个疗程的新辅助治疗后病情缓解，便于手术治疗，从而改善预后。     

紫杉特尔在乳腺癌化疗中的应用

紫衫特尔是新一代紫杉类化疗药物，具有高度的抗癌活性、确切的疗效、可以耐受的毒性反应，巴成为乳腺癌治疗中最重要的化疗药物之一，已有多种以紫衫特尔为基础的化疗方案广泛应用。现综述紫杉特尔在乳腺癌治疗中的研究及应用。     

中国早期乳腺癌卵巢功能抑制临床应用专家共识（2016年版）

乳腺癌已经成为威胁中国女性健康的第一大恶性肿瘤,发病率呈逐年递增趋势。中国乳腺癌发病率年增幅速度是世界平均水平的2倍,且年轻化趋势显著,约有60%的患者在诊断时仍为绝经前状态［1］。据统计,中国绝经前女性早期乳腺癌患者中50%~60%激素受体为阳性,辅助内分泌治疗是降低这类患者复发风险的重要手段,如采用他莫昔芬治疗5~10年已经成为绝经前激素受体阳性的早期乳腺癌患者的标准内分泌治疗方式［2-5］。     

乳腺癌骨转移内分泌治疗与化疗的对比研究

目的　对比分析内分泌治疗与化疗对乳腺癌骨转移的疗效。方法　对 138例无内脏转移的乳腺癌骨转移患者 ,行 2 89例次单独内分泌治疗或化疗。结果　内分泌治疗与化疗的一线治疗有效率分别为 35 .4 %和 31.7% ,差异无显著性 (χ2 =0 .16 3,P =0 .6 87) ;全部治疗有效率分别为 2 7.1%和 2 5 .0 % ,差异无显著性 (χ2 =0 .15 9,P =0 .6 90 ) ;临床获益率分别为 4 3.9%和 36 .6 % ,差异无显著性(χ2 =0 .6 0 3,P =0 .4 37)。但内分泌治疗与化疗的二线治疗临床获益率分别为 4 7.8%和 2 4 .2 % ,全部治疗为 4 7.5 %和 2 7.7% ,差异均有显著性 (χ2 =4 .5 37,P =0 .0 33;χ2 =11.2 0 1,P =0 .0 0 1)。内分泌治疗和化疗患者的中位治疗失败时间 (TTF)为 5个月和 2个月 ,中位病变进展时间 (TTP)为 5个月和 2 .5个月 ,差异均有非常显著性 (P均 <0 .0 0 1)。结论　单独内分泌治疗和化疗均为乳腺癌骨转移的有效治疗手段 ,其中内分泌治疗优于化疗。     

紫杉特尔在乳腺癌化疗中的应用

紫杉特尔是新一代紫杉类化疗药物,具有高度的抗癌活性、确切的疗效、可以耐受的毒性反应,已成为乳腺癌治疗中最重要的化疗药物之一,已有多种以紫杉特尔为基础的化疗方案广泛应用.现综述紫杉特尔在乳腺癌治疗中的研究及应用.     

功能MRI在乳腺癌新辅助化疗诊疗过程中的应用

随着功能磁共振的发展,其成为评估新辅助化疗疗效、病灶残留范围的首选检查,对于新辅助后的远期预后有潜在预测价值,在新辅助治疗的各个过程中均具有重要意义。全文就功能MRI在乳腺癌新辅助治疗中的应用进行综述。     

剂量密集化疗方案在乳腺癌中的应用

自20世纪70年代以来,关于乳腺癌化疗的研究报道逐渐增多[1],各国学者们不断探索,通过不同药物间的组合、改变给药顺序、增加药物剂量、延长或缩短给药时间等方式,力求使更多患者从化疗中获益.剂量密集方案是指单次用药剂量不变的情况下,缩短每次化疗之间的时间间隔,以期获得更好的治疗效果.本文就剂量密集方案在乳腺癌治疗方面的进展综述如下.     

节拍化疗在乳腺癌治疗中的应用

节拍化疗是近年来兴起的一种全新的化疗模式,是利用低剂量、多次不间断给药的方式,通过持续抑制肿瘤新生血管生成,达到缩小肿瘤体积、控制肿瘤生长、减少相关药物的不良反应、提高相关疗效、减少相关药物耐药性的作用.目前,在转移性乳腺癌患者的临床治疗中已经取得了肯定的治疗效果.随着治疗模式的改变、概念的不断更新以及越来越多的相关治疗机制被发现,目前节拍式治疗已经不仅是节拍化疗,而是贯穿化疗、放疗、内分泌治疗及相关辅助治疗的治疗模式.本文就节拍化疗在乳腺癌治疗中的应用作一综述.     

Protease Cargo in Circulating Exosomes of Breast Cancer and Ovarian Cancer Patients

Background: As is known, exosomes play an important role in promoting progression of cancers by increasingits invasive potential. The aim of this study was to evaluate the levels of tetraspanine-associated (ADAM-10) andtetraspanine-nonassociated proteases (20S proteasomes) in exosomes from culture medium, plasma exosomes ofpatients with breast tumors and plasma and ascites of ovarian tumor patients. Methods: MCF-7 and SVO-3 culturemediums and blood samples from healthy females (n = 30, HFs), patients with diffuse dyshormonal dysplasia of thebreast (n=28, BBTPs), breast cancer patients (n=32, BCPs), borderline ovarian tumor patients (n=20, BOTPs) andblood and ascites samples ovarian cancer patients (n=35, OCPs) were included in the study. Exosomes from plasma,ascites and culture mediums were isolated and characterized in according to Extracellular Vesicles Society. Theexpression levels of 20S proteasome and ADAM-10 in exosomes were determined using flow cytometry and westernblot analysis, correspondingly. Results: The subpopulation composition of the exosomes from MCF-7 culture mediumand from blood plasma of HFs and breast diseases patients is similar, however CD9/CD24 subpopulation significantlyincreased at cell supernatant. The similar results was obtained for exosomes from SVO-3 medium and blood plasmaand ascites of ovary tumor patients, but CD9/CD24 subpopulation significantly decreased at cells and illness samples,however CD63/CD24 exosomes increased significantly from cell supernatant. 20S proteasome level is significantlyincreased in exosomes from MCF-7 and SVO-3 culture medium, breast tumor patients and OCPs plasma in comparisonto HUVEC culture medium and HFs plasma samples. At CD9-positive exosomes from BCPs plasma and MCF-7 wasreveal a high expression of ADAM-10 and low expression is from BBDPs plasma and ovarian tumor patients plasma/ascites samples. Exosomes from ascites OCP had high expression of ADAM-10 in the CD24-positive subpopulation.Conclusion: Breast and ovarian cancer development is connected with functioning of immune proteasome forms inplasma and ascites exosomes, while increased ADAM10 expression at CD9-positive exosome was associated withbreast cancer and at CD24-positive subpopulation – with ovarian cancer. Obtained data confirm role of exosomalproteases in tumor progression.     

乳腺癌转移抑制基因1对卵巢癌细胞血管生成的影响及其机制探讨

目的探讨乳腺癌转移抑制基因1(breast cancer metastasis suppressor 1,BRMS1)对人卵巢癌细胞OVCAR3诱导血管内皮细胞形成管腔能力的影响及可能的机制。方法应用脂质体介导的方法将BRMS1 shRNA重组质粒转染人卵巢癌细胞OVCAR3,经G418筛选获得稳定转染株。荧光定量PCR和Western blot法检测BRMS1 mRNA和蛋白的表达水平;体外血管形成实验检测OVCAR3诱导人脐静脉内皮细胞(HUVECs)的血管形成能力;Western blot法检测生长抑制因子4(ING4)和白细胞介素-6(IL-6)的蛋白表达情况。结果稳定转染BRMS1 shRNA后,OVCAR3细胞BRMS1的表达在 mRNA和蛋白水平均受到明显抑制。体外血管形成实验提示,BRMS1表达下调后能显著促进卵巢癌细胞诱导的HUVECs形成管腔样结构的能力;Western blot法显示干扰组中ING4蛋白表达量较对照组下降30%,而IL-6蛋白表达上调,是空白对照组的1.5倍,差异有统计学意义(P<0.05)。结论干扰BRMS1基因的表达可促进卵巢癌细胞诱导血管形成能力,其机制可能与调节下游基因ING4和IL-6的表达有关。     

Risk Factors for Tamoxifen-Induced Ovarian Hyperstimulation in Breast Cancer Patients

IntroductionAdjuvant endocrine therapy is an integral component of care for hormone-dependent breast cancer. Tamoxifen is a potent inducer of ovarian function and consequent hyperestrogenism in premenopausal women. However, the incidence rate and risk factors associated this phenomenon remain unclear.Patients and MethodsData of patients younger than 60 years who received adjuvant tamoxifen therapy for hormone-dependent breast cancer (stages 0-III) and who underwent regular follow-up of laboratory results for follicle-stimulating hormone and estradiol levels were retrospectively analyzed. Univariate and multivariate analyses were performed to identify clinicopathologic factors related to ovarian hyperstimulation.ResultsAmong 205 patients, 19 (9.3%) showed high values of serum estradiol during tamoxifen therapy. The mean (± SD) serum concentrations of estradiol and follicle-stimulating hormone were 1047.97 ± 638.8 pg/mL and 11.5 ± 7.3 mIU/mL, respectively. A mean of 400.83 days elapsed from the start of the single administration of tamoxifen to the initial detection of a high concentration of estradiol. Univariate and multivariate analyses showed that younger age (< 40 years) and only endocrine therapy without chemotherapy were significantly related to a higher prevalence of ovarian hyperstimulation (P = .015, relative risk = 7.49 for age < 40 years; P = .017, relative risk = 32.9 for no chemotherapy). Pathologic stages and tumor characteristics were not related to the manifestation of ovarian hyperstimulation.ConclusionYoung age (< 40 years) and endocrine treatment without chemotherapy were risk factors for the incidence of ovarian hyperstimulation during tamoxifen treatment. Close monitoring of endocrine parameters during treatment with tamoxifen especially in this patient group is essential.     

Prevention of Chemotherapy-Induced Nausea and Vomiting in Cancer Patients

The supportive care of patients receiving antineoplastic treatment has dramatically improved over the pastfew years and development of effective measures to prevent nausea and vomiting after chemotherapy serves asone of the most important examples of this progress. A patient who starts cancer treatment with chemotherapylists chemotherapy-induced nausea and vomiting as among their greatest fears. Inadequately controlled emesisimpairs functional activity and quality of life, increases the use of health care resources, and may occasionallycompromise adherence to treatment. New insights into the pathophysiology of chemotherapy-induced nauseaand vomiting, a better understanding of the risk factors for these effects, and the availability of new antiemeticagents have all contributed to substantial improvements in emetic control. This review focuses on currentunderstanding of chemotherapy-induced nausea and vomiting and the status of pharmacological interventionsfor their prevention and treatment.     

Chemotherapy-Induced Toxicities and Their Associations with Clinical and Non-Clinical Factors among Breast Cancer Patients in Vietnam

Understanding the burden and factors related to chemotherapy-induced toxicity is important in treatment planning for breast cancer patients. We conducted a prospective study among 396 newly diagnosed and chemotherapy-treated breast cancer patients recruited in two major cancer hospitals in northern Vietnam. Toxicities were captured through medical chart reviews and patient self-reports and graded using NCI CTCAE classification. Associations for sociodemographic and clinical factors with chemotherapy-induced toxicities during first-line chemotherapy were evaluated via multivariable logistic regression. Severe (i.e., grade ≥ 3) hematological (38.6%), and gastrointestinal (12.9%) toxicities were common. A pre-existing nephrological condition was significantly associated with the risk of severe hematological toxicity with adjusted odds ratios (OR) and 95% confidence intervals (CIs) of 2.30 (1.32–4.01). Patients living in rural areas had a lower risk of severe hematological toxicity (OR = 0.48; 95% CI, 0.30–0.77). Patients diagnosed with stage II and stage III–IV had a lower risk of severe gastrointestinal toxicity with ORs and 95% CIs of 0.26 (0.12–0.59) and 0.47 (0.20–1.10), respectively. Triple-negative/basal-like subtype was associated with a higher risk of severe hematological (OR = 3.15; 95% CI, 1.56–6.34) and gastrointestinal toxicities (OR = 3.60; 95% CI, 1.45–8.95) comparing to hormone receptor (HR)-positive HER2-negative subtype. Further research investigating underlying mechanisms would facilitate the development and delivery of personalized treatment and care plans.     

Measuring Ovarian Escape in Premenopausal Estrogen Receptor-Positive Breast Cancer Patients on Ovarian Suppression Therapy

PurposeThis study evaluated the proportion of premenopausal women who experience persistent ovarian escape (OE) while receiving ovarian suppression (OS) therapy for estrogen receptor‐positive (ER+) breast cancer treatment. The study also examined clinical factors that may predispose to higher risk of persistent OE.Materials and MethodsThis was a retrospective, “real‐world” study to evaluate premenopausal women receiving adjuvant endocrine OS therapy. The primary objective was to measure the percentage of persistent OE within the first 3 months of OS injections (using either leuprolide or goserelin). The secondary objective was to associate baseline clinical data (age, body mass index [BMI], and previous chemotherapy) with the probability of OE.ResultsOf the 46 patients included in this analysis, 11 (23.9%) women did not achieve OS within 3 months. Three women (6.5%) remained in OE at 12 months. Older age (odds ratio, 0.86; confidence interval, 0.76–0.98, p = .024) was associated with lower chance of developing OE. BMI, previous chemotherapy, and drug used (tamoxifen versus aromatase inhibitor) did not correlate with the likelihood of OE in this patient cohort.ConclusionAmong the premenopausal women who did not attain complete ovarian suppression, young age was a significant risk factor for likelihood of OE. Although the clinical relevance of this finding is not yet known, it should prompt further studies to determine whether inadequate OS is associated with higher recurrence risk for patients with ER+ breast cancer.Implications for PracticeBecause up to a quarter of premenopausal women do not attain adequate ovarian suppression within the first 3 months of gonadotropin‐releasing hormone (GnRH) agonist therapy, bloodwork should be checked to ascertain hormone levels prior to starting aromatase inhibitor therapy, and at regular intervals, for these women.     

日本乳腺癌和卵巢癌死亡率的特点

目的：对1947年－1997年日本的乳腺癌与卵巢癌死亡情况及居民食物变化特点进行研究分析，为我国的肿瘤防治措施借鉴。方法：从“日本死亡统计数据库（Vital Statistics of Japan)”中，收集自1947年至1997年以来日本乳腺癌和卵巢癌年龄别死亡人数和5岁年龄组人口数，用世界标准人口对死亡率进行标化。所有资料输入计算机，用SPSS软件对其标化死亡率进行分析研究；从日本文部省收集1946年－1997年国民营养调查资料，对几种有关的食物进行动态分析。结果：乳腺癌和卵巢癌的死亡率分别增加了2和6倍，以50岁以上年龄组增加最明显；乳腺癌死亡率模型与卵巢癌相似，但卵巢癌随时间变化增加较迅速。出生队列研究发现，出生越晚，死亡率越高，这是两者的共同特点；居民营养调查发现，从1947年到1997年的50年内，动物性食物的消费量明显增加，其中以牛奶增加最为显著。结论：近50年来日本乳腺癌和卵巢癌的死亡率在不断升高，可能与膳食的结构变化有关。