佟仲生乳腺癌辅助内分泌治疗的指南推荐和药物选择重点分析.pptVIP

第三代芳香化酶抑制剂的机制区别 Upfront研究 ATAC BIG 1-98 TEAM 患者基本情况 BIG 1-98 vs .ATAC 的试验设计 尽管不同试验之间的比较是有争议的，也是困难的，但某些发现将为进一步的临床研究提供参考 BIG1-98 和 ATAC试验是辅助治疗非常有价值的循证医学证据 在两个试验中的对照药物都是他莫昔芬 BIG 1-98 试验设计与ATAC 相同 ，都是初始应用AIs 5年 来曲唑与阿那曲唑的基础研究 体外实验中对芳香化酶活性的抑制能力 P039: Clinical Study of AI P039: 对体内总芳香化酶的抑制能力 乳腺癌组织中残余雌激素含量阿那曲唑 vs. 来曲唑 ASCO 2006 #552  ALIQUOT Clincal trialJ. Michael Dixon, et al 目的 来曲唑是否比阿那曲唑可以更强有力地抑制E2水平? 54名绝经后受体阳性的浸润性乳腺癌患者被随机分为两组,分别接受 12 周的来曲唑治疗,然后12周阿那曲唑治疗 (L A), 或 12 周的阿那曲唑治疗,然后12周来曲唑治疗 (A L) E2的检测采用高敏的放射免疫法测定, 检测的标准低限是3 pmol/L. 低于低限的检测值通过外推法估算 结论 同阿那曲唑相比, 来曲唑是效能更强的AI 无论治疗的次序如何, 同阿那曲唑相比,54名患者中的53名经来曲唑治疗后,其E2水平更低 同阿那曲唑相比, 来曲唑进一步降低E2水平42% 随机、开放的多中心III期临床研究来曲唑vs 阿那曲唑做为绝经后受体阳性、淋巴结阳性的早期乳腺癌的辅助治疗Femara vs. Anatrozole Clinical Evaluation Dr. Geisler reviewed the results of several trials investigating the degree of suppression with letrozole and anastrozole. As shown by this table, an indirect comparison of results from two studies that measured tissue estrogen with similar techniques found that letrozole was significantly better than anastrozole at repressing estradiol, estrone, and estrone sulfate levels in breast tumor tissue samples. In the anastrozole study, the recorded tissue levels of estradiol, estrone, and estrone sulfate to be suppressed to 11,0% (95% confidence interval 4.5 to 26.8), 16.6% (95% confidence interval 7.5 to 36.8) and 27.1% (95% confidence interval 13.9 to 52.7) of pretreatment levels during treatment with anastrozole. In contrast, in the letrozole study, tissue levels of estradiol, estrone, and estrone sulfate were suppressed to 2.4% (95% confidence interval 1.2 to 4.6), 9,3% (95% confidence interval 4.6 to 18.7), and 9.9% (95% confidence interval 3.8 to 25.9) of pretreatment levels during treatment with letrozole, respectively. Individual values are shown for estradiol (E2) measurements for the two groups of  women at entry (Pre) and after they were randomized to receive either A (Post A) followed by L (Post L), or L (