乳腺癌的内分泌治疗进展PPT.ppt

* But when Ellis did the Erb B1 and 2 levels on patients, it turns out that patients who are HER-2 positive and ER positive were more likely to benefit from letrozole than they were from tamoxifen. If you were HER-2 negative and ER positive, the response rates to these 2 drugs appear equivalent, appreciating that these are fairly small numbers. So the data for superiority of one aromatase inhibitor over the other are not addressed by that question, but at least we have data that there is a unique aspect to an aromatase inhibitor in HER-2-positive disease. Whether that bears up in the other 2 aromatase inhibitors I think remains to be shown. Can you cross over from one aromatase inhibitor to another? Historically we didnt go from one type of estrogen to another estrogen in the prearomatase inhibitor era when treating metastatic disease, and one selective estrogen receptor modulator (SERM) was presumed to be somewhat cross-resistant with the others. At least in tamoxifen and toremifene, its not clear that you can go from one to another. * Fig. 1 A, the dose effect of exemestane compared with letrozole and tamoxifen on the growth of MCF-7Ca breast tumor xenografts in ovariectomized athymic mice. All animals were inoculated with MCF-7Ca aromatase-transfected human breast cancer cells at two sites per flank and supplemented with androstenedione (4A, 100 g/day) for the duration of the experiment. When tumor volumes reached 500 mm3, animals were grouped (n 5) for treatment with vehicle, letrozole (10 g/day), tamoxifen (500 g/day), and exemestane at different doses (50, 100, 250, 500, and 1,000 g/day). Tumor volumes were measured weekly and expressed as the percentage change from the initial tumor volume. B, the dose effect of exemestane compared with letrozole and tamoxifen on the tumor weights of MCF-7Ca breast tumor xenografts in ovariectomized athymic mice. After 4 weeks of the indicated treatments, the mice were sacrificed, and tumors were removed and weighed. The ove