陆劲松-福州-乳腺癌的内分泌治疗进展.ppt

* SPEAKER’S NOTES This slide summarizes the events contributing to disease-free survival for the IES trial. Overall, there were fewer first events contributing to DFS were for exemestane (354) than for tamoxifen (454). The total number of events in this analysis was 808. Exemestane reduces both distant and local recurrences as well as the incidence of contralateral breast cancer. In this setting, distant recurrences are more common than local recurrences. The number of non breast cancer deaths (intercurrent deaths) is also lower for exemestane. Reference 1. Coombes, et al. First mature survival analysis of the Intergroup Exemestane Study: a randomized trial in disease-free, postmenopausal patients with early breast cancer randomized to continue tamoxifen or switch to exemestane following an initial 2 to 3 years of adjuvant tamoxifen. Presented at: American Society of Clinical Oncologists (ASCO) Annual Meeting; June 2-6, 2006; Atlanta, GA, USA. * cumulative * * * * * * ‘Zoladex’ (goserelin) is a synthetic agonist analogue of naturally occurring luteinising hormone releasing hormone (LHRH), which is a decapeptide Goserelin differs from LHRH itself at residues 6 and 10 along the decapeptide chain The abbreviated formula of goserelin is D-Ser(But)6,Azgly10-LHRH * Following initial administration of ‘Zoladex’ 3.6mg depot, all the LHRH receptors on the surface of the pituitary cell become occupied by goserelin (Figure A) This results in a transient increase in serum LH, but the occupied LHRH receptors form clusters and gradually disappear into the cell, leading to a profound suppression of LH and, subsequently, of oestradiol New receptors are constantly resynthesised but, once again, they become occupied by the goserelin, which is continually released from the ‘Zoladex’ 3.6mg depot Hence, on chronic administration of ‘Zoladex’ 3.6mg, the continuous presence of goserelin prevents a sufficiently large amount of LHRH receptors from being stimulated by the pituitary glan