乳腺癌的内分泌医学治疗.pptVIP

安全性总结 接受弗隆治疗的病人高酯血症、3－5级的中风和其他心血管事件的发生更多。 报告新发生骨折的数字弗隆组为5.8% ，他莫昔芬组为4.1% (p0.001) 由于非乳腺癌复发而引起死亡的病例中，弗隆组有更多的病人死于中风 (7 vs. 1) 或心脏疾病 (26 vs. 13)。但所有这些事件导致的死亡两组并未显示统计学的差异。这些死亡病人的平均年龄为70岁，而试验中病人的中位年龄为61岁。IBCSG正在对数据做进一步分析以便明确引起死亡的关键因素。 Initial adjuvant therapy: conclusions Tamoxifen should no longer be viewed as the standard of care Evidence for the aromatase inhibitors cannot be used interchangeably Giving an aromatase inhibitor at the earliest opportunity is the best option to prevent recurrence in the first 5 years Which AI shall I select ? NCCN 2005 – adjuvant hormonal therapy in postmenopausal women nccn.org/professionals/physician_gls/PDF/breast.pdf Postmenopausal Anastrozole 5 years Women with contra-indication to AIs or who decline AIs given tamoxifen5 years Tamoxifen 2-3 years Anastrozole or exemestane2-3 years Tamoxifen 4.5-6 years Letrozole5 years ASCO technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with HR+ve* breast cancer: Status report 2004 Five years’ tamoxifen should no longer be the standard treatment choice for patients with early breast cancer “Adjuvant hormonal therapy for postmenopausal women with hormone receptor-positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumour recurrence” Winer E et al. J Clin Oncol 2005;23:619-629 *HR +ve = Hormone receptor-positive  AI用于术前新辅助内分泌治疗 ER(+)的老年患者，TAM可获得60~70%的有效率。 来曲唑：2001年国际协作多中心Ⅲ期临床研究证实，来曲唑与TAM比较，临床体检有效率为55% Vs 36%(P＜ 0.001)，疗后保乳术比例为45% Vs 35%(P=0.022)。 进一步分析表明：ER与HER-2同时阳性患者，来曲唑组有效率88%，TAM组21%(P=0.0004)。 依西美坦：2002年一项25mg/d的Ⅱ期临床实验，瘤体体积下降＞80%，保乳术比例明显提高。 AI用于术前新辅助内分泌治疗 IMPACT研究(ATAC试验基础上)结果: 随机对照比较了单用阿那曲唑、单用三苯氧胺和联合用药，新辅助治疗拟行保乳手术或乳腺切除的乳腺癌的临床疗效。124例疗前评价为应行乳腺切除的患者，在接受3月治疗后不少患者转化为可进行保乳手术，转化率在阿那曲唑组、三苯氧胺组、联合用药组分别为45.7%、22.2%、26.2%，阿那曲唑组的转化率为三苯氧胺组的两倍。 该研究再次显示出阿那曲唑不差于三苯氧胺的疗效 2003年 ASCO 3-year disease-free survival was similar for patients receiving preoperative chemotherapy or endocrine therapy